Introduction

Getting injured often causes psychological reactions such as depressive symptoms or anxiety (see for an overview Brewer & Redmond, 2017). Such reactions not only compromise the athletes’ wellbeing, but can also impact the athlete’s rehabilitation behaviour, the overall outcome of the rehabilitation, and the fact if he/she returns to sport (e.g., De Heredia et al., 2004). A recent meta-analysis showed that negative affective responses had a negative effect on successful return to sport (Ivarsson et al., 2017). Thus, it seems appropriate to integrate psychological interventions alongside the physical rehabilitation. Reviews supported the effectiveness of psychological interventions (mostly based on Psychological Skills Training or biofeedback) during rehabilitation of sport injury to reduce the negative emotional responses and improve behavioural responses during rehabilitation (Schwab Reese et al., 2012). However, several authors call for the use of other interventions, such as mindfulness- and acceptance-based interventions (MABI).

Aim and theoretical framework

The aim of this presentation is to highlight the potential benefit of adopting MABIs, such as mindfulness, Acceptance Commitment Therapy (ACT), and Mindfulness-Acceptance-Commitment approach (MAC), to help injured athletes handle the negative emotions and thoughts caused by a severe sport injury. The central feature of MABIs is to elaborate a modified relationship with internal experiences (such as thoughts, feelings, bodily sensations) rather than seeking to suppress them or change their form or frequency (as done in PST). By learning to monitor, decenter from, and accept one´s inner experiences, the individual develops a healthier relationship to, and will be less affected by such internal experiences, which leaves more room to engage in valuable behaviours that move the individual toward his/her goals. Specific focus will be laid on mindfulness interventions, as mindfulness is an integral part in all MABIs.

Method

A thorough literature search has been conducted to find articles about outcomes of mindfulness training and about mechanisms that are related to these outcomes. Likewise, a specific search for studies done with any MABI with injured athletes and for studies investigating variables related to MABIs has been conducted.

Results

Results from reviews reveal that mindfulness practice has a positive effect on stress, anxiety, depressive symptoms, emotion regulation, wellbeing, and on behavior regulation in adults (e.g., Keng et al., 2011), and on self-confidence, life quality and pain acceptance in non-athletic populations of adults in rehabilitation (Hardison & Roll, 2016). Mechanisms for these beneficial effects are among others monitoring, acceptance, decentering and exposure (Brown et al., 2007; Lindsay & Creswell, 2017).

Four studies have been conducted using MABIs with injured athletes. They show promising results; however, they contain methodological concerns such as short intervention length or small sample sizes. Two recent studies investigated variables that are central in MABIs, acceptance and psychological flexibility. Higher levels in these variables were related to better adherence and emotional response during injury rehabilitation.

Discussion and conclusions

Based on the results above, it seems appropriate to adopt MABIs in sport injury rehabilitation. Given the fact that MABIs have become increasingly popular for performance enhancement in elite sports, it seems time to integrate and scientifically study these approaches more thoroughly in the context of sport injury rehabilitation.

References

Brewer, B. W., & Redmond, C. J. (2017). Psychology of sport injury. Champaign, IL: Human Kinetics.

Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18, 211-237.

De Heredia, R. A. S., Muñoz, A. R., & Artaza, J. L. (2004). The Effect of Psychological Response on Recovery of Sport Injury. Research in Sports Medicine, 12, 15-31

Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. The American Journal of Occupational Therapy, 70, 1-9.

Ivarsson, A., Tranaeus, U., Johnson, U., & Stenling, A. (2017). Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis. Open Access Journal of Sports Medicine, 27. doi:10.2147/OAJSM.S112688

Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychological Review, 31, 1041-1056.

Lindsay, E. K., & Creswell, J. D. (2017). Review: Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT). Clinical Psychology Review, 51, 48-59. doi:10.1016/j.cpr.2016.10.011

Schwab Reese, L. M., Pittsinger, R., & Yang, J. (2012). Review: Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science, 1, 71-79. doi:10.1016/j.jshs.2012.06.003