The combined demands on an adolescence in an elite sports high school can negativelyaffect mental health (eg, stress, burnout, depression, anxiety). Late adolescence is alsowhen elite-striving athletes typically transition from junior-to-senior level programs. In addition, adolescent elite lean sports athletes have an increased risk of suffering from abnormaleating pathology. The purpose of this study was to investigate the perceived psychosocialneeds that young, elite-striving lean sports athletes in sports high schools find essential fortheir sports careers and transition from junior-to-senior level sports. Eight Swedish elitestriving lean sports athletes (2 men and 6 women; median age 17.0 years, range: 16–18years) participated in this study and sports represented were athletics (n = 1), gymnastics (n= 3), and wrestling (n = 4). Semi-structured interviews were performed, and data was analyzed by thematic analysis. Results showed integration, both in the present situation and forthe future, as an overarching theme perceived as essential for a successful elite sportscareer over time. Three additional themes were also identified: (a) Psychosocial stress(combined performance demands, diminished social life, sports-related body weightdemands, taboo talking about eating disorders, injuries), (b) Protective psychosocial factors(social support and psychological safety, communication and coordination school andsports, self-care/health behaviors), and (c) support needs junior-to-senior transition (careeradvice and mentorship, individualized support). As a result, elite-striving, lean sports athletes attending sports high schools need additional support to excel in their academic andathletic endeavors. Sports developmental programs continue to provide inadequate supportbefore and during the junior-to-senior level transition. Similarly, despite the continued callsfor reducing the stigma of mental health, athletes in sports schools still encounter barriersfrom coaches and peers, making the subject taboo, particularly surrounding eatingpathologies.

The  Tokyo  Summer  Olympics  2020  were  postponed  by  a  year  due  to  Covid-19. This postponement came as a surprise to both athletes and support staff. How did the pandemic affect the Olympic preparations and the mental health of the athletes? Twelve athletes, both Norwegian and Swedish medal candidates from nine sports,  were  interviewed.  Norwegian and  Swedish  athletes  had  different  training  options,  but  they  tried  to  adapt  as  best they  could  to  current  situations  and  what  they were allowed to do. This resulted in different set of goals as they adapted to the conditions.

Objectives This study described differences in lifestyle factors (sleeping problems/fatigue, pressure/activation), perceived coach autonomy support and  indicators of mental health (well-being and poor general mental health) across various age groups (children ≤12 years, youths 13–15 years, junior to senior ≥16 years) and sports (basketball and gymnastics). Second, the relationships between lifestyle factors and mental health indicators were explored, hypothesising that the relationships would be mediated by perceived coach autonomy support.

Methods A cross-sectional study design was implemented by using an online survey which assessed lifestyle and environmental factors as well as mental health indicators. Participants were recruited through sports clubs in basketball and gymnastics. A total of 209 athletes (77 basketball players and 132 gymnasts) in the age range of 10–22 (median=13) years volunteered to complete the survey.

Results Separate two-way analyses of variance showed significant main effects for age group on sleeping problems/fatigue, sleep quantity, pressure/activation, well-being and poor general mental health, with higher scores reported for older age groups of athletes. Path analysis displayed sleeping problems/fatigue and pressure/activation to significantly affect decreased well-being and poor general mental health; however, the relationships were not mediated by perceived coach autonomy support.

Conclusion Lifestyle factors play a prominent role in mental health outcomes. Researchers studying athlete mental health should consider both general lifestyle and sports-related factors, considering developmental phases in the young athlete’s sporting context and overall life.

ObjectivesThis study described differences in lifestyle factors (sleeping problems/fatigue, pressure/activation), perceived coach autonomy support and indicators of mental health (well-being and poor general mental health) across various age groups (children & LE;12 years, youths 13-15 years, junior to senior & GE;16 years) and sports (basketball and gymnastics). Second, the relationships between lifestyle factors and mental health indicators were explored, hypothesising that the relationships would be mediated by perceived coach autonomy support.MethodsA cross-sectional study design was implemented by using an online survey which assessed lifestyle and environmental factors as well as mental health indicators. Participants were recruited through sports clubs in basketball and gymnastics. A total of 209 athletes (77 basketball players and 132 gymnasts) in the age range of 10-22 (median=13) years volunteered to complete the survey.ResultsSeparate two-way analyses of variance showed significant main effects for age group on sleeping problems/fatigue, sleep quantity, pressure/activation, well-being and poor general mental health, with higher scores reported for older age groups of athletes. Path analysis displayed sleeping problems/fatigue and pressure/activation to significantly affect decreased well-being and poor general mental health; however, the relationships were not mediated by perceived coach autonomy support.ConclusionLifestyle factors play a prominent role in mental health outcomes. Researchers studying athlete mental health should consider both general lifestyle and sports-related factors, considering developmental phases in the young athletes sporting context and overall life.

The aims of this scoping review were to map the current literature on interventions for improving mental health in athletes, identify knowledge gaps, and generate future research questions. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided this review. A systematic literature search was conducted in SPORTDiscus, PsycINFO, and SCOPUS and 44 intervention studies met the inclusion criteria. Results showed that 22 studies (50%) implemented cognitive behavioural principles, and the majority of these studies were influenced by various mindfulness programmes. Most studies (93%) included healthy athlete samples, and athletes aged 15–19 were the most examined age group (43%). Only three studies used clinical criteria in their sampling of participants and mediators were examined in two studies. The scarcity of studies examining mediators and subclinical or clinical samples revealed critical knowledge gaps in the literature. Furthermore, the critical appraisal showed that regardless of study design, most studies demonstrated low internal validity. We propose the use of high-quality single-case studies with athletes who experience subclinical or clinical mental health issues, and further investigation of mechanisms of change linking intervention components to outcomes of interest.

Objectives: The aim of the study was to compare the effects of a brief body scan with relaxation as an active control group to better understand their respective contributions to the reduction of sleep problems and anxiety symptoms among adolescent athletes.

Method: Two hundred and six adolescent athletes were recruited during the school year 2016/2017 and randomized into four arms: 4 weeks body scan, 8 weeks body scan, 4 weeks relaxation, and 8 weeks relaxation. Sleep problems and anxiety were measured at baseline and 4, 8, and 16 weeks after baseline. Time trends in sleep problems and anxiety were estimated using linear repeated measures models and compared between the four groups.

Results: Overall, there were beneficial time changes for sleep problems and anxiety symptoms in all four intervention groups, but significantly so only for anxiety symptoms. Specifically, the reduction of anxiety symptoms varied between − 11% permonth for 8 weeks body scan,− 12% per month for 8 weeks relaxation, − 13% per month for 4 weeks relaxation, and − 16%per month for 4 weeks body scan. However, the time trends did not differ by intervention type or duration.

Conclusions: Both types of interventions had beneficial effects on anxiety independent of length of intervention, suggesting that a brief body scan as well as a brief relaxation could be part of a daily recovery practice for adolescent athletes.

This chapter focuses on wellbeing and wellbeing promotion among soccer players from youth to the professional level. Within the general psychology literature, wellbeing is conceptualized as independent from, but related to, mental illness. As a result, psychological interventions can act to change levels of wellbeing, illbeing, or both. Two different philosophical perspectives on wellbeing dominate the literature, the hedonic and eudaimonic orientation views. The hedonic view adopts the label subjective or emotional wellbeing and considers it synonymously with pleasure and comfort. The eudaimonic perspective focuses on positive functionality and self-realization of individual talents. Organized sports, and particularly team sports, is an avenue where wellbeing among youths can be strengthened by use of mental health interventions. Most of the career transition research in soccer focuses on career termination, primarily at the elite or professional level. While soccer players face many challenges across their careers, times of transition are especially demanding on their mental health, particularly forced or unexpected retirement.

Background: Research shows child abuse to be devastating for psychological health, but children and adolescents display varying reactions from maltreatment. Resilience is known as a protective factor, but sparse research is conducted on adolescents or assess resilience with consideration of ecological theories. Adolescent Resilience Questionnaire (ARQ) was developed to assess the five dimensions: Individual, Family, Peers, School, and Community and covers the broader ecological resilience spectrum. Objective: As resilience is a part of the human being survival system we wanted to investigate if resilience measured with ARQ, could moderate associations between experiences of trauma and trauma symptoms. Method: Six hundred fifty adolescents between 15 and 17 years old were asked to complete the Linkoping Youth Life Experience Scale (LYLES), the Trauma Symptom Checklist for Children (TSCC), and the Adolescent Resilience Questionnaire (ARQ). Result: The results showed that high scores on any dimension of the ARQ were negatively associated with trauma symptoms and that the dimension Peers moderated the effect of trauma symptoms on both interpersonal traumatic events and adverse childhood circumstances for males. The dimension Family moderated the effect of trauma symptoms on noninterpersonal traumatic events for females. Conclusion: Resilience seems to be an important factor when it comes to evaluating posttraumatic symptoms and that different resilience factors have different meanings for different types of traumas as well for boys and girls.

BackgroundDespite good physical function, many athletes do not return to sports after an anterior cruciate ligament reconstruction (ACLR). One important reason for this is fear of new injury. The aim of this study was to investigate young athletes’ experiences of knee-related fear after an ACLR and how they perceive this fear to affect them in their sporting and everyday life.

MethodsA qualitative interview study was conducted, using semi-structured interviews. Athletes who were active in contact or pivoting sport before an ACL injury, with the goal of returning to the same sport and who scored highly on fear of new injury at six months post-ACLR, were asked to participate. Ten athletes (six women and four men, aged 17–25 years), were interviewed by an independent researcher, 7–9 months after ACLR. Content analysis employing an abductive approach was used.

ResultsThe analysis resulted in three categories with associated subcategories: 1. The expressions of fear; (i) reason for fear, (ii) changes in fear over time, and (iii) injury situation. 2. Reactions, consequences, and adaptations; (i) reactions, (ii) behavioural adaptation and influence on rehabilitation and daily life, (iii) present consequences, and (iv) consequences for the future. 3. Fear and adaptations related to returning to sports; (i) fear related to returning to sports and, (ii) adaptations in sports and life due to fear. Fear was described in broad and complex ways, with fear of a new injury being expressed as one of several aspects. Various reasons (e.g., seeing others getting injured in the past, previous experience of injury, failed rehabilitation, perceived knee instability) were given to explain the fear, and athletes reacted both physically and mentally to fear. Both positive and negative adaptations to fear were described, in both daily life and sports.

ConclusionThe results contribute to an increased understanding of fear as an essential psychological factor to consider during rehabilitation and leaves the way open for research to investigate how physiotherapists can work to manage fear better among ACLR patients.

In this chapter we draw on our applied experiences and research to highlight how perfectionistic athletes can be supported using Acceptance and Commitment Therapy (ACT). The first part of the chapter describes ACT and research that has examined its use for perfectionism. In keeping with other chapters in this section of the book, the second part of the chapter presents a case example of a perfectionistic athlete. Our case example is an aspiring young athlete who in making the transition to the senior performance squad has begun to experience emotional and behavioural problems. Our novel contribution to previous work of this kind is our focus on ACT. Few studies have adopted ACT interventions to reduce perfectionism even though we believe it to be a valuable way of doing so. In addition, there are even fewer exemplars of how to implement this type of intervention in sport. As such, our intention is that the chapter serves as a guide for practitioners unfamiliar with ACT and is a useful addition to other illustrative examples of how to work effectively with perfectionistic athletes.

In this study, we examined knowledge and understandingof sport-related injuries among youth athletics (track andfield) athletes and assessed their needs in managing anyhealth problems. Qualitative data were collected via 12focus groups with youth athletes (16–19 years) studying atSwedish sports high schools with an athletics specialism. Allfocus group discussions were audiorecorded and transcribedbefore being analysed using a thematic analysis approach.Four researchers independently reviewed the transcripts,generated codes and developed themes. Three overarchingthemes related to the athletes’ knowledge and understandingof sport-related injury were developed: (1) awareness ofinjuries, (2) perception of injuries, and (3) factors contributingto injuries. The youth athletes were typically uncertain abouthow to acknowledge a sport-related injury. They expressed thatknowledge about injuries was obtained in part by reflecting onthe lived experiences of their peers. It was also demonstratedthat there appears to be a ‘culture of acceptance’ regardinginjury occurrence. In contrast, causes of injuries were viewedas dependent on multiple factors (eg, lack of context-specificknowledge about training practices). Regarding athletes’needs in managing injuries, an additional three themes weredeveloped: (1) creating functioning elite sports environments,(2) application of knowledge and (3) fostering athletes. Anapparent lack of structure and organisation related to theschool environment was identified as an important issueto review to create opportunities for sustainable athleticdevelopment. The study identified areas that can be improvedin Swedish sports high schools with an athletic specialism andcould be applied in other youth sports contexts. The resultsof this study guide school stakeholders, alongside the sportgoverning bodies who have the mandate to influence activitiesin youth sports contexts, whereby special attention should bedirected towards improving the social environment for youthathletes.

The youth-to-first team phase presents a number of challenges in the careers of modern football players with stagnation, inconsistent performance and dropout being reported. The aim of this study was to investigate the perception of staff involved in professional academy football clubs around the globe, with a particular focus on youth and first team transition demands, resources as well as transitions barriers and coping among male academy football players. Participants from 29 male youth academies distributed across 29 countries took part in the survey. Our main findings suggested training and match intensity reported as being greater at the senior-level and also pressure from parents. The majority of respondents indicated their clubs having long-term strategy for player development and specific roles supporting successful player transitions. Exposure to different playing styles was deemed important to prepare players for the first team. Likewise, having the academy and the first team training on the same site was perceived to ease the transition, with the majority of respondents indicating that players are able to cope with the pressure of first team training and games. Perceptions on whether staff do not have the skills/resources to prepare players for the changes in environment and culture when players move from youth-to-senior level were unclear. Collectively, our study extends previous transition research on youth football academies suggesting the importance of a club-based playing philosophy to prepare players for the first team demands and challenges.

Psykiskt mående och prestation går hand i hand och för en långsiktig och hållbar elitidrottskarriär är båda delarna centrala och ofta sammanflätade. Det finns idag ett ökat intresse från idrotten att fördjupa sin kunskap kring psykisk hälsa, samtidigt tycker många att det är ett svårt ämne att få grepp om. I denna artikel försöker vi sammanfatta viktig grundläggande kunskap inom området, för dig som jobbar med eller kommer i kontakt med elitidrottare.

Elitidrottares psykiska hälsa och välbefinnande har fått en explosionsartad uppmärksamhet inom idrottsforskningen under senare år Frågorna fick också stort medialt utrymme under de Olympiska spelen (OS) i Tokyo 2020. Den amerikanska gymnastikstjärnan Simone Biles kom till Tokyo 2020 med ett stort antal världsmästerskaps och olympiska medaljer i ryggsäcken och förväntades erövra nya OS-medaljer. Under massiv uppmärksamhet från media avbröt hon kvinnornas lagfinal och ställde in individuella finaler. Genom sitt agerande skickade hon ett viktigt budskap till idrottsvärlden: Elitidrottare är inte bara idrottare utan också människor vars fysiska och mentala hälsa behöver prioriteras även om det pågår ett OS. 

The present study explored Norwegian and Swedish Olympic aspirants’ perceived challenges for the preparations of Tokyo 2020 Olympic Games (OG) and risk and protective factors for mental health. The focus for this study was the timespan between the declaration of the postponement of Tokyo 2020 and the final months before the Games. A secondary purpose was to explore experiences of both elite athletes affected by lockdown (i.e., Norwegian athletes) and elite athletes not affected by lockdown in their home country (i.e., Swedish athletes). Twelve elite athletes (Norwegian: n=6; Swedish: n=6; Women: n=6; Men: n=6) with a mean age of 28.25 (SD = 3.60) participated. Semi-structured interviews were conducted between April and June 2021. Seven athletes had qualified and five were still trying to qualify. Eight of the interviewed athletes had previous experiences with OG participation. Template analysis revealed two main themes: (a) challenges and risk-factors for mental health and (b) protective factors. The pandemic exposed athletes to several psychological strains like uncertainty, difficulties with planning/ preparations for the OG and personal and social challenges (i.e., worry about physical health and risk of overtraining, social contacts, identity, and life issues). Protective factors included perceived benefits of increased recovery and time for quality training. The athletes used several coping strategies and self-care behaviors (e.g., focus on the controllable, playfulness, putting sports in perspective, daily routines, short-term goals, working or studying for personal development) and they tapped into various internal and external psychosocial resources perceived as protective for mental health, personal growth, resiliency, and adjustment to the pandemic. The holistic perspectives used contribute to an increased understanding of elite sport athletes’ mental health needs in stressful and unforeseen situations such as a pandemic. The present study explored Norwegian and Swedish Olympic aspirants’ perceived challenges for the preparations of Tokyo 2020 Olympic Games (OG) and risk and protective factors for mental health. The focus for this study was the timespan between the declaration of the postponement of Tokyo 2020 and the final months before the Games. A secondary purpose was to explore experiences of both elite athletes affected by lockdown (i.e., Norwegian athletes) and elite athletes not affected by lockdown in their home country (i.e., Swedish athletes). Twelve elite athletes (Norwegian: n=6; Swedish: n=6; Women: n=6; Men: n=6) with a mean age of 28.25 (SD = 3.60) participated. Semi-structured interviews were conducted between April and June 2021. Seven athletes had qualified and five were still trying to qualify. Eight of the interviewed athletes had previous experiences with OG participation. Template analysis revealed two main themes: (a) challenges and risk-factors for mental health and (b) protective factors. The pandemic exposed athletes to several psychological strains like uncertainty and difficulties with planning and preparations for the OG and personal and social challenges (i.e., worry about physical health and risk of overtraining, social contacts, identity, and life issues). Protective factors included perceived benefits of increased recovery and time for quality training. The athletes used several coping strategies and self-care behaviors (e.g., focus on the controllable, playfulness, putting sports in perspective, daily routines, short-term goals, working or studying for personal development) and they tapped into various internal and external psychosocial resources perceived as protective for mental health, personal growth, resiliency, and adjustment to the pandemic. The holistic perspectives used contribute to an increased understanding of elite sport athletes’ mental health needs in stressful and unforeseen situations such as a pandemic. 

The present study explored Norwegian and Swedish Olympic aspirants perceived challenges for the preparations of Tokyo 2020 Olympic Games (OG) and risk and protective factors for mental health. The focus for this study was the timespan between the declaration of the postponement of Tokyo 2020 and the final months before the Games. A secondary purpose was to explore experiences of both elite athletes affected by lockdown (i.e., Norwegian athletes) and elite athletes not affected by lockdown in their home country (i.e., Swedish athletes). Twelve elite athletes (Norwegian: n = 6; Swedish: n = 6; Women: n = 6; Men: n = 6) with a mean age of 28.25 (SD = 3.60) participated. Semi-structured interviews were conducted between April and June 2021. Seven athletes had qualified and five were still trying to qualify. Eight of the interviewed athletes had previous experiences with OG participation. Template analysis revealed two main themes: (a) challenges and risk-factors for mental health and (b) protective factors. The pandemic exposed athletes to several psychological strains like uncertainty and difficulties with planning and preparations for the OG and personal and social challenges (i.e., worry about physical health and risk of overtraining, social contacts, identity, and life issues). Protective factors included perceived benefits of increased recovery and time for quality training. The athletes used several coping strategies and self-care behaviors (e.g., focus on the controllable, playfulness, putting sports in perspective, daily routines, short-term goals, working or studying for personal development) and they tapped into various internal and external psychosocial resources perceived as protective for mental health, personal growth, resiliency, and adjustment to the pandemic. The holistic perspectives used contribute to an increased understanding of elite sport athletes mental health needs in stressful and unforeseen situations such as a pandemic.

The WHO1 defines mental health as ‘a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community’ (p. 12). According to this definition, mental health is more than a lack of symptoms of mental ill-being or disorders. Variations in mood and perception of symptoms, also with aversive valence, may occur during regular participation in competitive sports. This editorial discusses the importance of acknowledging nuances in studies of mental health and psychiatric disorders in sports medicine and calls for a deepened understanding of ‘mental health’ and how various mental health symptoms and disorders are reported.

Social support and sports participation are protective factors for mental health. Social distancing restrictions in the early phases of the COVID-19 pandemic limited student-athletes’ social interactions with their teams and possibilities to perform their sports. This study aimed to determine the long-term effects of the social distancing restrictions on the positive (i.e., wellbeing and QOL) and negative (i.e., anxiety, depression, worry) elements of mental health. Hypothesis was that participation and competition in sport would improve student-athletes’ mental health by increasing positive mental health and decreasing negative mental health. Participants were 40 individual and team sports student-athletes (Mage = 19.7 years, SD = 1.18) from two NCAA Division I universities in the United States. Two data collection rounds were performed; in the Fall 2020 and in the Spring 2021. The results did not support the hypothesis; no significant changes were found from restrictions to post-restrictions for positive mental health variables (total wellbeing, subjective wellbeing, psychological wellbeing, social wellbeing, and QOL) or negative mental health variables (anxiety, depression, worry) from restrictions to post-restrictions. It is concluded that sport participation itself may not be as important for mental health as the physical activity and social connectedness that comes with sport. This study contributes with important insights on essential factors that may support student-athletes in uncertain times.

The purpose of this study was to explore the views and experiences of sport psychology consultants who have worked with perfectionistic elite athletes and, particularly, their views on the use of cognitive behavioral therapy (CBT). Semi-structured interviews were conducted with four professional sport psychology consultants who identified themselves as having experience of working with athletes they consider to be perfectionistic. Two themes were generated: manifestations of perfectionism, and management of perfectionism. The consultants found perfectionistic athletes to have rigid attitudes and strong negative emotional experiences, to use safety behaviors and to regularly underperform. CBT techniques such as mindfulness, cognitive restructuring, and psychological skills training were most commonly used and were largely viewed as effective against a backdrop of sporting environment that could often encourage athletes to be perfectionistic. The findings highlight the complexity of perfectionism from a consultancy perspective and the challenges associated with working with perfectionistic athletes.

Eitidrottares mentala hälsa och pres-tation är ofta sammanflätade vilketsynliggjordes under covid-19-pande-min. I mars 2020 tog den InternationellaOlympiska Kommittén (IOK) det historiskabeslutet att skjuta fram Tokyo 2020 till senastsommaren 2021. Elitidrotten, i likhet medsamhället i övrigt, blev överrumplade av deomfattande konsekvenser pandemin fick ochhur långdragen pandemin skulle komma attbli. Initialt saknades också erfarenhet ochforskning om hur en pandemi i kombinationmed ett framflyttat OS kunde hanteras. Situationen skapade en extra stress utöver de nor-mala utmaningar elitidrottare vanligtvismöter inför ett OS och fick stor påverkan påalla involverade, inklusive elitidrottsorganisationer världen över.

Contemporary research reports several interrelated risk-factors for athlete mental health within elite sports-systems (Purcell et al., 2019). Risk-factors include, for example,organizational stressors, stigma related to mental health problems, normalization of unhealthy behaviors, injuries, career dissatisfaction, harassment and abuse, and toxic sports leadership or other dysfunctional relationships (e.g., Mountjoy et al., 2016;Reardon et al., 2019; Kuettel and Larsen, 2020). Increased commercialization and professionalization, together with stakeholders and media, place further demands and obligations on athletes (Timpka et al., 2008). Most sport-specific risk factors for mental health in elite sports environments are known to be modifiable, and the collection of studies published in recent years pointsto the need for researchers to study support systems for mental health promotion and prevention. Such efforts should focus on proactive support increasing athlete wellbeing and resiliency in response to both expected and naturally occurring stressors in the environment and support the development of targeted prevention and treatments when mental wellbeing or mental disorders are suspected (e.g., Purcell et al., 2019; Lundqvist et al., 2022). This Research Topic includes an important collection of articles spanning authors from several continents with contributions targeting mental health from a variety of conceptual and theoretical perspectives. Several articles have a direct application for researchers and practitioners working with mental health support in various elite athlete populations and cultures.

The authors were operating in professional roles related to preparations for Tokyo 2020 when the COVID-19 pandemic changed the world. The purpose of the article is to share applied experiences and personal reflections from different parts of the world of psychological challenges and support strategies adopted in elite sports during the first phase of the pandemic. The article focuses on the period between March–August 2020. Common themes experienced across countries included motivational issues, stress and anxiety, loss of routine, life balance challenges, but also benefits for some athletes of extended preparation time and recovery. Variations in support strategies and consequences from the effects of COVID-19 occurred across countries, sports, and staff and athlete roles in elite sports.

The objective of this article is to discuss: (a) the various theoretical perspectives on mental health and mental health disorders adopted in sport psychology, and (b) how the adoption of these various theoretical perspectives in studies might impact upon the interpretations and conclusions in research about the mental health of participants in elite sports. Well-being as a target construct, holistic models, the single continuum or stage models and Keyes’ dual-continuum model of mental health are described, together with a sports psychiatric view of mental health. The strengths and limitations of various mental health perspectives are discussed. We conclude that mental health is a complex  construct and that the sport psychology literature, much like the clinical psychology literature, has struggled to reach a consensus regarding a definition or a feasible approach to investigating mental health. For the researcher, it becomes important to make explicit the underlying theoretical perspective adopted and the operationalization upon which conclusions about elite athletes’ mental health are based so that an increased knowledge base with high scientific credibility can be established and consolidated over time. 

In reaction to the COVID-19 pandemic, restrictive policies altered student-athletes’ academic and athletic life. Sparse research has investigated the pandemic’s effect on student-athlete mental health in terms of both negative (e.g., depression, anxiety) and positive (e.g., well-being, quality of life) dimensions. This study explored the effect of the COVID-19 pandemic on well-being and QOL among NCAA Division I student-athletes at different stages of their collegiate career. Ninety-nine student-athletes (Mage = 19.7 years, SD = 1.5) completed assessments on their mental health. Regression analysis revealed experiences directly related to COVID-19 did not affect general well-being or QOL, but anxiety, depression and significant insomnia did. Social well-being was lower for student-athletes closer to graduation (e.g., juniors, seniors), independent of reported anxiety and depression levels. These findings highlight the importance of psychosocial support, particularly in times of crisis, and indicate that tailored support might be beneficial at later stages of the collegiate years. 

This study explored the essence of Swedish elite athletes’ experiences of their Quality of Life (QOL). A total of eight individual elite sport athletes (3 men and 5 women; mean age 25.5 years, range: 20-32 years) were interviewed twice. By use of interpretative phenomenological analysis, results showed the essence of QOL to consist of a superordinate category of an inner strive to move forward in the athletic development. Lower order categories of QOL consisted of a perceived gratitude to the opportunity to invest in the sport, value-driven behaviours, where goals and efforts were linked to the athletes’ inner values, combined with a perceived relief from various impeding life- or sport related stressors. The importance for future research and applied sport psychology practice to consider the holistic subjective experiences, including individual and social resources, values and goals as well as impeding factors for health and QOL is discussed.

This chapter focuses on the benefits of stimulating well-being and quality of life (QOL) among athletes as a natural part of sustainable sport participation. Well-being promotion involves proactive support to help athletes develop psychosocial resources to stay functional in the sport environment and life. The historical development of well-being and QOL as a research field in sport psychology is presented. Moreover, scientific definitions, frameworks, and models commonly used in contemporary well-being or QOL research are reviewed together with examples of studies performed with elite athletes. In the final section of the chapter, future research directions and applied implications are discussed and a summarizing model is presented to stimulate future studies and applied work on well-being and QOL in sport.

In sport psychology, the roots of mental skills training and performance enhancement strategies have been heavily influenced by the cognitive branch of Cognitive Behavioural Therapy. Some of the traditional methods in CBT, such as exposure and behavioural experiments, have not gained much attention despite strong research evidence of their effectiveness. This chapter will describe how exposure and behavioural experiments can be useful in working with performance enhancement in Olympic level athletes. Common procedures are outlined and lessons learned from the elite sport context are provided.

This case report describes the use of behavioral activation when a former Olympic athlete developed depression after career termination. Four sessions were conducted, one session each week, followed by a boost session one month later. In Session 1, the former Olympic athlete displayed mild to moderate depression with anxiety and a low quality-of-life (MADRS-S = 21; GAD-7 = 17; BBQ = 44). By Session 3, the Olympic athlete no longer met the diagnostic criteria for clinical depression or anxiety (MADRS-S = 2; GAD-7 = 7) and quality-of-life was improved (BBQ = 60). Follow-up assessments one year post-treatment confirmed that the former Olympic athlete continued to improve (MADRS-S = 0; GAD-7 = 0; BBQ = 96). This case report discusses the benefits of proactive support to elite athletes and the use of established clinical psychological treatments, for example behavioral activation, when athletes develop health-related conditions.  

The primary aim with this chapter is to share personal and practical experiences, as well as theoretical considerations, of providing psychological support to injured elite athletes. Fundamental principles and approaches, based on evidence-based practice from clinical psychology as well as more traditional sport psychology research, found to be functional and helpful in the work of injured athletes are discussed.

Research examining the student-athlete experience proposes a number of factors that can be both sources of stress and/or support. The dual career pathway offers a number of potential positive outcomes including psychological, social, and financial benefits; however, challenges including time management, fatigue, and restricted social activities are well documented. In consideration of the multidimensional student-athlete experience and the numerous factors that influence the complexity of potential stress, a mixed methods research study design was used in the study. First, data collected from surveys completed by 173 elite junior alpine skiers were analyzed to identify the degree to which athletes report experiencing stress associated with specific aspects pertaining to training, life, and organizational factors. These factors were then explored through semi-structured interviews with six coaches at the associated national elite sport schools. Taken collectively, athletes reports of psychophysiological training stress on the Multidimensional Training Distress Scale were low. Scores on the college studentathletes life stress scale revealed very low levels of general life stress; although the subscales associated with "performance demand" and "academic requirements" scored marginally higher. Scores on the Organizational Stressor Indicator for Sport Performers indicated low levels of organizational stress. The interviews with coaches elucidated the underlying factors potentially influencing athletes positive adaptations to stress as they reported programming a number of strategies to reduce negative outcomes. Coaches aimed to teach athletes self-awareness and regulation strategies through the use of the training diaries and ongoing communication to promote positive adaptation to stress. A number of coaches also worked with sport psychology consultants to optimize athletes training and study situations. Traditionally, research has noted high levels of stress in student-athletes due to co-occurring demands (school amp; sport); however, the data in the present study suggests that optimizing support mechanisms across domains can promote positive adaptations to potential sources of stress.

In a recent volume of this journal, Schaffran et al. (2019) introduced the Burnout Prevention Questionnaire for Coaches (BPQ-C). Although we recognize the worthwhile efforts of Schaffran et al., we believe that there are several issues associated with this instrument. This commentary aims to expand on why we think the BPQ-C should not currently be used by practitioners and researchers to screen for burnout.

This article presents an evaluation of the effectiveness of an applied mindfulness intervention for stress reduction delivered to Paralympic leaders prior to the Paralympic Games. The intervention group of Swedish Paralympic leaders (n=10) received a mindfulness intervention of eight web-based seminars, while a Norwegian reference group (n=6) received no intervention. Three assessments were performed for both samples: at baseline, post-intervention and six weeks post-intervention. The evaluation indicated intervention effects of higher psychological flexibility (p=.03), less rumination (p=.02) and lower perceived stress (p=.001), and offers initial support for the applied usefulness of a web-based mindfulness training program as a supplement in stress-reduction programs for elite sport leaders. General challenges from an applied sport psychology perspective related to the implementation of mindfulness interventions in samples with experienced high levels of stress and perceived time-constraints are discussed.

The purpose of the study was to investigate the influence of flotation REST upon skilled and less skilled golfers anxiety in terms of physiological indicators of stress, self-rated anxiety scores, muscle tension, and the effect on golf putting. Prior to performing the putting task participants underwent a treatment of flotation REST or a period of resting in an armchair. Participants completed both treatments in a randomized order with a two-week interval. The results showed that both flotation REST and the armchair treatment reduced systolic blood pressure and heart rate, with no differences between treatments or athlete skill levels. No significant differences between treatments were revealed regarding self-ratings, level of muscle tension or putting precision. The results indicate that flotation REST may be useful for reducing negative symptoms related to stress and anxiety in general; however, no support for direct positive effects on golf performance were found.

Sexual harassment and abuse (SHA) can have a profound negative impact, but research on SHA in sport is scarce and studies of SHA in Swedish sport are absent. This study explores (a) self-reported prevalence of SHA perpetrated by coaches among male and female Swedish athletes, and (b) descriptive statistics for coach–athlete relationship factors and the association between these relationship factors and reported SHA. Current and former Swedish club sport athletes (n = 477) aged 25 participated in the survey. Athletes reported 5.5% prevalence of coach SHA, of which inappropriate, unpleasant, or offensive physical contact were most common. No significant differences of SHA frequency were displayed across gender, sport performance levels, or individual/team sports. A majority of athletes (55–95%) reported trust, closeness, substantial coach influence over sport performance, and instructional physical contact as main coach–athlete relationship factors. A minority (13–39%) reported dependency, substantial coach influence over personal-life, non-instructional physical contact, sexualized comments and jokes, and flirting. Prevalence of coach–athlete friendships, athlete attraction to coaches, and coaches’ instructional physical contact differed significantly between male and female athletes. Closeness and athlete attraction to coaches were negatively related, and coaches’ non-instructional physical contact and flirting were positively related to reported SHA. Multi-causality and ambiguity of coach–athlete relationship factors are discussed.

One common method in Cognitive behavior therapy (CBT) to treat anxiety problems is exposure, but there are few articles examining its applicability to sport. The aim of this article is to give a background of the use of exposure in sport and present a case of how exposure can be used with athletes. The athlete was a 17-year-old female cross-country skier with high levels of performance anxiety. In the case description, common procedures in CBT such as behavioral analysis, psychoeducation, and exposure are presented, as well as how anxiety can be managed. After the intervention the athlete perceived lower levels of anxiety as well as improved behavioral repertoire (e.g., less avoidant behaviors and more functional sport-specific behaviors). This case may be used to help practitioners consider the use of exposure in competitive sports.

More than 30 years of research on athlete burnout has yielded important insights and questions regarding the onset, nature, and consequences of this detrimental syndrome. Not surprisingly, burnout is considered an important matter, both from a research and practical standpoint. We comment on the work of Ryu, Ali, Kim, Choi, and Radlo, who examined the impact of burnout on cognitive performance among athletes.

The present study validated a Swedish version of the 47‐item Coaching Behavior Scale for Sport (CBS‐S). Sample 1 consisted of 506 team sport athletes [262 men and 244 women; mean age: 22.20, standard deviation (SD) = 3.90] distributed across 41 coaches at the two highest national levels of various sports. Athletes completed the CBS‐S and established questionnaires of coaching behaviors (LSS), self‐confidence (CSAI‐2R), and coach–athlete relationship (CART‐Q). An additional sample of 39 basketball players (21 men and 18 women; mean age = 17.40, SD = 2.39) completed the CBS‐S twice, approximately 4 weeks apart. Confirmatory factor analysis showed an acceptable model fit for the seven‐factor version of the CBS‐S, although two items of the negative personal rapport subscale displayed insufficient factor loadings. Correlations between the subscales of the CBS‐S and established instruments were in accordance with theoretical expectations, supporting the concurrent validity. Cronbach's alpha (> 0.82) for all dimensions provided support for the reliability of the CBS‐S, and test‐retest correlations indicated moderate stability over time. Cultural differences in the assessment of coaching behaviors and the usability of the CBS‐S by coaches for self‐reflection and development are discussed.

När livet och idrotten fungerar som bäst mår man fint och prestationsförmågan är på topp. I detta drömläge är behovet av KBT, kognitiv beteendeterapi, mycket litet. Men det är få förunnat att befinna sig i detta läge tjugofyra timmar om dygnet – varken hälsa eller prestationsförmåga är någonting statiskt.

Bättre prestation & hälsa med KBT ger en introduktion till KBT och de vanligast förekommande problemområdena som finns förankrade i såväl den kliniska psykologin som i ett idrottsspecifikt sammanhang. Du får flera beskrivningar och exempel på hur behandlingar kan gå till väga.

This study presents the development process and initial validation of the NyTid test, a process-oriented movement assessment tool for compulsory school pupils. A sample of 1,260 (627 girls and 633 boys; mean age of 14.39) Swedish school children participated in the study. In the first step, exploratory factor analyses (EFAs) were performed in Sample 1, consisting of one third of the participants. The EFA indicated that the 17 skills in the test could be reduced to 12 and divided into four factors. In the second step, the suggested factor structure was cross-validated with confirmatory factor analyses (CFAs) in the larger Sample 2. The NyTid test adopts a holistic perspective in which qualitative criteria offer an alternative approach to product-oriented measurement. The study confirms that the NyTid test is a valid process-oriented assessment tool designed for typically developed children aged 12 and 16.

This study investigated whether need satisfaction, need dissatisfaction, motivational climate, perfectionism and self-esteem relate to athletes’ discrete profiles of hedonic and eudaimonic well-being and perceived stress. Participants were 103 elite active orienteers (49 men and 54 women; mean age = 22.3 ± 4.4) who clustered into three distinctive well-being and stress patterns: Cluster 1 (lower well-being/higher stress; n = 26), Cluster 2 (higher well-being/lower stress; n = 39), and Cluster 3 (moderate well-being/moderate stress; n = 36). Cluster 1 and 2 constituted distinct well-being/stress profiles and differed significantly (p < .01) in mastery-oriented climate, need satisfaction, need dissatisfaction, perfectionistic concerns and self-esteem scores. A discriminant analysis showed these five variables to correctly assign 88 % of Cluster 1 and 2 participants into their respective groups, although mastery-oriented climate was revealed as a less influential indicator (function loading <.40). The substantial function loading of need dissatisfaction supports the importance of assessing both need satisfaction and dissatisfaction as they contribute uniquely to well-being.

Research has highlighted flotation-REST as a promising method for relaxation and performance enhancement in sport; however, to further evaluate the use of flotation-REST in an athletic environment, additional research is warranted. Semi-structured interviews were conducted with six elite track and field athletes about their experiences and perceived effects of flotation-REST. Athletes were interviewed twice; once for their immediate response and again to explore their perceptions of flotation-REST over time. The data was analyzed using interpretative phenomenological analysis. Flotation-REST was perceived as pleasant and relaxing. Five athletes reported less stress and an overall increase in well-being for one or two days afterwards, although they felt physically tired during training sessions. Being in a better mood, placing fewer demands on themselves, and feeling more optimistic and present were also perceived effects. This study shows the potential of flotation-REST as a technique for health promotion, stress management, and a means to practise mindfulness.

This study examined subjective (SWB), psychological (PWB) and social well-being (Social WB) at a global and sport contextual level among ten elite orienteers (6 women and 4 men, median age = 20.4, range 18–30) by employing semistructured interviews. Athletes described SWB as an interplay of satisfaction with life, sport experiences and perceived health combined with experienced enjoyment and happiness in both ordinary life and sport. SWB and PWB interacted, and important psychological functioning among the elite athletes included, among other things, abilities to adopt value-driven behaviors, be part of functional relationships, and to self-regulate one’s autonomy. The ability to organize and combine ordinary life with elite sport, and the use of strategies to protect the self during setbacks was also emphasized. For a comprehensive theoretical understanding of well-being applicable to elite athletes, the need for a holistic view considering both global and sport-specific aspects of WB is discussed.

Objective

In this study we examined the relationship between trait hope and burnout in elite junior soccer players and whether stress and positive and negative affect mediated this relationship.

Methods

Participants were 238 Swedish soccer players (166 males, 71 females; one did not indicate gender) aged 15–19 years who completed questionnaires measuring trait hope, perceived stress, positive and negative affect, and athlete burnout (i.e., emotional/physical exhaustion, a reduced sense of accomplishment, and sport devaluation).

Results

Bivariate correlations were consistent with hope theory contentions indicating significant negative relationships between hope and all three burnout dimensions. The relationship between hope and emotional/physical exhaustion was fully mediated by stress and positive affect. For sport devaluation and reduced sense of accomplishment, stress and positive affect partially mediated the relationship with hope. In contrast, negative affect did not mediate the relationship between hope and any of the burnout dimensions.

Conclusion

The results support earlier findings that hope is negatively related to athlete burnout. Support was also found for the hypothesis that high hope individuals would experience less stress and therefore less burnout. Promoting hope may be relevant in reducing the likelihood of this detrimental syndrome.

The objective was to examine the differences in anxiety ratings of elite and sub‐elite athletes when the relationship between intensity and direction scores of anxiety ratings is considered in analyses. Participants were 31 junior elite (Mean age: 17.7, SD=1.1) and 53 sub‐elite (Mean age: 17.5, SD=1.1) cross country skiers and swimmers who completed the direction modified CSAI‐2R before important competitions. Results showed that elite athletes rated a higher percent of items as facilitative to their performance whereas sub‐elite athletes rated a higher percent of items as debilitative. No significant differences between the elite and sub‐elite samples were displayed regarding rated direction scores of cognitive or somatic anxiety at moderate to high‐intensity levels. A significant difference in facilitative anxiety ratings was displayed at a low anxiety intensity level (Z=−2.20, P<0.05). Outcome performance data showed no consistent congruence with athletes' anxiety direction ratings. The findings suggest that facilitative direction scores are a consequence of low anxiety intensity, possibly combined with high self‐confidence levels. Directional anxiety researchers analyzing separate total scores of intensity and direction respectively, which is the traditional approach, may draw incorrect conclusions about the importance of facilitative ratings of anxiety symptoms.

This paper summarizes the topic of well-being as it applies to competitive athletes, with a particular focus on definitional and conceptual issues. Established definitions within research on human happiness and flourishing based on the hedonic and eudaimonic perspectives are contrasted against definitions applied within sport psychology. The majority of the reviewed sport psychology studies either failed to define well-being or used a variety of labels to describe the construct (e.g., subjective well-being, psychological well-being, mental well-being). A large number of assessments have been used to assess well-being among athletes, but most were applied with only a weak theoretical rationale and did not distinguish between well-being at the global and sport levels. It is concluded that well-being studies within sport psychology have been hampered by conceptual ambiguity, which makes it difficult to compare results across studies and generalize findings in order to develop a sound theoretical base of knowledge. Future research needs to more explicitly define the conceptual framework of well-being and the level (global or context-specific) on which the construct is investigated. Toward this goal, an integrated model is presented to provide a conceptual well-being structure in sport studies, and future directions for research are discussed.