Evaluation of Psychological Interventions in Sport and Exercise Settings
Summary and Keywords
It is important for sport and exercise psychology (SEP) professionals to demonstrate that the interventions they employ make a difference. Assessing the degree of an intervention’s effectiveness depends first and foremost on the nature and scope of the intervention (i.e., the objective of the intervention) and its targeted group. Traditionally, interventions have been quite varied between the fields of sport psychology and exercise psychology; a common thread however, can be seen as an enhancement of the sport or exercise experience, along with an attempt to help the individual better self-regulate engagement with the targeted behavior or mindset. The central aim of enhancing the experience and increased self-regulation is oriented toward performance enhancement within sport psychology interventions, whereas within exercise psychology interventions the orientation is toward physical-activity adoption and better exercise program adherence. Although the two fields may have different objectives, it can be argued that sport psychology interventions—specifically psychological skills training (PST) interventions—can inform SEP professionals’ research and applied practices with both the sport and exercise populations.
Psychological skills training includes the strategies and techniques used to develop psychological skills, enhance sport performance, and facilitate a positive approach to competition. Since the early 1980s, a growing body of evidence has supported that the PST interventions SEP professionals employ do make a difference. In particular, evidence from research in sport contexts supports the use of a multimodal approach to PST interventions—combining different types of psychological strategies (e.g., goal-setting, self-talk, imagery, relaxation)—because a multimodal approach has demonstrated positive effects on both psychological skills and sport performance. The research investigating the effectiveness of PST interventions in enhancing performance has primarily centered on adult athletes who compete at competitive or elite levels. Elite athletes are certainly important consumers of SEP services; however, SEP professionals have rightfully challenged researchers and practitioners to target other consumers of SEP services who they argue are as deserving of PST as elite athletes. For example, young athletes and coaches are two populations that have traditionally been overlooked in the PST research. PST interventions targeting young athletes can help them to develop (at the start of their sporting careers) the type of psychological skills that facilitate a positive approach to competition and better abilities to self-regulate their emotional responses to stressful competitive situations. Coaches are also performers with unique needs who could benefit from PST interventions. Researchers have begun to target these two populations and the results might be considered the most intriguing aspects of the current PST literature. Future research related to PST interventions should target exercise populations. Exercise professionals often operate as coaches in healthy behavior change (e.g., strength and conditioning coaches, personal trainers, etc.) and as such should also employ, and monitor responses to, PST.
To facilitate further development and growth of PST intervention research in both sport and exercise settings, SEP professionals are encouraged to include a comprehensive evaluation of program effectiveness. In particular, four major areas to consider when evaluating PST programs are (a) the quality of the PST service delivery (e.g., the knowledge, delivery style, and characteristics of the SEP professional); (b) assessment of the sport psychological strategies participants used as a result of the PST program; (c) participants’ perceptions of the influence of the PST program on their psychological skills, performance, and enjoyment; and (d) measurement of participants psychological skills, performance, and enjoyment as a result of the PST program.
Sport and exercise psychology (SEP) professionals provide services to a range of participants in various domains (e.g., sport, exercise, military, performing arts, and music). It is important for SEP professionals to demonstrate that the interventions they employ make a difference in participants’ performance and well-being because this evidence gives credibility to the field of applied sport psychology (Brown & Fletcher, 2017). Assessing the degree of an intervention’s effectiveness depends, first and foremost, on the nature and scope of the intervention (i.e., the objective of the intervention) and its targeted group. Traditionally, the interventions have been quite varied between the sport psychology and exercise psychology; a common thread however, can be seen as an enhancement of the sport or exercise experience, along with an attempt to help the individual better self-regulate engagement with the targeted behavior or mindset. For example, sport psychology interventions have primarily focused on sport performance enhancement (Vealey, 2007), and the focus of exercise psychology interventions has been on increasing physical activity and self-regulating exercise habits (Buckworth, Dishman, O’Connor, & Tomporowski, 2013). Although the two fields have different objectives, it can be argued that sport psychology interventions—specifically psychological skills training (PST) interventions—can inform SEP professionals’ research and applied practices with both the sport and exercise populations.
“Psychological skills training” is a term that “was coined to describe techniques and strategies designed to teach or enhance mental skills that facilitate performance and a positive approach to sport competition” (Vealey, 1988, p. 319). When SEP researchers and practitioners are developing PST interventions it is important that they make a clear distinction between psychological qualities, psychological skills, and psychological strategies. “Psychological qualities” are the characteristics or attributes that facilitate optimal performance, and they can be experienced to varying degrees (e.g., high and low self-confidence; Holland, Woodcock, Cumming, & Duda, 2010). “Psychological skills” involve the ability to regulate psychological qualities, such as the ability to maintain self-confidence (Holland et al., 2010; Vealey, 1988). “Psychological strategies” are the interventions or the methods used to purposefully teach those psychological skills and qualities (e.g., thought control; Vealey, 1988). PST is of interest to SEP professionals because if sport and exercise participants learn to regulate their psychological using psychological skills and strategies, then their performance, experience, and adherence may be enhanced. Therefore, identifying the psychological qualities that are related to performance success and well-being can serve as a guide in the development of PST interventions in both sport and exercise settings.
In exercise contexts, interventions tend to more closely follow a behavioral theory or combination of theories to help individuals develop a healthier approach and enjoyment of exercise. In line with the description of PST in the preceding paragraph (Vealey, 1988), the term PST is used here to refer to various psychological techniques designed to enhance psychological skills and qualities to facilitate optimal sport and exercise performance experiences.
Brief Background on the Development of PST Interventions
In North America, several pioneers in sport psychology began working in the research and practice of PST as early as the 1920s. In 1925, Coleman Griffith—known as the grandfather of American sport psychology—was the director of the first research laboratory devoted to sport psychology and worked with coaches at the University of Illinois to improve the performance of their athletes (Gould & Pick, 1995; Green, 2003). He was subsequently hired, in 1938, by the Chicago Cubs baseball team to improve players’ performance (Green, 2003). With the Cubs, Griffith conducted one of his largest sport-psychology research projects (Gould & Pick, 1995) and implemented several psychological techniques, such as goal-setting, confidence building, and competitive simulation (Green, 2003). Although he was trained in experimental psychology, Griffith also conducted research using systematic observations of and interviews with athletes and coaches (Gould & Pick, 1995). Like Griffith, Dorothy Yates (1943) was a researcher-practitioner who reported positive results in investigations of the effectiveness of PST interventions on performance. Yates is historically known for implementing PST interventions with boxers and aviators that primarily focused on the relaxation set-method and mental preparation, (Kornspan & MacCracken, 2001). The relaxation set-method is similar to the psychological techniques used in the 21st century by SEP professionals; it involved a mental set—or positive affirmation (e.g., “keep cool, be alert”; Yates, 1943)—that helped athletes focus on performance and relaxing. Yates induced relaxation through the use of Jacobsen’s progressive relaxation technique and then instructed the athletes to repeat the mental sets to themselves (Yates, 1943). In an experimental study with six pairs of evenly matched boxers, one boxer in each pair received the intervention and the other did not. Five of the six participants who received the relaxation set-method intervention won their matches (Yates, 1943).
Unfortunately, after the work of Griffith and Yates, sport psychology remained largely dormant; it wasn’t until the 1980s that the systematic study and practice of PST in sport emerged and became a major focus. It was during this time that the field of sport psychology transitioned from being an academic research discipline to an interdisciplinary profession providing services to various consumers (Vealey, 2007). At the time, however, much of the available intervention research involving psychological techniques did not include athletes as research participants and was conducted in highly controlled laboratory studies that used motor performance as the dependent variable. In fact, Greenspan and Feltz (1989) in their review of PST intervention research identified only four published studies prior to 1980 that employed PST interventions with athletes who competed on a regular and organized basis in actual competitive situations as participants. Richard Suinn (1972) conducted one of those studies and found that a PST intervention employing relaxation, imagery, and behavioral rehearsal with elite skiers improved their performance during races. This was encouraging, but the very limited PST research available at that time led SEP professionals to question the external validity and generalizability of studies using university students and measuring motor performance in contrived settings to athletes and sport performance in competition settings. For example, Dishman (1983) argued that it was “not clear to what extent contemporary sport psychology possesses a clearly defined and reliable technology for . . . intervention in applied settings” (p. 127). Similarly, Greenspan and Feltz (1989) later stated that “practitioners who utilize results from studies conducted in laboratories, or studies employing contrived setting, tasks, or dependent variables, rely on generalizations for which adequate validity has not been established” (p. 219).
Tensions surfaced between SEP researchers and practitioners, partly because professional practice issues appeared to command much of the field’s attention at the expense of research (Wrisberg & Dzikus, 2016). Although there was a call in the 1990s for a renewed commitment to the scientist-practitioner model—emphasizing the integration of theory, research, and practice—a gap between researchers and practitioners continued to widen over issues of evidence-based practice (see Wrisberg & Dzikus, 2016). Giacobbi (2003) interviewed Dan Gould about the gap between applied sport-psychology science and practice. Gould “expressed pride in the enormous scientific and practical progress the field has made in the last few decades” evidenced “by the explosion of knowledge in our journals and the number of conferences attended by scholars and practitioners around the world” (p. 29). He also questioned whether the field was recognizing the “delicate balance” between addressing the demands of academia and of those who might benefit from applied research. In other words, “researchers are focusing on issues that are sometimes different from what coaches, athletes, and exercisers experience” (p. 29). Wrisberg and Dzikus (2016) offer a detailed, critical, and analytical review of the history of PST in the field of sport psychology. In particular, they “examine the persistent tension that has existed between (a) proponents of academic and applied approaches to sport psychology, and (b) professionals trained in departments of kinesiology and psychology” (p. 20). In discussing sport contexts, the focus here is on the research employing an educational approach to PST based on the premise that participants (e.g., athletes, coaches) are basically mentally healthy and have the psychological skills needed to succeed. SEP professionals, therefore, help participants learn and optimize psychological skills and strategies to cope with the various demands of performance (Vealey, 2007).
In exercise settings, there is a common thread of utilizing psychological skill building or psychological manipulations in exercise- and physical-activity-focused interventions to help individuals to begin exercising, increase physical activity, or enhance adherence to regular exercise habits (see Berger, Weinberg, & Eklund, 2015; Buckworth et al., 2013). There has been a long history of interest in the relationship between psychology and exercise (some scholars have linked it to the writings of Heridocus and Hippocrates), but exercise psychology emerged as a focused field of study only in the 1960s (e.g., Layman, 1960), and became more fully established in the 1970s and 1980s. Much of the field’s progression has been credited to William P. Morgan, whose body of work focused on various psychological experiences associated with or mitigated by exercise, and his influence in seeing the viability of psychology as field of interest in physical education and exercise science. He is further credited with creating, in 1986, and serving as the founding president of Division 47: Society for Sport Exercise and Performance Psychology, a division of the American Psychological Association that focuses on the combined interests of exercise and sport psychology (Buckworth et al., 2013).
A binding force to overcome within exercise psychology is the prevention and remedy of hypokinetic disease—that is, disease caused by the lack of physical activity and the deleterious psychological and physiological effects that result, health hazards that are comparable to the risks associated with smoking (Berger et al., 2015). Exercise psychologists focus on wellness and on psychological enhancements caused by exercise, as well as on the psychological ailments associated with physical inactivity. To promote and encourage physical activity, some of these researchers invoke psychologically based interventions, relying on health-behavior theories and other psychological manipulations to encourage a routine of adequate physical activity. Utilizing some of the same psychological skills and strategies used in sport, exercise interventions in research tend to take on a motivational approach to increase the desire to adopt a physically active lifestyle. Professionals and researchers facilitating future interventions might consdier adopting a strategy of promoting the development of self-regulated psychological skills within individuals, since it is likely they would be able to better assist people in obtaining their optimal experiences, whether performance or enjoyment focused, in sport and exercise settings.
Psychological Interventions in Sport
The catalyst for the development and growth of the practice of sport psychology is the intriguing possibility that PST interventions can create psycho-behavioral changes in athletes (Vealey, 1994). Research applications in the area of PST interventions have facilitated the acceptance of SEP professionals into the ranks of other sport-science specialists (e.g., physiologists, biomechanists, athletic trainers, physical therapists, and nutritionists) and their role in enhancing performance and the sport experiences of athletes (Sullivan & Nashman, 1998; Vealey, 1994). Since the early 1980s, a growing body of evidence has supported that the PST interventions SEP professionals employ do make a difference in sport performance. For example, both qualitative reviews (e.g., Vealey, 2007) and quantitative reviews (e.g., Brown & Fletcher, 2017; Greenspan & Feltz, 1989; Martin, Thompson, & Regehr, 2004; Martin, Vause, & Schwartzman, 2005; Vealey, 1994; Weinberg & Comar, 1994) conducted to date indicate that SEP professionals can be optimistic about the efficacy of PST interventions in enhancing athletes’ performance.
In PST research, the intervention process involves “actions initiated by someone other than the athlete that focused on psychological skills [and strategies] in an attempt to improve the athlete’s performance during competition” (Greenspan & Feltz, 1989, p. 221). PST interventions have been primarily psychological in nature, defined as “any actions or processes that alter functioning and/or performance through changes in an individual’s thought and behavior” (Brown & Fletcher, 2017, p. 78). The psychological techniques that have been most widely used by sport psychology practitioners, and the focus of most PST intervention research, are imagery, goal-setting, thought management and self-talk, and physical relaxation and arousal regulation (Vealey, 1988, 2007). “Imagery” involves athletes’ use of their “senses to re-create or create an experience in the mind” (Vealey & Forlenza, 2013, p. 240); it has been argued to be the most widely studied technique in the PST literature, as well as the most popular psychological technique used by athletes (Vealey, 2007). Whereas a “goal” is simply a target one strives to attain, “goal-setting” for athletes involves developing a plan that focuses on specific task demands, mobilizes effort, encourages persistence through adversity, and promotes problem-solving and the development of strategies to progress toward achievement of the goal (Locke & Latham, 1990). “Thought management” involves athletes’ awareness and management of self-talk—that is, the internal dialogue athletes have with themselves, often in the form of giving reinforcement or instruction, self-evaluation, and interpreting feelings and perceptions (Vealey, 2007). Physical relaxation and arousal regulation are techniques used to help athletes’ manage their energy or level of activation in order to match what is needed for optimal performance (Williams, 2010). Variations of these four traditional techniques have been used in PST interventions (e.g., centering, cognitive restructuring, behavior modification, breathing techniques, and focusing; Sullivan & Nashman, 1998).
Between 1972 and 1993, a total of 45 studies that employed PST interventions with athletes in competition settings were identified. Greenspan and Feltz (1989) conducted the first comprehensive review of the PST intervention research that studied athletes who competed on a regular and organized basis and measured their performance in actual competitive situations. A total of 23 interventions across 19 published studies met the inclusion criteria and were categorized into three intervention categories: relaxation techniques (e.g., visuomotor behavior rehearsal and imagery); behavioral techniques (e.g., reinforcement, self-monitoring, feedback); and cognitive restructuring techniques (e.g., systematic desensitization and stress inoculation). Vealey (1994) has examined the status of the sport-psychology intervention research published since Greenspan and Feltz’s review. Using the same inclusion criteria, Vealey found an additional 11 articles that included 12 interventions and categorized these studies into three areas: cognitive (e.g., developing or restructuring thoughts); cognitive-behavioral (e.g., cognitive development or restructuring and a behavioral routine); and behavioral (systematic feedback). Although the relaxation-based-intervention category in Greenspan and Feltz (1989) made up a significant portion of the studies they included in their review, it was less common during Vealey’s (1994) review for PST interventions to employ only a single strategy. Instead, relaxation methods were included as part of a multimodal approach and subsumed within the categories of cognitive and cognitive-behavioral categories. Using the same criteria as the previous reviews, Weinberg and Comar (1994) identified 10 additional published PST intervention studies categorized into two areas: cognitive and cognitive-behavioral.
Of these 45 studies, 38 (85%) concluded that PST interventions were effective in enhancing performance in competitive situations, and causality (i.e., the intervention caused improvement in performance) could be inferred in 20 (45%) of the studies. Greenspan and Feltz (1989) noted that positive results were reported in all 11 cognitive-restructuring interventions and in 7 of the 9 relaxation-based interventions, and that 2 of the 3 behavioral studies indicated positive results. In Vealey’s (1994) review, positive performance results were reported in 5 of the 7 cognitive interventions, 2 of the 3 cognitive-behavioral interventions, and in both of the behavioral interventions. Weinberg and Comar (1994) reported that positive results were found in three of the four cognitive interventions and in all six cognitive-behavioral interventions. Performance outcome measures included a variety of tasks across the three reviews conducted (e.g., basketball free-throw shooting, batting averages, field-hockey tournament performance, figure-skating scores, football performance, golf performance, gymnastic performance, ski-racing results, sparring performance, swimming seasonal performance, table-tennis forehand attack and technical quality of shot, tennis serve accuracy, and tennis serve reception).
Several trends involving the characteristics of the intervention studies were reported in the reviews by Vealey (1994) and Weinberg and Comar (1994). First, a higher percentage of studies employed a control group, which was likely due to the greater use of single-subject designs. Second, more interventions adopted an educational-remedial approach (e.g., intervention was individualized based on athletes’ needs) compared to a general, educational approach. Third, the vast majority of the interventions in all three reviews were multimodal. According to Greenspan and Feltz (1989), of the five studies that compared the effectiveness of multimodal and single-intervention designs, three demonstrated greater effects using a combination of strategies as opposed to single treatments. For example, various combinations of relaxation plus imagery, or imagery and modeling, were found to be more effective than either relaxation or imagery alone. Fourth, while the majority of participants continued to be collegiate athletes, there were more studies that utilized elite and youth athletes as participants. For example, Greenspan and Feltz (1989) found that only 13% of interventions used national or elite athletes, and 9% used young athletes (under 18 years of age). Weinberg and Comar (1994) noted much greater percentages of elite (40%) and youth (40%) athletes as participants in the studies they reviewed. Fifth, a greater percentage of studies included the use of manipulation checks. For example, Weinberg and Comar (1994) found that 70% of the studies reported using manipulation checks, all of which demonstrated the effectiveness of the intervention. This is encouraging, but most of the procedures were minimal (e.g., interviewing participants about how they felt about the treatment). Sixth, the vast majority of interventions were conducted with athletes in individual sports or on individual skills (e.g., free-throw performance) in team sports. Lastly, interventions included a greater emphasis on cognitive restructuring and the development of cognitive-behavioral routines than was reported in previous PST intervention studies reviewed by Greenspan and Feltz’s (1989).
Eleven years later, Martin, Vause, and Schwartzman (2005) offered the next comprehensive review of PST interventions with athletes in competition. The researchers reanalyzed the 19 studies reviewed by Greenspan and Feltz (1989) and published experimental studies through 2002 that met the following inclusion criteria: all participants were athletes who competed on a regular and organized basis; athletic performance during actual competition was directly and reliably measured; and all studies were an experimental evaluation of an intervention using either an appropriate single-subject design or an acceptable control-group design. Given the conservative inclusion criteria, only 15 studies from the years 1972 to 2002 were included (Martin et al., 2005). Overall, 14 (93%) of the studies reported a positive effect of the PST intervention on performance; 9 reported a substantial positive effect, 5 demonstrated a small to moderate positive effect, and one did not show an effect on performance. Seven studies used single-subject designs (i.e., a multiple-baseline design across participants, multiple-baseline design across behaviors, and modified multielement design), and eight studies used group designs (i.e., AB1AB2AB3 within group design, matched-groups factorial design, and simple control-group design). Six (85%) of the seven single-subject design studies reported performance improvements as a result of the PST intervention, and all eight (100%) group-design studies demonstrated higher mean performance in the PST intervention group compared to the control group. The majority of studies used a multimodal approach (80%); studies that included imagery (six of seven studies) and goal-setting (all three studies) as part of the PST intervention were found to be particularly successful.
Martin and colleagues’ (2005) review also found that studies continued to primarily utilize adult athletes as participants, and the percentage of studies including young athletes (24%) was lower than in Weinberg and Comar’s (1994) review. The majority of studies in Martin and colleagues’ (2005) review also continued to focus on individual sports or individual skills within team sports; however, three (20%) focused on team behaviors within team sports (e.g., two or more players were needed for correct execution of behaviors). Twelve (80%) of the studies included at least a partial treatment-integrity check to make sure that an intervention was applied and experienced as intended.
The trend toward the use of PST intervention research employing single-subject designs has continued to increase (Barker, Mellalieu, McCarthy, Jones, & Moran, 2013; Martin, Thompson, & Regehr, 2004). Single-subject designs offer several advantages for PST intervention research. First, researchers need to locate only a few participants with the same performance problem because it is typical for single-subject designs to include between three and five participants. Second, all the participants in single-subject designs receive the intervention at some point, which may decrease the resistance of some coaches and athletes to participating in a study with a no-treatment control group. Third, single-subject designs are not “hampered by some of the assumptions required of groups designs” (Martin et al., 2005, p. 636). Fourth, in the context of the individual, single-subject designs can establish causation in the relationship between intervention and performance (APA Presidential Task Force on Evidence-Based Practice, 2006; Ivarsson & Andersen, 2016).
In their review, Martin and colleagues (2004) identified 40 single-subject design studies, between the years 1974 and 2003, that met their inclusion criteria: participants were athletes who competed on a regular and organized basis; the dependent variable was a direct measure of performance during practices or competitions; acceptable interobserver reliability data was reported on the dependent measures (or gave “game statistics” on objective measures); and graphs were presented and included the performance of individual subjects across baseline and treatment sessions. Overall, the reviewed studies demonstrated positive effects of PST interventions on a variety of athletic behaviors (e.g., working harder at practices, decreasing problem behaviors, increasing coaches use of reinforcement and feedback, skill improvements, and performance improvement in competition). The following techniques were part of a multicomponent intervention, all of which reported that the treatment was effective in enhancing performance: goal-setting was a prominent feature in 11 studies; self-talk and imagery were components in seven studies; self-monitoring was used in five studies four studies included behavioral packages (instructions, freeze technique, modeling, feedback); and three studies combined hypnosis with a behavioral “trigger.”
Several aspects of the studies demonstrated advancements in PST research. The ranges in the ages (preteens, teenagers, and adults) and in the ability levels (beginners to international-level competitors) of the athlete participants were quite considerable. A total of 16 sports were included in the studies, representing a wide range of individual and team sports. Of the 40 studies, 25 (63%) included either a procedural-reliability assessment or a treatment-integrity check. Clear evidence of generalization of treatment effects from practice to competition was found in all six studies that intervened at practices, assessed performance at practices, and also measured performance during competitions. Lastly, 26 (65%) studies conducted a formal social-validity evaluation, a much higher percentage and more detailed than had been reported in previous reviews (e.g., Greenspan & Feltz, 1989; Martin et al., 2005; Vealey, 1994; Weinberg & Comar, 1994). More specifically, studies reported positive responses to all three of the following questions: (a) What do participants think about the goals of the intervention? (b) What do they think about the procedures applied? and (c) What do they think about the results produced from the procedures applied?
The reviews conducted thus far indicate that, over the years, there has been a higher percentage of studies demonstrating substantial positive effects of PST interventions on athletic performance. This may be partially due to the use of more in-depth, multimodal, inclusive approaches to PST interventions that are individualized (educational/remedial vs. educational/general) and systematic (Martin et al., 2005; Weinberg & Comar, 1994). Multimodal PST interventions—combining different types of psychological strategies (e.g., goal-setting, self-talk, imagery, relaxation)—are more reflective of the applied work of SEP professionals in which psychological skills and strategies are identified based on the needs of the individual or team and presented simultaneously to participants. The majority of multimodal PST interventions continue to include relaxation, imagery, self-talk, and goal-setting (Greenspan & Feltz, 1989; Martin et al., 2004, 2005) with positive effects on performance, and imagery and goal-setting appear to have been particularly successful methods (Martin et al., 2005). Methodologies used by more recent researchers appear to be more sophisticated, employing single-subject designs. Although this is promising, the research investigating the effectiveness of PST interventions in enhancing performance has primarily centered on adult athletes who compete at the collegiate level. Collegiate athletes are certainly an important consumer of SEP services; however, SEP professionals have rightfully challenged researchers and practitioners to target other consumers of SEP services who they argue are as deserving of PST as adult athletes (Vealey, 1988). For example, young athletes (especially those in mid-childhood and early adolescence) and coaches are two populations that have traditionally been largely overlooked in the PST research. PST interventions targeting young athletes can help them to develop (at the start of their sporting careers) the types of psychological skills that facilitate a positive approach to competition and better abilities to self-regulate their emotional responses to stressful competitive situations. Coaches are also performers with unique needs who could benefit from PST interventions. Researchers have begun to target these two populations and the results might be considered the most intriguing aspects of the current PST literature. The section on current trends in psychological intervention in sport offers some exciting aspects of PST research that has been conducted since these reviews.
Psychological Interventions in Exercise
In the simplest terms, exercise interventions are designed to influence inadequately active, physically inactive, or sedentary individuals to move toward accumulating the World Health Organization’s recommended 150 minutes of moderate-intensity activity of per week (World Health Organization, 2010). Interventions focused on a psychological element or theory utilize some sort of interaction aimed at changing individuals’ thoughts or beliefs about their capability to exercise and, ideally, increasing their autonomous choices to be more active. Although they are not directly mentioned as PST in the exercise psychology literature, the tactics and techniques employed in reference studies and reviews of the literature highlighting how interventions that successfully influenced activity in underactive populations were implemented closely mirror what has been published in sport psychology interventions (e.g., behavior modification, enhanced self-regulation, etc.).
Simply educating populations about the benefits of exercise and the detriments of inactivity doesn’t seem to be efficient in promoting changes in physical-activity behavior. Hallal and colleagues (2012) worked to understand the trends in physical activity around the world, finding that an average of 31% of adults 15 years or older from 122 different countries failed to meet the recommended amount of engagement in physical activity (World Health Organization, 2010). The global phenomenon of physical inactivity has caused an increased public-health risk for chronic disease, to which physical inactivity is a primary contributor (see Kohl et al., 2012). This marked physical inactivity is despite research indicating that 68% of Americans are aware of exercise guidelines, and 94% are aware of traditional physical activities that provide a health benefit (Morrow, Krzewinski-Malone, Jackson, Bungum, & FitzGerald, 2004).
To best serve the population in need of further physical activity, it is imperative that the individual(s) and researchers helping the underactive population be highly attentive to the design and delivery of the messages employed to influence behavior. These interactions, like those in sport, focus on enhancing a psychological skill or skills (i.e., PST) to help the individual enhance their ability to self-regulate their engagement with a healthy level of physical activity. The use of behavioral theories in exercise psychology interventions has been shown to positively influence participants’ engagement in physical activity.
In a meta-analysis of 82 studies following randomized controlled trial methods and utilizing one or more theories to guide physical activity, Gourlan and colleagues (2016) concluded that no single theory was more efficacious in increasing physical activity than any other, returning an effect size of d = 0.31 overall. However, studies utilizing a single theory (n = 61) to increase physical activity returned a moderate effect of d = 0.35, whereas studies guided by two theories (n = 14) or more (n = 7) returned a smaller effect of d = 0.21. Thirty-one of the single-theory papers utilized the transtheoretical model (TTM); 16 studies utilized social cognitive theory (SCT); 8 utilized the theory of planned behavior (TPB); 5 followed self-determination theory (SDT); and one was based on the protection motivation theory (PMT). These findings underscore the need for individuals working to enhance physical activity to engage with the underactive and inactive populations from a supportive position, showing empathy, working to build competency, and promoting autonomy in choosing exercise activities.
The psychological quality of self-efficacy (Bandura, 1977) is present within the SCT, the TTM, the TPB, and the PMT. The construct of self-efficacy speaks to one’s belief, and the strength of that belief, to successfully engage in a behavior. Utilizing PST has a more direct influence on this belief, though research studies in sport and exercise tend to focus on outcome behaviors, such as performance (i.e., in sport) or accumulating more minutes of physical activity (i.e., in exercise). However, few studies report on actual changes in self-efficacy or, for that matter, in the accumulation of the psychological skill the intervention focuses on, rather measuring the targeted outcome. This is not a critique to suggest that the scientific veracity of the studies reported here and published in peer-reviewed journals are not valid; it is instead a strong suggestion to include measures of changes in the psychological skills that were taught or directly disseminated, in addition to outcome changes.
Motivational interviewing (MI) is a technique whereby one person guides another toward a more realistic perspective of goals and success potential by being empathetic and understanding and by positively promoting feasible problem-solving with respect to perceived goal barriers. As already noted, the review of PST research found that the psychological technique of goal-setting is commonly used in both sport and exercise interventions (see Vealey, 1988, 2007). MI focuses on a person’s readiness, willingness, and perceived ability to engage (or cease) a certain behavior. Karnes, Meyer, Berger, and Brondino (2015) constructed an Internet-based intervention for 23 underactive and inactive adults over a four-week period. Based on self-reported data about each participant’s numbers of steps, the results indicated significant increases in average daily steps and weekly energy expenditures. Additionally, the authors found that the web-based MI protocol also increased several psychological variables including increased physical activity enjoyment and enhanced self-efficacy.
Eight individuals were interviewed after participating in an exercise intervention program for six months (Kerkelä, Jonsson, Lindwall, & Strand, 2015). Throughout the program participants had interactions with a coach whose actions and suggestions were guided by the SDT principles of autonomy support, structure, and interpersonal involvement. Additionally, coaches utilized MI interviewing skills, including adopting empathetic stances, helping to clarify realistic goals, and developing problem-solving abilities. Generally, the participants highlighted an increased positive change in their attitudes toward exercise and reported feeling that the study’s intervention was well designed. Interacting with a caring coach was described as a crucial element in participants’ experiences, and the support and affirmation the coach shared helped them in setting goals and by encouraging them to improve their exercise regimen. Individualizing the exercise program helped participants to maintain the motivation to continue exercising. Furthermore, utilizing measurable facets of change in their bodies and psychological state through closely monitored goals and an exercise diary, along with a supportive and motivational coach, were described as the most important aspects of the participants’ ability to remain in the long exercise intervention.
Self-determination theory is a highly regarded and often utilized and cited psychological theory in advocating behavior adoption or change. In a systematic review of 66 SDT-based studies on exercise and physical activity, seven were SDT-based interventions, primarily centered on increasing autonomy support, or encouraging more active choice in pursuing physical activity (Teixeira, Carraça, Markland, Silva, & Ryan, 2012). In one such study, an exercise class that was focused on a mix of boxing and step aerobics served as the setting: one session included an SDT manipulation, and the other session was the control; both classes used the same instructor, who only altered her teaching style in the experimental condition (Edmunds, Ntoumanis, & Duda, 2008). In the experimental exercise class, the “instructor focused upon promoting autonomy support by taking the perspective of the exercise class participants into account, acknowledging their feelings and providing them with pertinent information and opportunities for choice” (Edmunds et al., 2008, p. 379). As a result of manipulating the instructor’s teaching style to alter the exercise climate, participants in the experimental condition reported significantly increased scores in autonomy support, structure, interpersonal involvement, relatedness, and competence need satisfaction (Edmunds, et al., 2008). Here, the psychological skills or manipulation onto the exercisers were focused on increasing the exercisers’ perceived sense of competency, autonomy, and stronger sense of belonging with the instructor. This is in line with research in sport such as the aforementioned psychological techniques common in thought management (Vealey, 2007).
Fortier, Sweet, O’Sullivan, and Williams (2007) also focused on changing perceptions of autonomy in a 13-week randomized control trial; results indicate that participants in the experimental condition were more successful in changing their autonomous self-regulation to reach their physical activity goals, and predicted increased engagement with physical activity at the end of the 13 weeks.
Although autonomy support was a primary focus in the SDT-based interventions, resulting in positive exercise changes and experiences, across all the studies in this systematic review, among the three needs associated with SDT, competence was the strongest correlate with physical activity behaviors, while relatedness was most often null (Teixeira et al., 2012). “In sum, existing interventions are limited in number and highly varied. Longer and more comprehensive longitudinal interventions are needed, especially those which work toward the development of autonomous motivation, allow more time for changes in motivational and behavioral processes to take place, and assess whether those changes (and associations) persist in the long-term” (p. 26). Teixeria and his colleagues encouraged better-designed interventions that will allow enough time to pass, with frequent interactions among researchers and participants, so that, perhaps, a more salient and rewarding exercise experience can be reached. Additionally, collecting data throughout the intervention and for a length of time after the intervention would allow researchers to identify the efficacy of their protocols to create long-lasting, self-regulated, and self-motivated exercisers.
In all the studies that have been mentioned, the participants’ success hinged on how the individuals guiding the intervention protocol interacted with them. For the individuals guiding the exercise-adoption and physical-activity behavior, being cognizant of how they approached the unique characteristics of the underactive participant could have a positive influence on the participant’s current exercise level; as is commonly noted in the exercise psychology literature and textbooks, one size does not fit all (Berger et al., 2015; Buckworth et al., 2013). Furthermore, including teachable psychological skills can allow exercisers to learn to employ the psychological techniques on their own, much in the way that the psychological skills and techniques employed in PST interventions that enhanced sport performance.
For example, the results of a study tracking exercise and diet indicated that mindfulness training significantly reduced reward-driven eating (characterized by a lack of control over eating, preoccupation with food, lack of satiety, and psychological stress; Mason et al., 2016). In comparing a control group and mindfulness group, both of whose participants were enrolled in a diet and exercise program aimed at teaching them to make healthier food and exercise choices to assist in weight loss, the participants in the mindfulness group reported significantly less reward-driven eating after the six-month program ended, and these reductions were also related to weight loss at a 12-month follow-up. Mindfulness training is focused on increased self-awareness and self-regulation. The strategies utilized in Mason and colleagues’ (2016) intervention mirrored PST by teaching deep breathing and increased self-awareness when the participants engaged in their daily eating routines. The authors advocate for additional focus on changing reward-driven eating through mindfulness training to assist in weight loss interventions, along with exercise.
In another example using newspaper ads, television commercials, radio commercials, and public-education activities at worksites and in community organizations, researchers targeted a small town in West Virginia (Reger et al., 2002). The messages used in the campaign were guided by the TPB, particularly the control- beliefs aspects. Messages encouraged the feasibility of control and time to engage in a daily 30-minute walk. Using a similar town in West Virginia with a different media market, data was collected from pre- and postintervention telephone surveys and observational data collected from ten observational sites. Results showed a 23% increase in observed walking compared to the control community. Researchers conducted a three-month follow-up from the media campaign, and found that those individuals in the targeted town who were in communities that were more aesthetically pleasing, had benches for resting, high connectivity, and lots of other walkers reported 87 more minutes of walking per week than those living in less walkable parts of town (Gebel, Bauman, Reger-Nash, & Leydon, 2011).
Using carefully designed interventions focused on enhancing the participant’s autonomy, competency, and self-efficacy with respect to their health habits, showed the greatest results in increasing physical activity. The reviews of exercise interventions here highlight how focusing on participant’s psychological skills and regulation have a positive influence on their physical activity choices. As noted in Morrow et al.’s (2004) findings, a person’s lack of engagement in exercise is not based on a misunderstanding or lack of knowledge about the benefits of exercise, but is more likely due to a lack of motivation or inadequate feelings of efficacy to change one’s physical activity choices. Though the interventions described in the exercise psychology literature have strong research designs (e.g., RCT, longitudinal data collection), exercise researchers should be encouraged to access the strengths from the sport psychology literature and the PST interventions employed therein. Individualizing the approach to enhanced exercise experiences, acquisition of exercise behaviors, and adherence to exercise programming, with more specific and nuanced psychological strategies to improve the psychological skills that manifest in better psychological qualities (e.g., higher self-confidence) could be an exciting endeavor to assist in this important habit. Future researchers and SEP professionals are encouraged to focus on the efficacy of using PST in exercise settings, especially with respect to increasing autonomy, teaching realistic goal-setting, and enhancing efficacy and self-awareness in physical activity.
Psychological Interventions in Injury
Injury is a context relevant to both sport and exercise participants. The integration of PST interventions with injured athletes and performers has seen a recent rise in the literature. Work related to the prevention of injury is largely based on Williams and Andersen’s (1998) stress-injury model (see also Andersen & Williams, 1988), which posits that the stress response may increase the likelihood of injury or, through successful intervention, detour or prevent injury. The stress-injury model suggests that the stress response can be influenced by PST interventions, limiting the likelihood of injury occurrence.
Ivarsson, Johnson, Andersen, Fallby, and Altemyr (2015) utilized mindfulness in soccer training as a potential preventive measure for injury. The authors described mindfulness and suggested that
paying attention to what is happening right here, right now has had tremendous survival value. Being mindful is part of our evolutionary heritage, but with our complex and negatively oriented brains we constantly slip out of being present and drift to times and places that actually set us at risk for all sorts of unhappiness, including sport injuries.
The researchers hosted a seven-week mindfulness-based intervention program with 21 Swedish junior elite soccer players compared to 20 similar players assigned to an attentional-focus control group. Injuries for all 41 athletes were monitored over a six-month period. Results showed that 67% (14 of 21) of the mindfulness-based intervention treatment group remained injury free, whereas only 40% (8 of 20) in the control group sustained no injuries.
Tranaeus, Ivarsson, and Johnson (2015) conducted a meta-analysis of psychological-injury-prevention interventions, albeit small, identifying only seven studies. The inclusion criteria involved the using PST interventions to prevent injuries in athletes. Six of these studies identified a significant reduction in the frequency of injury among participants, with a total Hedges’ g effect size of 0.82. The one study with nonsignificant reduction in injury utilized a single information session as its educational intervention; whereas the other studies were guided by much larger frequency of interaction, up to 16 sessions. The significance in reduction of injury through interventions with multiple PST sessions supports the notion that including well-trained individuals to deliver relatively frequent informational sessions on PST toward injury prevention may reduce the stress response (Andersen & Williams, 1988) thus decreasing injuries experienced in a competitive season.
Appaneal and Habif (2013) report that studies focused on psychological techniques for reducing injury risk were grounded in cognitive-behavioral stress management (see Meichenbaum, 1977). These studies demonstrated a reduction in injuries, relaying that when athletes are educated about their cognitive appraisals and stress-response symptoms and then taught strategies to enhance their awareness and coping, they are more likely to avoid injury. Assessing these physiological variables (i.e., total amount or reduction of injuries) is an important step in determining the effectiveness of the interventions; however, as with the interventions in exercise populations (e.g., autonomous self-regulation, sense of relatedness), researchers should also attempt to collect data around the strategy utilized, or the psychological variables the strategy targets, in order to better draw conclusions and make comparisons around the strength of particular psychological modalities.
PST interventions have also been undertaken with injured persons and athlete groups. The focus in these studies has been on examining how a psychological strategy or skill may enhance outcomes related to a better recovery or better mood states while coping with injury. When placing military personnel with nonspecific low-back pain in an experimental group focused on goal-setting, a therapist-led exercise therapy group, or a non-therapist-led therapy exercise group for three weeks, Coppack, Kristensen, and Karageorghis (2012) found that self-efficacy and adherence was significantly higher with the experimental group, suggesting that goal-setting can enhance the rehabilitation or exercise therapy experience. Similar findings were supported in an earlier study by Evans and Hardy (2002). After a five-week intervention, injured athletes in a goal-setting experimental group showed increased self-efficacy and adherence.
Schwab Reese, Pittsinger, and Yang (2012) conducted a systematic review, identifying six studies that targeted reduction of psychological consequences or enhanced psychological coping, or both, through PST-based interventions with samples of injured athletes. Based on their review, the authors suggest that guided imagery coupled with relaxation training had a positive influence on psychological coping and enhanced moods. Furthermore, Schwab Reese and colleagues noted that additional techniques involving acceptance and commitment therapy and microcounseling skills had shown reductions in negative psychological consequences and improvements in psychological coping, which are related to an elevated response to stress, lessening the susceptibility to injury.
When employing PST interventions for injury prevention and recovery, researchers have identified positive results with respect to increased perceived social support (Brown, 2005), adherence (Flint, 1998), reduced injury susceptibility (Ievleva & Orlick, 1991), and prevention of injury (Williams & Andersen, 1998); however, health professionals who have had the most frequent interactions with the injured population (beyond research settings), have reported feeling inadequately trained to incorporate and deliver PST (Arvinen-Barrow, Penny, Hemmings, Corr, 2010). Alexanders, Anderson, and Henderson (2015) report that physical therapists (PTs) recognize the importance of psychological well-being, and that recovering from injury and surgery often causes psychological distress. Although PTs training curricula cover psychological concepts, they report feeling inadequately prepared to initiate psychological interventions in their practice with patients (Arvinen-Barrow et al., 2010). To better grasp the current perspectives of PTs, Alexanders et al. (2015) systematically reviewed the research examining how these health professionals perceive and practice psychologically based interventions in their rehabilitation protocols with patients. From 2002 to 2013, only six papers were found to match the inclusion criteria. The findings of these studies indicated that PTs commonly utilize goal-settings, positive self-talk, and effective communication. Although these studies highlighted that PTs find these psychological tools beneficial, PTs far too often express being inadequately trained to fully utilize PST in practice. This particular finding is highlighted in Arvinen-Barrow et al.’s (2010) qualitative study, despite Farouk’s (2010) findings that incorporating the goal-setting PST during rehabilitation shows enhancements in patients’ confidence, self-esteem, and self-efficacy; all beneficial psychological strengths that can strengthen positive regard and adherence to rehabilitation programs.
Current Trends in Psychological Interventions in Sport
Fourteen years’ worth of studies have been conducted since Martin and colleagues’ (2005) review of PST intervention research on sport performance. A recent comprehensive review by Brown and Fletcher (2017) offered insight into the current trends in the most rigorous PST intervention research available and addressed “some of the perplexing issues in the sport psychology intervention literature (e.g., do interventions have a lasting effect on sport performance?” (p. 93). A total of 35 studies met the following inclusion criteria: participants were of any age who competed in sport at various competitive standards (i.e., local, regional, national, or international); athletic performance was examined as an outcome measure (i.e., technical task, component of fitness, or overall performance or competition outcome); the effects of a psychological (i.e., any action or process using thoughts and behaviors), social, or psychosocial (i.e., thought and behavior and social factors) intervention on sport performance were evaluated; all studies were an experimental evaluation of an intervention using randomized control trials; and sufficient statistical data was reported to calculate effect sizes. Thus the studies included were those with high internal and external validity. Since no social intervention studies were identified, findings were limited to studies that evaluated the efficacy of either psychological interventions (26 studies) or psychosocial interventions (5 studies). Four studies included intervention types that met the criteria for both psychological and psychosocial classifications.
Overall, psychological and psychosocial interventions were found to have a moderately positive effect on performance. Larger effects were in Brown and Fletcher’s (2017) review than had been found in previous reviews of PST intervention research, specifically for mental practice, goal-setting, team building, and self-talk. Eight studies (23%) reported follow-up analyses; interventions were found to have large positive effects on performance at least one month following the completion of the intervention. Estimated mean effects also indicated psychosocial interventions to be more effective in enhancing performance than psychological interventions; although, Brown and Fletcher (2017) noted two outlier studies using psychosocial interventions that may have amplified the effect. Competitive standard intervention components (e.g., single component or multimodal), and type of performance outcome were found to be unrelated to the effects of the intervention. Although reviews mentioned in the section “Psychological Interventions in Sport” supported the use of multimodal interventions, Brown and Fletcher’s review found no difference between single-component and multimodal interventions. However, because psychosocial interventions were found to be the most effective and also consist of multiple parts, Brown and Fletcher (2017) argued that multimodal interventions may be more effective than single-component interventions if they include both psychological techniques (e.g., imagery) and a social agent (e.g., coach). Interestingly, results with type of intervention provider (i.e., coach, equipment, practitioner, researcher, self) found the highest estimated mean effects for interventions delivered by coaches and lowest mean effects for interventions delivered by practitioners. Given the importance of the coach-athlete relationship on athlete performance and well-being (e.g., Mageau & Vallerand, 2003), Brown and Fletcher (2017) also recommend that SEP practitioners involve coaches to gain the greatest effects from PST interventions.
The findings reported in Brown and Fletcher (2017) offer a strong base of evidence for the use of psychological techniques with athletes, and the PST research has only continued to become more sophisticated. This is likely because SEP researchers and practitioners have continued to identify, and attempted to address, areas of PST intervention research that need attention. These areas appear to be promising steps toward closing the gap between the science and practice of applied sport psychology mentioned in the section “Brief Background on the Development of PST Interventions.”
Thelwell, Greenlees, and Weston (2010) identified three important areas that researchers are starting to include in PST program studies. First, what, why, and how skills and strategies are selected and delivered are being discussed in the more recent PST intervention literature with a variety of sports (e.g., Hanton & Jones, 1999; Rogerson & Hrycaiko, 2002; Thelwell & Greenlees, 2003; Thelwell et al., 2010; Thelwell & Maynard, 2003). And researchers are using evidence-driven models and frameworks to guide and provide a rationale for the development of PST programs. Second, some researchers have started to focus on and provide evidence for the benefits of PST interventions on performance subcomponents, such as shooting performance in soccer (Johnson, Hrycaiko, Johnson, & Halas, 2004); goaltender save percentage in ice hockey (Rogerson & Hrycaiko, 2002); and success in passing, tackling, and first touches in soccer (Thelwell et al., 2010). Third, how psychological skills and strategies impact performance or performance subcomponents throughout competition has started to be included in PST program research (Thelwell et al., 2010).
In response to these three important areas, Thelwell and colleagues (2010) employed a multiple-baseline across individual’s single-subject design and delivered a PST package over a three-day period that included relaxation, imagery, and self-talk with three soccer midfielders who had not previously participated in a structured PST program. The researchers used Taylor’s (1995) conceptual model for integrating athletes’ needs and sport demands to develop the PST program; the psychological strategies were chosen based on the physical, technical, logistic, and psychological demands of the specific midfielder role. More specifically, relaxation strategies were chosen because they allow for a greater perception of control for physiological and psychological performance demands throughout competition. Soccer midfield participants were introduced to what relaxation is and when it might be beneficial within their role, experienced progressive muscle relaxation to raise awareness of tension and relaxation, were taught a centering strategy to enable quick and effective relaxation, and were encouraged to use the strategy in training sessions when there was a break in play. What, why, and how imagery and self-talk were selected and delivered were also reported. The dependent variables were performance subcomponents (i.e., pass, tackle, and first-touch percentages) measured during two stages (i.e., first- and second-half performance) throughout the competition. Data was collected over eight games. The researchers and a fourth individual who was external to the group (i.e., a qualified soccer coach) individually rated the performance subcomponents during the training sessions and games until a suitable interobserver reliability was achieved (i.e., greater than 80%). Procedural-reliability procedures were also employed in which an independent researcher checked that the intervention elements were applied correctly and consistently. Results indicated that the PST program improved performance at different stages of competition, and participant midfielders improved in at least two subcomponents in second-half performance. Social validation data revealed that participants were satisfied with the PST program and felt that the intervention was of use to them.
Researchers have also advocated for more thorough evaluations of overall PST program effectiveness through the use of qualitative methods (Sharp, Woodcock, Holland, Cumming, & Duda, 2013). Back in 1998, Strean argued that qualitative methodology is particularly well suited to evaluating PST program effectiveness because the interventions take place in the complex world of sports, and “this setting does not lend itself easily to experimental investigation” (p. 340). Given that nearly 20 years have passed since Strean’s call, it is surprising that the qualitative investigations evaluating PST program effectiveness are still limited in number. Nonetheless, the more recent uses of qualitative methods is perhaps one of the most exciting developments in evaluating PST program effectiveness.
Sharp and colleagues (2013) conducted one of the few studies that employed a qualitative methodology to evaluate the perceived effectiveness of a PST program delivered in an Under-16 Scottish rugby union development program. The researchers developed the PST program based on the psychological demands of youth rugby (see Holland et al., 2010; Woodcock, Holland, Duda, & Cumming, 2011); needs of the sport; and the perspectives or recommendations of youth athletes, parents, coaches, and administration staff for the delivery of a PST program with Under-16 youth rugby athletes. Sharp and colleagues delivered the content of the PST program (i.e., performance profiling, goal-setting, self-talk, arousal control, imagery, precompetition routines, and precompetition plans) through nine interactive sessions and on-field training support over the course of the program’s rugby season (six months). At the end of the season, they conducted a number of focus groups with the athletes and coaches to assess their perceptions about the effectiveness of the PST program, quality of the service delivery, psychological techniques used by athletes, and perceived influence of the PST program on athlete performance. Sharp and colleagues investigated these areas based on the recommendations made by Anderson, Miles, Mahoney, and Robinson (2002) on completing a thorough evaluation of sport psychology services. Overall, athletes and coaches viewed the PST program favorably and viewed it as a valuable addition to the rugby development program. Indicators of PST program effectiveness included athletes’ and coaches’ perceptions that the program was interactive and well-planned, the atmosphere was fun and relaxed, athletes developed increased knowledge of psychological techniques and awareness of the importance of the psychological aspect of performance, and the PST program nurtured team cohesion. Instead of a focus on one isolated skill or strategy, the use of the multimodal approach was perceived to be effective, since athletes reported that they were able to select the technique(s) they felt worked best for them and to effectively apply them in their performance. Furthermore, both the athletes and coaches believed the psychological techniques they had chosen to use were effective (e.g., self-talk was effective in helping an athlete calm down) in regulating athletes’ behaviors during rugby performance. Coaches’ knowledge and support of the program was also assessed; participants believed that it was important to increase coaches’ knowledge and understanding of PST so that they would be able to encourage athletes and offer support and on when and how to use the psychological techniques. Lastly, athletes and coaches provided recommendations for future PST program delivery. Both the athletes and coaches felt that teaching and practicing psychological skills and techniques in the competitive environment (e.g., on the field duirng training sessions) would be essential components to add to the PST program and preferred more frequent PST sessions so that athletes would remember what was taught.
Following Vealey’s (1988) recommendation, SEP professionals have made attempts to expand PST program research participation to youth athletes (Fournier, Calmels, Durand-Bush, & Salmela, 2005; Gucciardi, Gordon, & Dimmock, 2009; Haddad & Tremayne, 2009; Larsen, Henrikse, Alfermann, & Christensen, 2014; Sheard & Golby, 2006) and to coaches (Olusoga, Maynard, Butt, & Hays, 2014). As in the work of Sharp and colleagues (2013), some of the PST program research has included both youth athletes and coaches as participants in their study (e.g., Gucciardi et al., 2009; Larsen et al., 2014). Much of the research evaluating PST program effectiveness with coaches has focused on their perceptions of the program (e.g., Gucciardi et al., 2009; Larsen et al., 2014; Newin, Bloom, & Loughead, 2008; Sharp et al., 2013). Other PST research with coaches has focused on exploring how they use psychological techniques with their athletes (Hall & Rodgers, 1989; Newin et al., 2008). While this information has been useful (and more research is needed in this area), more recent literature is starting to explore coaches’ personal use of psychological techniques because coaches are considered performers themselves who must cope with stress and pressure (Olusoga et al., 2014; Olusoga, Butt, & Maynard, 2010; Olusoga, Maynard, Hays, & Butt, 2012; Thelwell, Weston, Greenlees, & Hutchings, 2008). Interviews with 13 elite-level coaches revealed that they utilized self-talk, imagery, relaxation, and goal-setting before, during, and after training and competitions (Thelwell et al., 2008). Self-talk and imagery were used most frequently and for the purposes of overcoming concerns about athletes’ performance, controlling emotions, developing confidence, helping to plan training sessions, and getting into the appropriate frame of mind. Olusoga et al. (2010) interviewed 12 world-class coaches and found that they reported only minimal use of psychological skills, and instead avoided stressors as a way of managing stress. It appears that psychological skills and strategies help coaches cope with the demands of coaching, and there is a need for SEP professionals to help coaches identify and develop these skills.
Olusoga and colleagues (2014) conducted a six-week PST program with five coaches that was aimed at encouraging them to use various psychological skills (e.g., emotional control, communication, confidence). The psychological skills were chosen because they had been found to be essential by highly successful Olympic coaches in previous research (Olusoga et al., 2012). An educational approach and cognitive-behavioral framework (e.g., exploring thoughts, emotions, and behaviors related to stress and challenging irrational thinking) was adopted for the delivery of the workshops, while also being client-centered (e.g., discussing and exploring relevant issues significant to the participants; Olusoga et al., 2014). Coaches were also taught cognitive and somatic relaxation strategies. The researchers measured coaches’ use of psychological skills, perceptions of precompition state anxiety , and coping abilities before and after the PST program. Results revealed positive changes in coaches’ perceived ability to coach effectively under pressure; the most pronounced changes were in their ability to relax. Coaches’ relaxation skills improved, and they used these skills effectively during competition and rated their somatic anxiety symptoms during competition significantly lower after the PST program. Social validation provided the practical significance of the PST program, in which positive coaching performance changes were reported as a result of the intervention. Coaches also reported being satisfied with the PST program and highlighted building self-confidence and developing the ability to relax as beneficial aspects of the program.
In comparison to traditional PST intervention research in which a single or multimodal intervention involved limited psychological-technique training (e.g., researchers had limited contact with participants, with simple instructions directing participants to apply the technique during a task), the more current research evaluates the effectiveness of the overall PST program. PST programs typically involve several contacts with participants over a sustained period of time (e.g., over an entire sport season), include education about several psychological skills and strategies and their application in a variety of situations, and are partly classroom based (e.g., the teaching takes place away from the location of physical training sessions; Eccles & Riley, 2014). Combining psychological skills and strategies in a comprehensive PST program can be advantageous, especially in group settings, because it can influence a greater number of people and facilitate team bonding, while also being flexible enough to accommodate individual differences (Blakeslee & Goff, 2007; Sharp et al., 2013). The use of team and organizational-level interventions addresses one of the limitations reported by Brown and Fletcher (2017), in which the studies in their review involved only individual-level interventions.
PST program research has not been designed to determine how much any one skill or strategy included in the program is responsible for the treatment’s effectiveness. This is interesting given that qualitative evaluations of PST programs allow researchers to examine which processes are making the intervention(s) effective (Strean, 1998). Although this was not directly assessed by Sharp and colleagues (2013) in their qualitative evaluation, one participant did report that “self-talk helped me the most” (p. 226), providing some evidence that participants may believe one method to be more useful than others. This also demonstrates that PST programs can equip athletes with a toolbox of psychological techniques and likely provide a solution to individual athlete’s concerns (Patrick & Hrycaiko, 1998).
Gardner and Moore (2012) offered a critique against traditional PST intervention research, which
incorporates therapeutic strategies (i.e., goal-setting, imagery, precompetitive routines, self-talk) focused on developing personal control over one’s cognitions, emotional states, and physiological sensations in the service of the creation and/or maintenance of an assumed ideal performance state
PST interventions have largely been rooted in cognitive-behavioral therapy principles (Whelan, Mahoney, & Meyers, 1991), and researchers have questioned the notion that athletes need to control cognitions, emotions, and physiological sensations in order to enhance performance (Gardner & Moore, 2012). Based on this critique, interventions using mindfulness and acceptance-based models have gained popularity in the performance-enhancement intervention research (Gardner & Moore, 2012; Sappington & Longshore, 2015). Gardner and Moore (2012) state that mindfulness and acceptance-based models are in direct contrast with traditional PST interventions. Instead of changing athlete’s internal experiences (i.e., cognitions, emotions, and physiological sensations), mindfulness and acceptance-based models seek to modify them, with
(a) a nonjudging (i.e., not good, not bad, not right, not wrong) moment-to-moment awareness and acceptance of one’s internal state, whatever that may be; (b) an attentional focus on task-relevant external stimuli, instead of a focus on internal processes that includes judgement and direct efforts to control/modulation; and (c) a consistent and effortful personal values-driven commitment to behavioral actions/choices that support one’s athletic endeavor
(Gardner & Moore, 2012, p. 309).
In their review, Sappington and Longshore (2015) identified 19 empirical studies (six case studies, two qualitative studies, seven nonrandomized trails, and four randomized trials) that used athletes (at any level) as participants and evaluated the use of mindfulness-based intervention techniques directly or indirectly on performance. Overall, the results of these studies provide preliminary support for the efficacy of mindfulness-based techniques in improved sport performance (e.g., competitive rifle shooting performance). However, based on their review, Sappington and Longshore (2015) also concluded that “research on mindfulness training for athletes must undergo a dramatic shift toward more methodologically rigorous empirical testing” (p. 256).
To facilitate further development and growth of PST intervention research in both sport and exercise settings, SEP professionals are encouraged to include a comprehensive evaluation of program effectiveness. In particular, four major areas to consider when evaluating PST programs include (a) quality of the PST service delivery; (b) assessment of the psychological strategies participants used as a result of the PST program; (c) participants’ perceptions of the influence of the PST program on their psychological skills, performance, and enjoyment; and (d) measurement of participants psychological skills, performance, and enjoyment as a result of the PST program (see Anderson et al., 2002).
Much of the sport-based PST program research to date appears to focus on evaluations of the psychological strategies participants used, of perceptions of the influence of the PST program on performance, and measurements of participants’ performance as a result of the intervention. An area that is often overlooked yet equally important in PST program intervention research involves participants’ perceptions, attitudes, and expectations about sport psychology services and the program. While Sharp and colleagues (2013) did not assess athletes’ and coaches’ expectations about the PST program until after the season had ended, participants expected athletes to gain a basic understanding of PST techniques and when to apply them, and of how to prepare for and manage their thoughts and emotions during competition. Sharp and colleagues (2013) reported that their athletes had more positive expectations about the outcomes of the PST program than what has been reported in previous research, perhaps because “youth male rugby athletes indicated no initial negative perceptions associated with the term ‘sport psychology’” (p. 224); however, this was not directly assessed.
Understanding potential sport and exercise participants’ attitudes toward and expectations about sport psychology and PST service use can help researchers and practitioners identify which psychological skills and strategies might be attractive to participants and help to establish initial rapport (Martin, Zakrajsek, & Wrisberg, 2012). Zakrajsek and Martin (2011) developed a multidimensional model of sport psychology service provision using research on perceptions and attitudes toward sport psychology services within several distinct segments of populations found in sport programs, such as coaches, athletes, athletic trainers, and administrators. It provides a framework to illustrate how antecedents, such as the personal characteristics of both the SEP professional and the user of the services, as well as situational factors (e.g., type of sport, competition level, exercise domain) influence attitudes and beliefs about SEP services. Attitudes and beliefs in turn influence the intention to use, actual use of, and satisfaction with SEP services. The model predicts a cyclical pattern in which intended and actual use as well as satisfaction with services influences subsequent attitudes and beliefs. The model lays the foundation from which researchers are encouraged to continue to identify and refine factors that ultimately facilitate or hinder potential or current users’ use of and satisfaction with SEP services.
SEP researchers and practitioners are encouraged to include an assessment of participants’ attitudes toward and expectations about SEP services prior to and after PST program interventions, as another measure of program effectiveness. Four factors have been associated with athletes’ and coaches’ attitudes toward SEP services: stigma tolerance (i.e., belief that athletes and coaches are negatively labeled if they seek assistance from a SEP professional), confidence in the SEP consultation (i.e., a belief that consultation and PST are useful), personal openness (i.e., a willingness to be involved in PST), and cultural preference (i.e., strong identification with a cultural background and preference for working with a SEP professional with a similar background; see Martin, Kellmann, Lavallee, & Page, 2002; Zakrajsek, Martin, & Zizzi, 2011; Zakrajsek & Zizzi, 2007, 2008). A recent study by Zakrajsek and Zizzi (2008) involving a sport psychology workshop with coaches found positive changes in their attitudes, intentions, and subsequent sport psychology usage behaviors both immediately after the workshop and at the one-month follow-up.
Perhaps the strongest factor that has been found to impact consumers’ (e.g., athletes, coaches, and athletic trainers) perceptions of the benefits of services, positive attitudes toward services (e.g., higher confidence in and lower stigma toward SEP services), and willingness to use SEP services has been the quality of experiences and interactions with the SEP professionals (Martin, 2005; Wrisberg, Loberg, Simpson, Withycombe, & Reed, 2010; Wrisberg, Simpson, Loberg, Withycombe, & Reed, 2009; Zakrajsek, Martin, & Wrisberg, 2015, 2016; Zakrajsek, Steinfeldt, Bodey, Martin, & Zizzi, 2013). It therefore seems imperative that PST program research needs to assess the quality of service delivery by examining what contributed (or detracted from) participants’ experiences and interactions with the SEP professionals delivering the program. SEP professionals who
do good work and build positive relationships with sport [and exercise] participants will not only enhance their own prospects of providing services but will also contribute to the development of positive perceptions about the field of sport psychology so essential to its future
(Martin et al., 2012, p. 23).
The perceived quality of the relationship between the researcher or practitioner and the consumers (e.g., athlete, coach, athletic trainer) is closely tied to consumers’ attitudes toward, expectations about, and willingness to use the services. A trusting relationship between a service provider and a consumer has been emphasized in sport psychology (see Petitpas, Giges, & Danish, 1999; Zakrajsek et al., 2013) and counseling (see Rogers, 1992; Sexton & Whiston, 1994) as an essential and highly consistent factor influencing service delivery effectiveness. SEP professionals working to enhance exercise experiences and adherence would also do well to consider consumers’ thoughts and perceptions about exercise leaders (e.g., fitness instructors, personal trainers, health-behavior coaches) and how their actions may shape the exercise context and thus the targeted exercise outcome. Again, exercise psychology interventions framed by behavior-change theories have been successful (see Gourlan et al., 2016; Teixeira et al., 2012) but these have not collected much data on participants’ perceptions about the individual guiding the manipulation or their perceptions about the benefit of working with an SEP professional. It is important for future researchers to acknowledge and assess the SEP professional–consumer relationship and its impact on the effectiveness of PST interventions.
Research, summarized here in several reviews and in individual studies, has been done on the effectiveness of interventions based on a targeted outcome, that is, on attributing the success of the PST-focused intervention on athletes’ performances, on exercisers’ changed physical-activity behavior, or on the decrease in injuries. But overall, few of such studies have commented on the acquisition of the psychological skill that was utilized toward this outcome change, or on the quality (compared to the quantity of intervention sessions) of the service delivery. To engage in a more programmatic evaluation of a series of PST interventions within a single sport or exercise setting, researchers must be cognizant not only of changes in the targeted outcome, but also of the quality of service delivery, participants’ perceptions of that delivery, and the actual acquisition of the skill or skills utilized to influence the outcome. SEP professionals are strongly encouraged to review the literature on “program evaluation,” which is “the use of social research methods to systematically investigate the effectiveness of social intervention programs in ways that are adapted to their political and organizational environments and are designed to inform social action to improve social conditions” (Rossi, Lipsey, & Freeman, 2004, p. 16), and to carefully follow evaluation theory to guide this important inquiry (see, e.g., Alkin & Christie, 2004). Utilizing the methodological guides of program evaluation will best align the identification of unique programs’ contributions to behavior changes, and the participants’ views of those programs. Such evaluations will help SEP professionals to better identify the mechanisms of change noted in the contemporary research literature and best advance the applied science that is sport and exercise psychology.
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