Sports Medicine Research: In the Lab & In the Field: Psychological Strategies Effectively Reduce Perceived and Physiological Markers of Stress (Sports Med Res)
Tuesday, November 18, 2014

Psychological Strategies Effectively Reduce Perceived and Physiological Markers of Stress

Examining the effectiveness of psychological strategies on physiologic markers: Evidence-based suggestions for holistic care of the athlete.

Dawson MA, Hamson-Utley JJ, Hansen R, Olpin M. J Athl Train. 2014;49(3): 331-337. doi: 10.4085/1062-6050-49.1.09. 

Take Home Message: Both cognitive and somatic relaxation strategies reduce perceived stress and physiological markers of stress.                   
Not only are the collegiate years among the most stressful in a lifetime, student-athletes who are undergoing rehabilitation for an injury face additional stressors compared with non-athletes. Increasingly, clinicians perceive the importance of incorporating psychological techniques into rehabilitation programs but there is limited evidence to support the various psychological techniques. Therefore, the authors conducted a randomized trial to examine the usefulness of both cognitive and somatic relaxation strategies compared with a control condition as tools for college-aged students to manage their stress levels. Specifically, the authors quantified whether cognitive strategies (e.g., imagery) or somatic strategies (e.g., breathing exercises) were more effective than a control (no strategy) at reducing cortisol levels and self-reported stress. Participants reported their stress with the Stress-O-Meter (SOM) and Perceived Stress Scale (PSS) scores. The authors measured stress pre- and post-intervention. The main investigator did not know what treatment a participant received.  Each treatment was fifteen minutes in length, including: a visual imagery script (cognitive relaxation), a deep breathing exercise script (somatic relaxation), or ambient nature sounds (control). The students wore headphones and played their designated script from an iPod. Women reported greater stress compared with men. The authors found that the imagery and the deep breathing strategies were effective at reducing both physiological markers of stress (salivary cortisol levels) as well as an athlete’s perceived level of stress. 

Knowing the results of this study, clinicians should consider implementing these types of psychological strategies to help their patients. It will be interesting to see if these techniques also help athletes, especially injured athletes. Despite this limitation in our knowledge the possible benefits may outweigh the minimal harm or other downsides. The additional finding that women generally report a higher stress level than men is clinically relevant, also. It is important for clinicians to keep this in mind when working with female athletes; clinicians could employ a variety of psychological strategies with highly stressed athletes to find an effective strategy for each individual.

Questions for Discussion: Do you teach athletes to use psychological strategies during rehabilitation? Would using psychological techniques other than audio scripts show different results than this study? Do you feel prepared to implement psychological strategies into your rehab program?

Written By: Caitlin Dios & Bryan Pope
Reviewed by: Kim Pritchard

Related Posts:
External Support Decreases the Detrimental Psychological Effects of Injury Among Athletes
Dawson, M., Hamson-Utley, J., Hansen, R., & Olpin, M. (2014). Examining the Effectiveness of Psychological Strategies on Physiologic Markers: Evidence-Based Suggestions for Holistic Care of the Athlete Journal of Athletic Training, 49 (3), 331-337 DOI: 10.4085/1062-6050-49.1.09


Dlbutal said...

Stress, which is the response of the body to any demand made upon it, can be caused by several different factors. In this case, student athletes who are recovering from an injury face additional stressors compared to non athletes. I would imagine that these additional stressors are due to the fact that they need to recover rather quickly in order to continue their sport. The amount of time it takes to recover can cause additional stress for these athletes versus someone who does not need to fully recover in such a short amount of time. I have recently gained a significant amount of knowledge about stress. There are many ways of coping with stress. One of which is called problem-focused coping which is doing something to improve the situation. In this study, it was found that visual imagery and deep breathing strategies were effective at reducing physiological markers of stress, as well as the athlete’s perceived level of stress. I have learned that relaxation is an excellent way to reduce unnecessary anxiety so I am not at all surprised that these relaxation techniques helped to reduce their stress. I have also learned of many other ways of reducing stress that athletes could try. One of them is gaining social support. Studies have found that people who have close contact with a loved one experience less stress. Also, athletes can try the strategy of distraction. They can try to get involved in another activity while they are recovering in order to keep the focus off of returning to their sport. These various techniques reduce excess anxiety which will reduce stress.

Lauren said...

Stress is a student killer. College is the beginning of a whole new life, everything is changing, living on your own, and being totally responsible for yourself. On top of all of this we have classes, which we are not really prepared for in high school. It's a fact that changes cause people stress, the amount of changes will determine the intensity of stress. College students face obstacles putting them under ridiculous amounts of stress. Being a student myself I practice deep breathing when I get stressed, especially if the stress seems to be constant. Long-term stress can cause health problems, like wearing down the immune system making it harder to fight illness, and it can even cause heart problems later in life. My Dad was recently diagnosed with a heart problem, which puts me at risk automatically and if something as simple as breathing techniques can help then why not?

Caitlin Dios said...

@Dlbutal: Thank you for your response and added insight! Social support is immeasurably important to the psychological aspect of coping with stress and rehabilitation. As athletic trainers, it's important for us to keep our athletes involved in the world of their sport to encourage this social support from their team. Having them involved also helps to show the athlete that just because they are injured, doesn't mean they aren't part of the team. Keeping them involved will help them stay tied to their identity of being an athlete. Your final example of keeping the athlete distracted is a new idea to me. It is not common, in my experience, to distract the athlete from their focus on returning to sport. We use that goal of returning as a primary motivating factor throughout the course of their rehab. We will often set smaller goals to help keep them on their path to returning to sport, but I haven’t come across an AT who uses distraction as a strategy.

@Lauren: I couldn’t agree more! Psychological strategies like imagery and breathing exercises are easy to implement and don’t have negative side effects. The worst that could happen is that a specific technique doesn’t work, and in that case, there are plenty of others to try until you do find one that fits your needs. Have you noticed the breathing exercises working for you? Best of luck to you as we approach exam season!

kc210502 said...

I am currently taking a class where we are learning about stress and I found this article very interesting. Along with @Lauren, I am a college student who deals with stress that can stem from classes, changes in environment, along with many other things in life. I think it's very interesting to see how certain approaches work towards reducing stress among groups of people. Because we all perceive the stress in different ways, the amount of ways to combat this stress are endless. We read about a study that used journaling as a way to reduce the stress and I really enjoy learning about others' methods of minimizing the effects of stress and how they can help all of us in those situations.

Bryan Pope said...

Thank you both for your comments! They were well written and organized. As for the topic of stress as a result of academic challenges is an extremely common source of stress for almost everyone who is enrolled in school. Dealing with that stress is critical in order to be successful. As our perceptions of stress are all individualized a coping strategy that works for one person may not work for another person. That is why researching many different techniques such as imagery, using a journal, meditation or any number of other techniques is important.

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