Category Archives: Mental health

Why aren’t we educating those supporting injured players about mental health?

By Caroline Heaney

Photo by Fancy Crave on Unsplash

Recently, The Independent reported that professional football clubs are failing to provide injured players with the psychological support they need (Lovett, 2019). The psychological impact of sport injury is well documented – for example, the IOC consensus statement on mental health in elite athletes (Reardon et al., 2019) recognises that sport injury can have a significant impact on mental health, and several sportsmen and women (e.g. footballer Danny Rose) have cited injury as a trigger for mental health difficulties. So why is it that the psychological aspects of sport injury are being ignored in professional football?

The article in The Independent, which explored a study conducted by Dr Misia Gervis, pointed towards a lack of education and training amongst medical staff treating injured players – an area that I have researched extensively with my colleagues at The Open University. My early work in this area (Heaney, 2006) investigated the attitudes and perceptions of physiotherapists working in professional football and identified that whilst physiotherapists recognised that injury had a psychological impact they largely did not have the education or training to be able to respond effectively. This was supported by our 2012 investigation into physiotherapy education in the UK (Heaney et al., 2012) which revealed great diversity in the provision of psychology education in physiotherapy programmes and an inconsistency between the reported importance of psychology and the demonstrated importance of psychology through its visibility within the curriculum.

Photo by Jesper Aggergaard on Unsplash

These findings indicate that UK physiotherapy training does not adequately prepare sports medicine staff for dealing with the psychological aspects of sport injury and that training in this area would be beneficial, but is this the case? To answer this question we conducted two further studies. The first (Heaney et al., 2017a) examined the sport psychology related attitudes and behaviours of ninety-four qualified sports injury rehabilitation professionals (physiotherapists and sports therapists) working in sport. These professionals were split into two groups – those who had been exposed to education on the psychological aspects of sport injury as part of their undergraduate or postgraduate studies and those who had not. It was found that those who had studied the psychological aspects of sport injury integrated significantly more sport psychology into their practice and referred more athletes to sport psychologists for further support than those who had not.

Photo by Hussain Ibrahim on Unsplash

The findings of this study suggest that sport psychology education is beneficial to sport injury rehabilitation professionals and the athletes they treat, but what about the professionals who aren’t lucky enough to receive sport injury psychology education as part of their undergraduate or postgraduate training? How can they access the benefits of sport injury psychology education? We wanted to know whether post-qualification continuing professional development (CPD) training on the topic can derive the same benefits and so we conducted a further study (Heaney et al., 2017b) exploring the impact of an online sport injury psychology education module on the attitudes and behaviours of ninety-five physiotherapists working in sport who had not been exposed to sport psychology education as part of their undergraduate or postgraduate training. The physiotherapists were randomly assigned to either an intervention group who studied an online CPD module titled ‘sport psychology for physiotherapists’ or a control group who studied an equivalent online CPD module on strength and conditioning which had no psychology content. Physiotherapists working in sport tend to be busy professionals who work unsociable hours and travel a lot (e.g. traveling to competitions across the country or the world) and therefore it was important that the CPD module was flexible, accessible and of a duration that would promote adherence. Consequently, an online format was adopted with a study duration of approximately 12 hours. The ‘sport psychology for physiotherapists’ module covered three main areas – (1) understanding the psychological impact of sport injury, (2) psychological skills and techniques for injured athletes, and (3) referral and professional boundaries. Attitudes and behaviours towards sport psychology were measured before the module and at three points after the module had been completed (immediately, 3 months and 6 months after). It was found that those who had studied the sport psychology module demonstrated an improvement in their attitudes towards sport psychology immediately following its completion that was significantly higher than those who had studied the control module. Use of sport psychology also increased following the sport psychology module, with significant differences seen between the intervention and control group indicating that those who had studied the sport psychology module were integrating more sport psychology techniques into their practice than those who had studied the control module.

Photo by Jesper Aggergaard on Unsplash

The findings of this study indicated that CPD courses can address the limitations that some physiotherapists and other members of the sports medicine team have in their understanding of the psychological aspects of sport injury, but it also uncovered another issue – a distinct lack of CPD offerings in this area in the UK. We have sought to address this by developing a free Badged Open Course Exploring the psychological aspects of sport injury, which we hope will contribute to bridging the gap, but more still needs to be done to ensure that sport psychology is properly integrated into undergraduate and postgraduate training so that injured players get both the physical and psychological support they need during sport injury.

Its not all doom and gloom when it comes to this topic and its important to note that some professional football clubs do utilise sport injury protocols that integrate psychological factors and use multidisciplinary sports medicine teams that include sport psychologists to support the injured athlete. Indeed, The Independent article gives the example of Queens Park Rangers where sport psychology is firmly embedded within the treatment room. Dr Misia Gervis suggests that for this to become more commonplace “a cultural shift of practice is needed by medics, physios and coaches.” It is my belief that educating sports medicine professionals is the first and key step to enabling this cultural shift.

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Please watch the video to find out more about the free Badged Open Course (BOC) Exploring the Psychological Aspects of Sport Injury

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On the Ropes: Depression in Boxing

By Inspire team – Corey Johnson, Joseph Bolton, Darcy Skelton and Gavin Macdonald (E119 18J Students)


This blog was written as part of a collaborative team work task by students studying E119. They had to select a topic and then decide on what roles each person would perform in the team, such as researcher, writer, editor and leader. This blog was chosen as one of the four best blogs from around 80 blogs that were produced.


Boxing. The ‘Sweet Science’ of sport. It is often regarded as a macho man’s profession in which there is no place for the weak. However, having said that, in the modern day it is now becoming more prominent that boxers are suffering from inner, more personal fights of their own – Depression.

Sharkey and Gaskill (2013, p. 35) state that depression can be characterised as a collective of having low self esteem, as well as a sense of hopelessness and never ending despair. One man as of late within boxing who has suffered from such an ordeal is former WBA (Super), WBF, IBF and IBO World Heavyweight Champion, ‘The Gypsy King’, Tyson Fury.

Recently, within the past year, Tyson Fury has been incredibly open about his ordeal with depression in the hope to educate others. He was the man who had it all – fame, money and a healthy family – but he also had his demons. When appearing on the Joe Rogan Podcast (How Tyson Fury Bounced Back From Depression & Addiction, JRE MMA Show #47 with Tyson Fury, 2018), Tyson recollected a story in which he was driving towards a bridge at 190mph in a convertible Ferrari which he had only recently just bought (Blair, 2018).

He stated, “I didn’t care about nothing, I just wanted to die so bad. I gave up on life but as I was heading to the bridge I heard a voice saying, ‘No, don’t do this Tyson, think about your kids, your family, your sons and daughter growing up without a dad.”

It was at that moment Tyson decided that he needed to change not just for himself but for his family. The voice that had been putting him down throughout the years had suddenly switched and become the voice for change, to get his life back on track. In the years that followed he overcame many obstacles including battles against substance abuse, weight problems and against boxing authorities to obtain a boxing license.

His appearance on the podcast was to promote his major comeback fight against American Heavyweight boxer Deontay Wilder but it became something much more. Following the appearance he became the people’s champion and an advocate for mental health. Fury’s status grew furthermore after the fight against Wilder when he credited his renewed faith amongst other factors for his successful battle against his ill mental health.

Tyson Fury is a big name in the sports world who was affected by ill mental health. One boxer who was willing to talk to us about mental health in boxing was Team GB’s Lewis Richardson. In an interview with him he stated that;

“Mental health is neglected in boxing due to the image of the sport. Everyone see’s boxing being a macho sport and you have to be physical strong and fit however it is mentally tough”

Here, it is quite evident that due to the perception that modern day society has of boxing, issue such as depression and ill mental health are often overlooked. A lot of people don’t truly understand what elite athletes like Lewis has to go through.

He went on to say, “Mental health issues can come into play particularly with big and pressure fights, as you go to bed thinking about your opponent and that fight is always on your mind until the fight is over.”

From this you can see that fighters at any level can often put themselves into a negative cycle and frame of mind due to the obsession of the opposing boxer. The one thing on their minds is the fight, how can they combat their opponents’ strengths and weaknesses to better their own chances of a victory.

He later added, “Pressure of making weight, pressure of winning, pressure of performing at training and afraid of losing are all factors that could affect mental health in boxers as it is business and the pressure on them is extortionate.”

One key issue that could influence a negative episode could be the hype of positivity which ends up in negativity due to losing a fight or due to an injury in training. All these factors actually coincide with what Tyson Fury had to say himself. It is interesting to say that both boxers, who are going down two very different paths, both share similar beliefs in regards to such important matters.

Various studies show that depression effects one in every four people within the UK. Also, suicide as a result of depression is the biggest killer in males under the age of 45. The male to female ratio of death by suicide is 3:1, which is an alarming observation which needs to be addressed (Gigney, 2017). This is often the case due to the stigma surrounding men suffering from ill mental health and the lack of acceptance of the issue by the man himself.

In regards to sport, this issue is often escalated. This belief is supported by Sports Psychologist Dr Caroline Silby (Gigney, 2017) who, in an interview with Boxing World, states that;

“Elite athletes have a difficult time accepting emotional struggles and seeking assistance. However, once they do seek assistance they often apply their sports work ethic to their emotional recovery, making progress more likely.”

This statement is backed up by Tyson Fury himself who decided the best to overcome his struggles was to box along is long journey of recovery. He openly admits that he still has his off-days in which he has some negatives thought but that is a fairly normal for somebody going through these issues.

Depression can take effect on anybody, no matter how big or small a person is. Boxing proves this, these elite athletes who are stereotyped to be ‘macho men’ can be brought down to rock bottom as a result of depression. However, one thing to remember is that if you, the reader, are going through a battle like this then you too can overcome it with the correct support.

Links for information on Mental Health support

NHS – https://www.nhs.uk/using-the-nhs/nhs-services/mental-health-services/how-to-access-mental-health-services/

Time to change – https://www.time-to-change.org.uk/mental-health-and-stigma/help-and-support

Mind – https://www.mind.org.uk/about-us/our-policy-work/sport-physical-activity-and-mental-health/

Reference list

Blair, A. (2018) Tyson Fury opens up on depression, boxing career and Deontay Wilder fight [Online]. Available at https://www.news.com.au/sport/boxing/tyson-fury-opens-up-on-depression-boxing-career-and-deontay-wilder-fight/news-story/54479d963a55b8da9c5ede2f86660f42 (Accessed on 29/01/2019).

 Gigney, G. (2017) LONG READ Boxing needs to address its mental health problem [Online]. Available at http://www.boxingnewsonline.net/long-read-boxing-needs-to-address-its-mental-health-problem/ (Accessed on 29/01/2019).

Joe Rogan – How Tyson Fury Bounced Back From Depression & Addiction (25/10/2018) YouTube video, added by JRE Clips [Online]. Available at https://www.youtube.com/watch?v=XrM6WqYEj9Y (Accessed on 29/01/2019).

JRE MMA Show #47 with Tyson Fury (25/10/2018) YouTube video, added by PowerfulJRE [Online]. Available at https://www.youtube.com/watch?v=vNZtibrPo0g (Accessed on 29/01/2019).

Sharkey, B. and Gaskill, S. (2013) Fitness and Health (7th edn). Leeds, Human Kinetics.

Competing in the Dark: Mental Health in Sport Conference

** Registration for the conference is now closed, but we are hoping to provide a live stream of keynote speakers for OU staff and students on the day here and we will share some videos from the conference on this blog after the event **

If you have already registered for the conference, don’t forget to make your payment!

For more information please click here

To register for the conference please click here

To view the conference booklet and programme please click here

To download an abstract submission form  click here (completed forms should be sent to WELS-Sports@open.ac.uk)

To download a copy of this flyer  click here

Conference: Competing in the Dark – Mental Health in Sport, The Open University, Milton Keynes, 21st March 2018

On Wednesday 21st March 2018 the Open University Sport and Fitness Team will be hosting their 3rd annual conference. This year’s conference will be exploring the contemporary issue of mental health in sport.

While top level athletes are often idolised and portrayed as figures of supreme physical and mental strength, more and more are speaking out about the mental health challenges they have faced. This conference seeks to raise awareness of mental health issues in sport and explore contemporary research in the field and strategies to support athletes.

Confirmed speakers

  • Olympic Gold Medallist (hockey) Helen Richardson-Walsh
  • Kitrina Douglas and David Carless (Leeds Beckett University)
  • Richard Bryan (Rugby Players’ Association)
  • Jessie Barr (University of Limerick)

Click here to view the conference booklet and programme

Registration

** Registration for the conference is now closed, but we are hoping to provide a live stream of keynote speakers for OU staff and students on the day here and we will share some videos from the conference on this blog after the event **

To register for the conference please complete the online registration form on the link below. Details on how to pay for the conference can be found here.

Online Registration Form

The delegate fees are listed below:

  • Standard = £110
  • Early bird = £100 (available up to Friday 12th January 2018)
  • Student = £50
  • OU Student = £20

(fee includes lunch and refreshments)

Oral and poster presentations

Academics, researchers, students and professionals are invited to submit abstracts for oral or poster presentations that relate to mental health in sport. We are particularly interested in submissions that relate to the negative impact of sport on mental health, rather than those that focus on sport and exercise as a strategy to improve mental health.

Please submit your abstract (maximum of 250 words) on the form below to:
WELS-Sports@open.ac.uk

Competing in the Dark Conference – Abstract Submission Form

  • Deadline for oral presentation abstracts = Friday 5th January 2018
  • Deadline for poster presentation abstracts = Sunday 4th February 2018

 

There is a prize worth £100 for the best poster presentation (sponsored by Switch the Play)

Advertising opportunities

Opportunities are available to advertise in the conference programme and abstracts booklet, which will be provided to all delegates. For more information on this please contact WELS-Sports@open.ac.uk

Conference updates

 

To keep up to date on conference developments please follow us on Twitter @OU_SportConf

Exercise: The miracle treatment for mental health?

By Caroline Heaney

Recent campaigns such as Heads Together have helped to raise awareness of mental health difficulties. Mental health issues affect everyone – it is estimated that 1 in 4 people experience a mental health problem each year, which means that most of us will be affected by a mental health condition at some point in our lives, either directly or through someone close to us. It is vital that once someone has taken the difficult step to disclose mental health difficulties that they can access the right treatment and support, however, NHS funding for mental health services has been reduced whilst demand has increased. It is estimated that by 2030 there will be 2 million adults with a mental health problem, and an NHS funding shortfall of £44-54 billion over the next decade. There are various treatment options available including therapies and medication, but medication is reported to be the most commonly used treatment for mental health problems. This comes at a huge cost to the NHS who reportedly spend £285 million per year on antidepressant medications. If only there was a low-cost treatment with few side effects and many additional health benefits. Well there is – exercise!

Image courtesy of nenetus at FreeDigitalPhotos.net

Exercise has long been recognised as an effective intervention in both the prevention and treatment of mental health conditions. For example, in their meta-analysis of the literature exploring exercise in the treatment of depression Josefsson, Lindwall and Archer (2014), found exercise to be an effective treatment in those with mild and moderate depression, with the potential to be effective with those with more severe depression. Similarly, exercise has also been found to be an effective tool in the prevention of depression (Mammen and Faulkner, 2013). The simple logic behind the link between exercise and mental health is that exercise can make us feel better. This means that exercise can benefit your mental health whether or not you have a diagnosed mental health problem. As well as combating diagnosed mental health conditions such as depression, exercise can enhance mood and reduce stress levels, thus allowing us to tackle daily challenges in a more positive, optimistic and constructive way.

BBC 1’s Mind Over Marathon showed the power of exercise as it charted the experience of a group of people with mental health conditions as they prepared to run the 2017 London Marathon. The people in this programme were not unique in their experience of finding exercise therapeutic in their fight against mental health conditions. Up and down the country there are many people who are advocates for the beneficial role of exercise in preventing and treating mental health conditions. A few years ago I was lucky enough to meet a group of inspiring people in Essex who were referred to a Healthy Lifestyle Programme which involved prescribing exercise as part of a programme to tackle mental health conditions such as depression and anxiety. A clear message from these participants was that exercise was a powerful tool in helping them to combat mental health challenges. They described exercise as a far more positive treatment than medication.

Potentially, exercise can be used to treat mental health problems in place of or in addition to medication and other therapies, but in order for patients to benefit, medical professionals need to be confident in its role as a treatment and have access to suitable programmes to which they can refer their patients. Data from the Mental Health Foundation suggests that whilst more than half of the GPs they surveyed recognised exercise as an effective treatment for mild to moderate depression, only 21% would actually refer a patient to a supervised exercise programme. This could however be due, in part, to a lack of access as 40% of the GPs surveyed said that they didn’t have access to an exercise referral scheme.

There lots of evidence to show that exercise can have a positive impact on mental health, but why is this the case? What is it about engaging in physical activity that leads to enhanced mental health? There is no one theory or hypothesis that has been universally accepted to explain the link between exercise and mental health. Instead, several different hypotheses have been proposed. These can be split into two categories: physical or psychological explanations (see table 1). It may be that a combination of factors is causes improvements in mental health, rather than one factor alone. Additionally, because people differ greatly, explanations for improvements in mental health may vary according to the individual concerned.

Table 1: Examples of physical and psychological explanations for the relationship between exercise and improved mental health (adapted from Weinberg and Gould, 2015)

Physiological Explanations Psychological Explanations
  • Increases in cerebral blood flow
  • Changes in brain neurotransmitters (e.g., norepinephrine, endorphins, serotonin)
  • Increases in maximal oxygen consumption and delivery of oxygen to cerebral tissues
  • Reductions in muscle tension
  • Structural changes in the brain
  • Enhanced feeling of control
  • Feeling of competency and self-efficacy
  • Positive social interactions
  • Improved self-concept and self-esteem
  • Opportunities for fun and enjoyment

 

Conclusion

It would appear that exercise can be a highly effective tool in the prevention and treatment of mental health conditions. Exercise is a comparatively low cost treatment that can be used on its own or as an adjunct therapy and has virtually no side effects. In addition, it can tackle many other health conditions such as hypertension and heart disease. Surely prescribing exercise to treat mental health is a no brainer!

To find out more on this topic try our free course Exercise and Mental Health.