Anxiety Disorders in Athletes

Get your Head in the Game!: A Review of Factors that Impact Collegiate Student-Athlete Mental Health Using a Biopsychosocial-Structural Framework

PURPOSE OF REVIEW

Over 500,000 college students compete in the three divisions of the National Collegiate Athletic Association (NCAA) each year. The rates of most mental health issues among collegiate student-athletes approximate the rates among non-athlete college students. In recent years, greater attention has been given to recognizing and treating the mental health concerns of student-athletes. This paper examines some of the specific mental health considerations that may arise when working with student-athletes.

RECENT FINDINGS

Using a biopsychosocial-structural framework, we were able to identify several broad categories of factors that influence the mental health of student-athletes. Within those categories we identified specific diagnoses (such as physical injury), life events (such as early retirement from sport), ways of thinking (including stigma against mental health treatment), and external influences (such as racism and sexism) that impact the mental health of student-athletes. Mental health concerns among college students are common. When working with student-athletes, there are biopsychosocial-structural factors that affect the mental health of student-athletes in unique ways compared to their non-athlete college student counterparts.

Psychiatric treatment preferences of sports psychiatrists for athlete-patients across competitive levels: a 2024 update

OBJECTIVES

Only two small, prior studies ascertained psychiatric treatment preferences for athletes among sports psychiatrists. This study aims to build upon and update those results by describing comprehensive psychiatric treatment preferences and rationales for those preferences, across competitive levels of athletes, among practicing sports psychiatrists.

METHODS

In 2024, organizations with large concentrations of sports psychiatrists were provided an invitation regarding an anonymous, web-based survey on psychiatric treatment preferences in working with athletes with mental health symptoms and disorders.

RESULTS

Seventy-five respondents who identified as psychiatrists or psychiatrists in training and who had treated athlete-patients within the past 3 years completed the survey. Top choices of psychiatric medications for athletes included bupropion for depression without anxiety; escitalopram for depression with anxiety, generalized anxiety disorder, and social anxiety disorder; sertraline for obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder; melatonin for insomnia; methylphenidate extended release osmotic-controlled release oral delivery system for attention-deficit/hyperactivity disorder; aripiprazole for bipolar spectrum disorder (manic/hypomanic phase); lamotrigine for bipolar spectrum disorder (depressive and maintenance/prophylaxis phases); and aripiprazole for psychotic disorders. Regarding side effects, respondents reported being most concerned about sedation/somnolence, weight gain, and reduction in performance. The majority of respondents indicated they order a variety of medical evaluations at least as often or more often with athletes compared to non-athletes. The first choice of psychotherapy setting was individual psychotherapy, followed by family therapy, and then a tie between couples therapy and group therapy. The preferred type of psychotherapy was cognitive behavioral therapy followed by a tie among behavioral therapy, dialectical behavioral therapy, and mindfulness.

CONCLUSION

Sports psychiatrists tend to prefer medications that are relatively more energizing and less likely to cause weight gain. They undertake medical evaluations for their athlete-patients with relatively great frequency. Their preferred psychotherapy types are skills-based and can be completed within relatively short time-frames.

Effects of mindfulness intervention on competition state anxiety in sprinters-a randomized controlled trial

Objectives

With the rapid growth of China's sprint program's international competitiveness, the psychological problems of sprinters have become a common concern in sports training theory and practice. Hence, the study examined the impact of a 7-week Mindfulness training program on competition state anxiety in Chinese sprinters.

Methods

Twenty-four sprinters (Mage = 22.46 ± 1.351) were selected in a 2 × 3 mixed design, with the group (mindfulness/control) as the between-subjects variable and test time (pre-test/mid-test/post-test) as the within-subjects variable. The dependent variables corresponded to the mindfulness score and competition state anxiety score. One 60-min session was conducted once a week for 7 weeks, and the control group did not undergo any psychological training. The mindfulness group received mindfulness training, and the control group received regular psychological guidance. The subjects filled in the Five Facet Mindfulness Questionnaire (FFMQ) and the Competition State Anxiety Scale at baseline, followed by additional assessments 3 weeks and 7 weeks later.

Results

(1) In terms of competition state anxiety, there were no significant differences in the pre-test between the mindfulness group and the control group. There were significant differences in sprinters' competition state anxiety after mindfulness intervention in terms of time, group, and the interaction between time and groups (p = 0.03, 0.004, and 0.009). (2) In terms of the mindfulness level, the difference between the mindfulness group and the control group was not significant in the pre-test. The sprinters' mindfulness level was significant in the interaction between groups and that between groups and time after mindfulness intervention (p = 0.027 and 0.028).

Conclusion

Mindfulness training alleviated sprinters' competition anxiety by reducing sprinters' somatic state anxiety (SSA) and cognitive state anxiety (CSA), as well as improving state self-efficacy. The results provide guidance and references for Chinese sprinters' psychological problems.

The Effect of Cannabidiol on Performance and Post-Load Recovery among Healthy and Physically Active Individuals: A Systematic Review

Athlete performance and post-load recovery can be considered one of the most important and actively discussed topics in professional sport. One substance aimed at improving performance is cannabidiol (CBD), which has been actively gaining popularity with several studies published in recent years. The PubMed, Scopus, and Cochrane Library databases were searched from inception to April 2024 according to PRISMA recommendations to identify studies on the effects of CBD on exercise capacity and post-load recovery. An initial search identified 901 publications, of which seven fully met the inclusion criteria. Current evidence supports a limited beneficial effect of CBD on a number of physiological parameters, such as VO2, mean power, and relative mean power. At the same time, there were limited data on the beneficial effects of CBD on strength parameters (including vertical jump, counter movement jump, one repetition max bench press, and barbell back squat) and post-load recovery. Notably, most of the studies included in the analysis were conducted between 2021 and 2024, indicating a growing interest among researchers in the use of CBD in healthy, physically active individuals. Further studies are needed to assess the safety of different CBD administration protocols in professional athletes.

Passion and performance anxiety: How it affects the incidence of musculoskeletal disorders in dancers

OBJECTIVES

This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks.

DESIGN

Prospective cohort study.

METHODS

A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary.

RESULTS

A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (β = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season.

CONCLUSIONS

Findings of this study support the role of obsessive passion in the development of MDEs in dancers.