Cognitive and Behavioral Aspects for Overall Health and Well-Being

WHAT: An after-school program is being implemented for overweight middle school students through a community grant.  The program goals are to reduce risk for cardiovascular disease and diabetes, through promoting physical activity.  Student participants don’t need to pay for this program and the program will utilize facilities within the school.  Most of the students involved are in early stages of exercise, such as contemplation and preparation.  The challenge will be to move these students from early exercise stages into the action and hopefully maintenance phase of exercise by the end of the program.  The student intern and program staff will need to use cognitive-based approaches for those in the earlier stages of exercise, and then focus on behavioral-based approaches for those in the preparation or action stage of exercise.  Enhancing participant’s self-efficacy is one approach for cognitive changes that will help them be ready to engage in physical activity.  Social support and reminders to exercise are behavioral approaches that should be utilized for those in the preparation or action stage of exercise.

SO WHAT: This program will be utilizing cognitive and behavioral approaches to improve the health and well-being of overweight middle school children through physical activity.  Since reducing cardiovascular disease and diabetes are the main goals, promotion and maintenance of physical activity is essential for this program.  As noted by Gill and Williams (2008), physical inactivity is associated with major health problems, including heart disease and diabetes, as discussed in the current program goals.  It is assumed that the majority of students attending this program are in early stages of the Transtheoretical model; likely contemplation and preparation.  Since the TTM will be used as guidance during the program, incorporation of self-determination will be important to tailor to the participants.  As participants move from one stage to another, such as contemplation to action, intrinsic motivation plays a factor.  Focusing on intrinsic motivation in exercise settings is a hopeful approach for such programs (Gill and Williams, 2008).  Aside from the individual level, the larger socio-environment is important as well.  Participants as well as their parents or guardians may not have knowledge of environmental resources which can contribute to an active lifestyle (e.g. walking trails or parks) in or nearby their neighborhoods.  The actual program is a great example of an environmental approach to physical activity because it provides access to a facility (the school) at no cost to the participants.  The cognitive challenges of participants in early exercise stages will be addressed through enhancement of self-efficacy, while the behavioral challenges will address social support, goal setting, and generalization training.

NOW WHAT: According to Gillison, Standage, and Skevington (2006), exercise goals relating to improving health, enjoyment of physical activity, and improving fitness levels represent intrinsic goals.  On the other end, goals focused on weight loss or changes in appearance are more extrinsically focused.  Although a goal of the program may be to help children lose weight, the children will not be exposed to this goal because it would take away from the purpose of the program.  Rather, the goals will focus on enjoyment, gaining friendships through social support, and improving overall health.  This way, intrinsic motivation can be represented and therefore help children transition from one exercise stage to another.  For those children who are in contemplation or action stages, the assistant and staff will work with improvement of self-efficacy as related to exercise.  Working with the children through exercises and helping them improve skill and ability will help them believe they are capable of accomplishing the task.  Participants will be asked which activities they prefer individually and then divided to help promote self-determination and intrinsic motivations for exercise.  For those participants in an action phase, the goal will be to get them into a maintenance phase.  Generalization training will be used toward the end of the program.  Generalization training is “the difficult transition from a structured to an unstructured setting” (Gill and Williams, 2008, p. 154).  Instructors will also use reinforcement with social support and appraisal throughout the program to encourage participants to continue exercising and help transition them into the maintenance stage of the TTM.  To encourage intrinsic motivation, participants will write out individual goals at the beginning of the program.  In a study on adolescent weight perceptions and exercise, Gillison, Standage, and Skevington (2006) found that intrinsic goals predicted self-determination, and that higher self-determination positively associated with higher physical activity and quality of life.  Finally, a focus on the overall social environment will be incorporated through providing access to the community recreation center to program participants with a 50% discount coupon.  Those participants who complete the program will be given rec-center discount coupons to continue exercising at the center.  Also, printed map hand-outs of local walking/cycling trails and parks will be distributed to participants to increase knowledge and awareness of existing facilities that are accessible to everyone in the community.  These approaches will help participants move to the maintenance phase and encourage healthy lifestyles that will hopefully reduce cardiovascular disease and diabetes risk in their future.

CONCLUSION: This after school program is tailored for overweight middle school children and hopes to reduce risk of cardiovascular disease, diabetes, and promote overall health.  The participants are in early stages of the TTM (contemplation or action) and are in need of cognitive and behavioral approaches as well as environmental aspects to promote transition into higher exercise stages.  Cognitive approaches will focus on increasing self-efficacy by working through exercises and increasing individual skill level and belief in exercise engagement.  Behavioral approaches will focus on self-determination (intrinsic motivation), social support, and utilize generalization training to promote the maintenance stage of physical activity.  Environmental factors addressed will be a discounted recreational center membership and community maps of walking/biking trails and parks in the local community.  Previous research supports the use of intrinsic motivation and goal setting to increase self-determination, exercise duration, and quality of life.  Utilizing these 3 approaches will make this program effective at helping participants progress through the stages of change in the TTM and encourage continuous exercise.  Participants in the maintenance stage of exercise will live more active lifestyles and therefore reduce their risk of cardiovascular disease and diabetes later in life.

REFERENCES:

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Gillison, F.B., Standage, M., & Skevington, S.M. (2006). Relationships among adolescents’ weight      perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behavior: A       self-determination theory approach. Health Education Research, 21 (6), 836-847.

What Motivates You Doesn't Necessarily Motivate Me

WHAT: Friends Jack and Ben have begun working out together.  They focus solely on weight training in the gym five days per week.  Initially, Jack has seen better gains then Ben but also has suggested aerobic work-outs to his friend.  Ben refuses to do aerobic work-outs, and the friends stick solely to the weight training.  Jack becomes unhappy and stops seeing gains in his work-outs and is now seeking help from his personal trainer Rudy to help motivate and change his exercise behaviors.  Jack’s biggest challenge is to find new ways to be motivated with his work-outs, enjoy working out, and being challenged with new work-outs to improve his ability and progress.

SO WHAT: Reviewing Jack’s situation, it is apparent that Jack has lost motivation in weight training and no longer pushes himself.  He has lost any enjoyment with weight training and wants to explore new exercise methods.  Jack shows interest in group aerobic work-outs; however his exercise partner Ben refuses to explore new exercise methods with Jack.  Gill and Williams (2008) discussion on intrinsic motivation from the cognitive evaluation theory seems to fit well with Jack’s situation.  The theory states that “people feel competent when engaging in an interesting, challenging task on their own volition” (p. 132).  Jack is at a point where he has lost interest in his work-outs, feels he reached his potential (no challenges), and does work-outs at the demands of his friend Ben.  Overall, Jack has lost his ability to be intrinsically motivated with work-outs and must make appropriate changes to become intrinsically motivated again.  Along with motivation, Jack deals with a lack of autonomy and competence in his ability to exercise.  The theory of self-determination (related to CET) explains that one’s perceived autonomy and competence, and relatedness reflects more of an intrinsic motivation rather than extrinsic motivation (Gill and Williams, 2008).  Jack already has extrinsic factors such as his work-out partner Ben and partially his progress in the weight room as well (reward example).   Autonomy seems to be another issue because Ben has challenged Jack’s autonomy to choose what method of exercise to participate in by denying his suggestion to join in a group aerobics class.  Jack’s perceptions of autonomy and competence to exercise and feel challenged are important changes he must adjust to in order to regain his intrinsic motivation.

NOW WHAT: Jack must not allow his exercise behaviors to be controlled by Ben any longer.  Going along with SDT, Jack must find ways in which he is able to make autonomous choices for his exercise and that will help him once again find intrinsic motivation.  According to Edmunds, Ntoumanis, and Duda (2005) the most autonomous form of motivation in the SDT theory is intrinsic motivation, which is the underlying issue faced by Jack.  He no longer finds enjoyment or motivation in weight training.  He has suggested another form of exercise (group aerobics) that would seem to provide him new challenges and suggests a new intrinsic motivator for him.  His friend’s Ben tendency to control Jack’s choices in exercise limits Jack’s ability to stay motivated, challenged, and happy.  Jack may be faced with introjection, which is similar to extrinsic motivation, however is used “to avoid negative emotions, such as anxiety or guilt, to support conditional self-worth, or to attain ego enhancement” (Edmunds, Ntoumanis, and Duda, 2005, p. 2242).  If Jack were to stop exercising with Ben, he may feel some form of guilt.  As the personal trainer, Rudy needs to explore aerobic activities with Jack and see if a change in exercise regimen enhances enjoyment or challenge toward Jack.  The initial training session is a great opportunity for Rudy as the trainer to ask Jack what motivates him and also what his goals are in regards to his fitness and health.  Once Jack is able to make autonomous choices with his personal trainer, he will be able to re-develop his intrinsic motivation and competence with exercise.  Finally, Gill and Williams (2008) discuss how people make attributions about others and why they behave and interact in certain situations.  Jack may have attributions about Ben regarding his refusal to participate in other forms of physical activity.  It will be important to discuss motivation with Jack and explain that everyone has different forms of motivation.  As discussed previously, Jack may feel guilt and hence chooses to adhere to Ben’s exercise wishes.  It would be beneficial to have the two friends communicate together about their personal goals, motivations, and challenges they have for themselves regarding fitness.  Once engaged with a personal trainer and beginning aerobic fitness, Jack may very well still exercise at the gym with his friend Ben, but perhaps only 2 days of the week and not 5 days.  Including work-outs with Ben can help Jack to avoid introjected regulation and focus solely on intrinsic motivations for his work-outs. 

CONCLUSION: Jack is struggling with motivation, enjoyment, and being challenged with his physical activity.  It is apparent that his friend Ben’s refusal to engage in alternative physical activity has caused Jack to lose motivation and also progress with his work-outs.  The CET and SDT state that intrinsic motivation is the most self-determined and autonomous form of motivation one can have.  The personal trainer should begin the initial session by asking Jack what specifically motivates him as well as individual goals he may have for his fitness.  Allowing Jack to decide what types of work-outs to engage in during sessions will also help him feel more autonomous and self-determined.  Suggesting Jack to talk with his friend Ben about their differences in motivation and exercise choices will help Jack struggle with introjected regulation, where he feels guilt and therefore does what Ben wants to do.  Discussing these differences will allow Jack freedom of choice, but also perhaps to continue working out with Ben a few days each week and then engaging in exercises that motivate him personally on the other days.

REFERENCES: 

Edmunds, J., Ntoumanis, N., & Duda, J.L. (2005). A test of self-determination theory in the exercise domain. Journal of Applied Social Psychology, 36, 2240-2265.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.).Champaign, IL: Human Kinetics.

React, Relax, and Refocus: Struggles of a junior tennis player

WHAT: At a camp for highly skilled junior tennis players, one particular individual is faced with unsteady emotions during match play.  He expresses anger with moves by opponents, match calls, and personal errors.  During final rounds of match play, he doesn’t perform at his best level and is consistently tense whether he is performing well or not during a match.  The central issue faced by this junior tennis athlete is emotional control.  His inability to focus relates to his consistent tension, feeling of anxiety, anger, and poor cognitive ability during matches.  By working on emotional control through relaxation, breathing exercises, and cognitive stress management skills, this junior tennis player will be able to maintain focus and likely improve performance during match play.

SO WHAT: These issues faced by this junior tennis athlete suggest poor emotional control and low cognitive stress management skills during match play.  Easily becoming upset with common match calls is causing this athlete to lose focus on the next serve, swing, and overall match at hand.  Jones (2003) describes a situation where a tennis player becomes upset with a poor line call and continues to stay angry.  Poor attention to the player’s task occurs in this situation, and performance is negatively affected.  This example illustrates the cost of poor emotional control on task focus and performance ability.  To ease his anxiety and consistent tension in match play, this athlete may use a self-talk approach. Describing self-statement modification, Jones (2003) states “positive self-statements have been used in conjunction with other techniques (e.g., relaxation training) in sport settings to reduce levels of anxiety” (p. 477).  One example this athlete may use during a performance error (e.g., hitting outside the line) is “I swung too hard on that serve, next time I know it will stay in play.”  Gill and Williams (2008) discuss Lauer’s three R’s program, which originally was used with hockey players, but can apply to tennis as well.  When our athlete is angered at calls or errors, Lauer would first suggest reacting to the given situation.  Knowing he gets angry, the athlete must acknowledge the error or call and move onto the second R, relax.  When he relaxes, he lets go of the frustration of the call or error and controls his emotions.  Finally, the third R states to refocus.  By refocusing on the task at hand, our athlete has cognitive control and focus on the next serve or final round of the match. 

NOW WHAT: We must help this junior tennis player to work on his emotional control and cognitive focus during match play.  During practice is the time to intervene with this athlete and work on coping skills for stress and emotions.  One example is that during a practice of serves when our athlete hits outside the lines and becomes angry, we stop him and suggest breathing exercises.  Getting him to relax and quickly release any tension is important for concentration and refocusing on overall match play and the particular task at hand.  Jones (2003) explains that athletes can train themselves to use anger to energize themselves for future tasks at hand.  Since our athlete does become so easily aggravated, this technique may be very useful during his match play and could enhance performance instead of hindering it.  Instead of losing focus and dwelling on anger at a poor call or personal error, training to use angry emotions in future play or the next serve is a much better response.  His lack of playing up to potential seems to hurt him during final rounds of tournaments and this also relates to stress, focus, and anxiety.  Instructors at camp can ask about the emotion felt by the athlete following an error or before a final round.  Then, as Jones (2003) suggests, have him use self-statement modifications to help channel and direct that anger in a positive manner.  Example statements may include “I’m feeling (insert emotion) but I know I can use it to my advantage on the next serve,” or “That was a bad line call, next time I’m going to hit the ball just inside the line.” Immediately before the final round, when he is known to lose focus and not play up to potential, our athlete can utilize Lauer’s three R’s as described by Gill and Williams (2008).  First, he needs to react to emotions felt during the final round, then relax and realize he has the capability of playing well.  Finally, our athlete must refocus on the tasks ahead in the final round of the tournament, while remembering to channel his anger in a positive approach to future tasks and serves in the match.  The athlete will be reminded of the three R’s approach in camp by having an instructor that holds up a large “R” sign before a final round of practice.   

CONCLUSION: Our junior tennis athlete is faced with poor emotional control during match play.  This camp for skilled players is a great opportunity to provide him with the knowledge and skills to improve his emotional control and stress management.  Holding onto anger and other emotion in match play is making his performance suffer.  By using self-statement modifications during times of stress or anger in match play, our athlete can have better focus on his match and improve control of anger.  When he feels tense and doesn’t play to potential during final rounds, using Lauer’s three R’s (react, relax, and refocus) will help calm our athlete down, realize he has potential to play well, and focus on the final round of his performance. 

REFERENCES:

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.

Jones, M.V. (2003). Controlling emotions in sport. The Sport Psychologist, 17, 471-486.

Breast Cancer Recovery: Quality of Life and Exercise

WHAT: A group of breast cancer survivors are participating in an exercise program through the cancer center.  The main issues among the group include overall quality of life and also their physical health.  Although it is important to incorporate physical fitness activities to enhance these breast cancer survivor’s physical health status, emotional and mental health are also key challenges which will help to promote their quality of life.  The physical health of individuals in the group will vary depending on their recovery status from chemotherapy, surgery, etc.  Quality of life issues often focus on negative emotions, but it will be important to reflect on positive emotions with these breast cancer survivors as well. 

SO WHAT: Due to the exercise setting, this program should focus on enhancing health-related quality of life among the group members and strengthen physical health through aerobic and anaerobic activities each session.  Gill & Williams (2008) suggest that research continues to accumulate on the promotion of quality of life through physical activity.  Since quality of life is a concern among group members, use of a QoL model along with program exercises will be helpful.  Regarding stress and poor health, Gill & Williams (2008) mention Crews and Landers meta-analysis in which exercise reduced depression and stress over prolonged periods.  Due to recovery and sedentary behavior, physical health is important to enhance among group members.  Courneya, Mackey, Bell, et al (2003) suggest that cardiopulmonary function decreases in breast cancer survivors after surgery and treatment.  The researcher’s link decreased cardiopulmonary function with lower QoL.  Wenzel, Fairclough, Brady, et al (1999) note that individuals receiving more chemotherapy for breast cancer treatment show slower improvements in QoL immediately following completion of treatment.  Knowing the differences in treatment methods and length will help the director to focus more attention to QoL issues with specific individuals within the group.  Those remaining with less invasive treatments may utilize the physical component more than those with serious QoL issues.  Allowing short discussion activities where the group shares QoL issues and struggles with their recovery may help with mental health and the ability to relate to others in the program.

NOW WHAT: We must establish the specific QoL issues faced by individuals in the group to determine how we will approach them and what QoL aspects seem to suffer over others.  Also, the physical health status will vary among the group, so aerobic and anaerobic exercises may be limited for some individuals, while others are not limited.  Participants will work on improving physical health through the use of treadmills and stationary bicycles, during the first 20 minutes of the exercise class.  Then the exercise staff will work with mobility and strength through resistance training to improve physical health that may have been affected during chemotherapy or in surgery.  Those who have recently undergone surgery may be limited in their physical functions.  Courneya, Mackey, Bell, et al (2003) found validity using the Functional Assessment of Cancer Therapy-Breast to measure QoL, so this same instrument will be used to measure QoL among these exercise participants.  It is assumed that with higher levels of exercise intensity, QoL will improve, as will physical health.  The FACT-B will be given at the end of the exercise program to assess if any improvements occur in the group.  Another way in which QoL will be addressed is through group discussion in which participants will share their QoL concerns and physical limitations with other group members.  Gill & Williams (2008) discuss Lee & Russell’s work on physical activity and mental health.  The researchers discovered that the higher levels of physical activity related with better mental health variables in their study.  Improvements in mental health are one way to improve the overall QoL of these group members.  Gill & Williams (2008) QoL hierarchy model will be used, with a focus on physical and emotional well-being throughout the program.  The groups will be informed of ways in which social, cognitive, and spiritual well-being can enhance QoL as well, however physical and emotional well-being will remain the central focus for the group.  The exercise staff will use heart rate to measure physical health improvements, specifically the time it takes for an individual’s exercise heart rate to return to their resting heart rate.  Also, group members will be asked to share improvements in mobility at home and in everyday activities as their physical health improves throughout the exercise program.  After the initial group discussion on QoL concerns relating to recovery from breast cancer, groups will get together again and discuss coping methods and strategies they use to improve the concerns they have had.  Wenzel, Fairclough, Brady, et al (1999) suggest that younger breast cancer survivors may have more diminished QoL due to aggressive forms of chemotherapy and other treatment, compared to older survivors.  Older members in the group can help younger members with QoL issues and share their experiences with one another.

CONCLUSION: A group of breast cancer survivors are about to begin an exercise program in order to improve their physical health.  Other concerns within the group include QoL after surgery and treatment, which may be different for younger group members.  The main QoL issues will be established and group members will get together to discuss the QoL issues they are facing during recovery from treatment and surgery.  The exercise program will consist of 20-minute aerobic exercise on a treadmill or stationary bicycle.  Following this, the group will be involved with resistance training with weights to improve strength and ability to perform daily tasks that may have been compromised due to surgery or aggressive chemotherapy treatments that left them sedentary.  Improvements in physical health will be measured by individual’s changes in return to resting heart-rate levels from exercise heart rates.  Improvements to QoL will be assessed in the FACT-B sheet at the end of the exercise program.  The research states that higher levels of physical activity seem to improve QoL while reducing stress, anxiety and depression.  Therefore, recommendations to continue regular exercise after the program will be given to all participants.  At the end of the program, group members will be congratulated by exercise staff for improving physical health and group members will be allowed to share QoL aspects they have seen improvement in through the duration of the program.

REFERENCES:

Courneya, K.S., Mackey, J.R., Bell, G.J., et al (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 21, 1660-68.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.

Wenzel, L.B., Fairclough, D.L., Brady, M.J., et al (1999). Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer, 86, 1768-74.

Cognitive Approaches to Athlete Rehabilitation

WHAT: A volleyball player has just had surgery to repair a torn ACL and will be out of practice for 6-8 weeks.  The athletes main issues are dealing with her injury and how it may affect her future performance and skills as a volleyball player when she returns to practice.  She is aware that the ACL surgery is complex and requires a specific rehabilitation process to help with healing and reconditioning her leg.  She has questions running through her head wondering how she can successfully get through rehab and progress through the re-conditioning with her athletic trainer.  She wonders what the best approaches are for her to complete rehab and be healthy enough to return to practice and play as a volleyball athlete.

SO WHAT:  Having a rehab period of 6-8 weeks with an athletic trainer will require establishing goal setting (mainly short-term) to assure she is able to successfully get through the rehabilitation process.  Gill (2008) examines Locke and Latham’s goal setting model which includes attributes of effective goals.  Of these, specificity, difficulty, and valence are three aspects that can relate to our injured volleyball player.  Our athlete is experiencing a serious injury and recovery from surgery on her ACL, and wants to return to practice as soon as possible. To assure her return to the same athletic level and strength within her leg, she must establish firm and difficult goals throughout her rehab process that will guide her back into practice and play within the 6-8 week time period.  She must think about the progress she wants to seek at the end of each week, such as the strength and mobility of her leg during exercises and daily activity.  According to Naoi (2003), self-talk and home exercise completion in ACL injured athletes had a positive relationship.  The volleyball player needs to practice positive self-talk with herself throughout the rehab process.  Use of self-talk will also help her successfully complete her goals that she sets at the beginning of the rehab process.  If our athlete is having problems coping with the injury overall, we can utilize imagery to help them get through that process.  Gill (2008) shares that Ievleva and Orlick (1991) found imagery helpful with being motivated throughout the rehab process. 

NOW WHAT: Initially, we must find out from our athlete their perception of the injury and what they are thinking as they go into the rehab process.  Obviously, she wants to heal quickly and effectively so she can return to practice and play.  The first objective as the athletic trainer will be to set up short-term goals with our athlete that help guide her through rehab.  Gill (2008) states Weinberg’s goal-setting principles, which include specific, realistic and challenging.  These tie in with Locke and Latham’s model in that goals must be both specific and challenging.  Our athlete must set specific goals that relate to her reconditioning day by day.  Although they are short term goals in rehab, they must be challenging to our athlete to assure that she is ready to return within 6-8 weeks to practice with her teammates.  According to Carson and Polman (2008, p.82), “goal setting was a principle coping strategy used during rehabilitation.”  The first few weeks may involve simple stretches and light weight on machines to help strengthen her leg.  After the initial few weeks, the goals will transition into actual floor movement with the leg and movement that will simulate that of her position in volleyball.  Setting up initial goals for her will give guidance in the rehab process.  In a study by Carson and Polman (2008), self-talk was used as an emotion-focused strategy with a rugby player who had also torn their ACL and was in rehab.  They expressed that using this approach allows the athlete control in their rehab process.  Finally, imagery will be used in the rehab process to help our athlete visualize themselves back on the practice or game court, with a fully rehabilitated knee.  Gill (2008, p.75) states that “imagery can be effective for practicing other psychological skills such as modifying self-talk, practicing concentration, and building confidence.”  Imagery will be practiced when our athlete struggles to use self-talk effectively or if they experience negative self-talk during the rehab process.  Imagery will mainly focus on reflecting on past practice or competitive experiences when the athlete was completely healthy to help give her guidance and also complete goals to regain what she once had.  Imagery will be help her want to accomplish goals and will develop self-talk so that it is always positive.  Once our athlete has fully rehabilitated her knee at the end of the 6-8 weeks, we will congratulate and confirm this to her.  We will encourage continued self-talk and imagery during her initial return to practice.  Goal setting can also continue to be utilized as she returns, assuming that some limitations or adjustments due to the injury may still exist. 

CONCLUSION:  Our volleyball athlete is about to begin her 6-8 weeks of rehabilitation on her knee.  We are aware of the cognitive thoughts and feeling going through her head about her injury and how she believes the rehab process will go.  Once we know how she is feeling, we can begin the rehab process.  We will begin immediately with short-term goal setting as guidance for her through the rehab of her knee.  Research has shown that goal setting is a key factor in athlete rehabilitation.  Throughout our 6-8 weeks, we will also focus on the use of positive self-talk that will assist our athlete in completing her goals and also focusing on returning to practice.  If she struggles with self-talk and begins to have negative self-talk experiences, we will introduce the use of imagery to help adjust self-talk to a more positive aspect and also to help her visualize getting through the rehab process, accomplishing her goals, and ultimately returning to practice after completing rehabilitation.  When her knee is rehabilitated, we will congratulate our athlete and encourage continued use of goal setting throughout her volleyball season, as well as self-talk to guide her back into the season and ability to play as she did before the injury. 

REFERENCES:

Carson, F. & Polman, C.J. (2008). ACL injury rehabilitation: a psychological case study of a professional rugby union player. Journal of Clinical Sport Psychology, 2, 71-90.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.

Naoi, A. (2003). The effects of cognitive and relaxation interventions on injured athletes’ mood, pain, optimism, and adherence in rehabilitation. Unpublished doctoral dissertation, West Virginia University, Morgantown, West Virginia. Retrieved September 16, 2010 from http://wvuscholar.wvu.edu:8881//exlibris/dtl/d3_1/apache_media/6598.pdf