The FINA Sports Medicine Web Pages are designed to provide team physicians and allied medical support staff with up to date medical and scientific information to guide their daily care of the aquatic athlete.
Coaches, athletes and parents can also use these pages to answer their questions regarding aquatic health issues.
Anxiety can certainly determine performance but there are strategies to cope with these symptoms of stress
Sport Psychology has become focused on how athletes in the aquatic sports interpret and deal with their anxiety and stress, particularly in the pre-competitive and competitive arena. Symptoms of stress are seen as to be “coped” with through a variety of mechanisms. These strategies include goal-setting, mental imagery, self-talk and relaxation. Used well, these coping mechanisms can help to optimize performance. Injuries bring additional stress for the aquatic athlete adding the uncertainty of recovery. With the help of a multidisciplinary team, injuries can be overcome, leaving the athlete with added stress, but the challenge of overcoming adversity.
Early research involving sport and performance focused primarily on the potentially debilitating effects of anxiety in the competitive arena. Thus in the 1980’s, anxiety during competition was looked at as a potential deterrent to an excellent performance. As thinking in regards to performance evolved, competitive anxiety in sport was seen on a continuum. The intensity of the anxiety could either have positive or negative effects. An “optimum” level of anxiety was often related to personal best performances. Today competitive anxiety is not always seen as negative. Sport Psychology is more focused on how individuals interpret their anxiety and what type of coping mechanisms they develop and use to deal with their symptoms of competitive anxiety. (See Figure 1)
Obviously, symptoms of anxiety, if unchecked, can hamper athletic performance in any of the aquatic sports. Coping mechanisms used by athletes to control competitive anxiety have been broken down into four categories: 1. Goal-Setting, 2. Mental Imagery, 3. Self-Talk and 4. Relaxation. All are used to help athletes “rise to the occasion” rather than to crumble under the pressure of competition. Every competitive situation is looked at as putting the body under stress. Rather than looking at how much stress or what types of stresses are good or bad, new models look at how the athlete copes with the stress. One who adapts positively to any stressful competitive situation is a true champion.
For optimum performance in the aquatic sports, goals related to the overall performance in general and goals related to specific technique during the performance are considered most useful. The athlete may simply put it, “The goals I focus on before competition relate to the time/score I/we want to achieve and the small technical things that have to be done to make this happen”. Such goal setting does not necessarily lower anxiety-related symptoms nor is this the objective. Control of the anxiety or stress, mastery over it, even using it, becomes the challenge. (See Figure 2) For athletes whose coping mechanisms automatically “kick in” when symptoms of competitive anxiety are present, their level of physical effort increases and these athletes believe their goals to be more achievable.
Mental Imagery, or visualization, allows the athlete to mentally see themselves doing their sport both in practice and in competition. Prior to competition, athletes use mental imagery in two different ways. They will imagine specific skills that need to be executed for a good performance and also imagine a positive overall outcome. Once again, as with goal-setting, the athlete uses imagery to perceive control over the symptoms of anxiety leading to a better performance. The anxiety or stress is not necessarily reduced. It can also be helpful for the athlete to find a consistent place at the competitive venue to do their mental imagery. Behind the bleachers or in a cubical in the toilet, listening to music, for example, can allow the athlete to find a space where they will not be disturbed. This allows for consistency regardless of where the competition takes place.
Athletes also use self-talk to help them manage their anxiety prior to competitions. They will talk out loud as well as talk to themselves in their thoughts. Self-talk involves the athlete making positive self-statements during the pre-competition period. For example, an athlete may keep telling themselves they will have a successful performance. Although it may sound arrogant, statements such as “Let’s show everyone how amazing I am!” are normal. Self-talk is often useful just prior to competition when there can be distractions which increase stress and anxiety. By talking to oneself internally or talking out loud, the athlete can focus on the task at hand, increase their concentration and once again perceive their anxiety as being under better control.
There are four ways that the aquatic athlete relaxes. The athlete can listen to music, take long-deep breaths, stretch or do “progressive muscular relaxation”. Progressive muscular relaxation involves either the imagined relaxation of muscles throughout the body or techniques to tense and then relax muscles progressively throughout the body. Everyone is individual. Different athletes will prefer different ways to relax prior to a competition and will try to relax only when they perceive that their symptoms of anxiety are out of their control.
All four ways of coping with pre-competitive and competitive stress help the athlete to deal with competition. Mentally tough athletes learn not only to view stress as a challenge, but champions thrive on it, successfully overcoming the pressure. Performing well in practice may make for an impressive athlete, but being able to perform in competition makes a champion.
Injury and Traumatic Injury
Injuries bring a new set of challenges to the aquatic athlete in the competitive arena. Certain steps must be gone through to overcome an injury and then return to competition psychologically strong. All injuries are by definition traumatic, but some can be psychologically traumatic as well. (See figure 3)
Psychologically recovering from an Injury
To recover psychologically strong from an injury an athlete will need to have faith in the diagnosing and treating team. From the outset of the injury there must be a belief that the injury can be overcome and the athlete can still reach their goals. These goals, however, may need to be modified and made realistic to adjust for the new situation. For this reason, sport specific health care professionals are needed, not just for proper and fast physical healing, but for the athlete to feel everything that can be done is being done to enhance healing. If treatment is both injury and sport specific, time to heal is minimized and therefore training time before the next competition is maximized. This will allow the injured aquatic athlete to have a psychological edge when they are able to return to their sport. They will feel that they have had more time to prepare physically and therefore mentally, before they next compete. At this point the athlete will need to use all the coping mechanisms mentioned above to deal with the added stress. Once again, the true champion will find the added stress challenging, and channel the energy into a winning performance.
Psychologically Traumatic Injury
Unfortunately most sports, especially at the elite level, do carry some element of physical risk. Some injuries, such as overuse injuries, generally are not psychologically difficult to overcome. Others, such as hitting the board in diving can leave damaging scars mentally. Sometimes, despite the best efforts of coaching staff and a sport psychologist, the athlete is unable to regain the level achieved prior to the injury. It is at times like these that one must consider a psychiatric consultation or the use of novel new treatments.
EMDR, or Eye Movement Desensitization and Reprocessing, has been used as a treatment for new and old traumatic stress outside the world of sport since the early 1990’s. Developed by Dr. Francine Shapiro in 1989, EMDR works on the premise that when a trauma occurs, it seems to get locked in the brain with the original picture, sounds, thoughts and feelings. This material can combine fact with fantasy and with images that stand for the actual feelings about the traumatic event. When doing EMDR, the brain is stimulated simultaneously from either side of the head with sounds, touches, or lights and images. EMDR allows the individual to travel between past traumatic memories or events and the safety of the present moment. It has been shown that EMDR works by “unlocking” the original pictures, sounds, thought and feelings that are linked to the traumatic event. The patient or athlete will remember all events surrounding the psychologically traumatic injury, but the traumatic feelings will be removed. At this point in time, an increasing number of athletes have been using this technique with very good outcomes. As treatment for injury - especially psychologically traumatic injury, - evolves in the world of sport, EMDR appears to be one of the treatments that will become increasingly useful.
The Psychological Edge in the Aquatic Sports
Over the last three decades, thinking in regards to the psychology of a good performance in sport has evolved immensely. Stress and anxiety are now seen as an inevitable part of the aquatic sports, especially just before and during competitive events. The focus is now on coping with the stress that accompanies competition. The four main coping mechanisms that are presently being used to aid in performance are goal-setting, mental imagery, self-talk and relaxation. Used effectively, these tools can help create champions and help athletes overcome great adversity. Injuries bring another dimension to the psychology of sport. Athletes need a specialized multidisciplinary team to recover completely, quickly and psychologically. Psychologically, traumatic injuries often need to be treated with more care. Not only are sport psychologists needed, but novel treatments need to be looked at if some athletes are to return to “pre-injury” form. All in all, to gain and maintain the psychological edge, the athlete must use all the tools available to them such as good coaching, good training and learning to adapt to the stresses that are inherently part of the competitive arena.
- Sport Psychology is presently focused on the interpretation of stress or anxiety in sport.
- The ability to deal with stress is seen as key in competitive performance
- Coping mechanisms of symptoms of anxiety include goal-setting, mental imagery, self-talk, and relaxation
- Injury in the aquatic sports brings special challenges to the athlete, coach, and multidisciplinary health care team.
*Dr. Saul I. Marks is a sports psychiatrist working at North York General Hospital in Toronto, Ontario, Canada. He holds a lectureship at the University of Toronto. He is presently on the Board of Directors of Diving Canada and the TUE Committee at the Canadian Center for Ethics in Sport. He also sits on the Board of Directors of the International Society for Sport Psychiatry and has a special interest in that area of medicine.
ASK THE DOC
- I am a water polo team doctor. One of my team members suffered a concussion about 5 days ago. Is there anything in particular I should watch for in his/her psychological recovery?
- Actually, in a recent study published in the Clinical Journal of Sport Medicine, athletes were seen to recover differently emotionally from a musculoskeletal injury then from a concussion. The athlete recovering from a concussion will be significantly fatigued with a lack of energy or vigor. The athlete with a musculoskeletal injury suffered from an elevated level of anger within the first two weeks.
You should be watching for less energy and fatigue which can often look like a depressed state in an athlete with a recent concussion. Although this research needs more replication, it appears that after a concussion, the team doctor needs to be alert to emotional, physical and mental changes in the academic, social and athletic performances of their athlete.