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:

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

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

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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