Welcome to Oxford Clinical Psychology
By Dr Alan Currie
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The four-year Olympic cycle seems to come around more quickly every time. Each Olympic Games brings new hope and new challenges for all competitors and their supporters. Among those supporters will be family, friends, team-mates, coaches, and a wide range of other disciplines helping the athlete to his or her best performance.
Overcoming obstacles and adversity is integral to the life of an athlete. Adversity may take the form of a setback such as an injury, or chasing down a lead against an opponent. However, one of the biggest challenges for an athlete is overcoming that posed by his or her own psychological state. Athletes at all levels are more likely to succeed it they have the ability to overcome and manage pressure. Events like the Olympics are among the most watched on the planet and the athletes who compete are judged largely by binary criteria – winning or losing. This will all magnify any pressures and increase the importance of the athlete being able to master their mental state.
Anxiety associated with performance (commonly referred to as ‘competitive anxiety’ or ‘performance anxiety’) has been defined as ‘an unpleasant psychological state, in reaction to perceived threat concerning the performance of a task under pressure’ (Cheng et al. 2009). It is considered to be the most common source of situational stress in sport, and is related to the perceived ‘ego-threatening’ nature of the competition. The added public scrutiny and evaluation in sport can mean that both participation and performance are strongly linked to an athlete’s self-esteem and self-worth. An athlete’s performance is judged (whether by themselves or others) and in turn, there are consequences (real or perceived) associated with the outcome of that performance. An athlete will believe they have something significant to lose or to gain, known as the ‘fear of failure’ or ‘fear of consequence’ (Goodger & Broadhead 2016). Finding the optimal mental state for competition is something that may come naturally to successful competitors but this can’t always be assumed and many sportsmen and women will occasionally need outside help from among the support team.
Recent years have brought recognition that sportsmen and women may have mental health needs that are just as important as their ‘physical’ health needs (Reardon & Factor 2010). In addition to everyday anxieties, the sports world contains a whole host of additional stressors and these are not merely restricted to the stresses of performance. The impact of injury or retirement is particularly associated with psychological stress, even depression, and in weight sensitive sports, the prevalence of disordered eating has long been noted (Currie & Johnston, 2016). However whilst the range of professionals providing support for athletes is broad and diverse and includes medical staff such as team doctors, physiologists, and physiotherapists it is still relatively unusual for a psychiatrist to be on the support team.
Many athletes struggle to come forward and acknowledge their mental health concerns – and when they do, help is not always readily available. For these reasons, two recent stories caught my eye. From 2005 to 2010, Andy Baddeley was Britain’s leading 1500m runner with a wealth of honours and victories to his name. A depressive illness halted his progress, but as a result, he became a vocal advocate within the mental health community and beyond. He has recently shown outstanding form winning a number of high quality races. The story of hurdler Jack Green too is one that inspires hope and optimism for recovery. Suffering from depression throughout most of 2012, he still managed to make the Great Britain team for the London Olympics, where he narrowly missed a medal in the 4x400m relay. Jack returned to the Olympic arena in Rio reaching the semi-finals in his number one event, the 400m hurdles.
Dr Alan Currie has been a consultant psychiatrist in full-time NHS practice in the north-east of England since 1997. He has advised a number of national sports organisations on mental health matters and in 2007 he edited, and co-authored the UK Sport guidelines on eating disorders. Along with Bruce Owen, he is author of Sports Psychiatry; a concise and practical pocketbook covering the breadth of psychiatric conditions that can present in sportsmen and sportswomen. This work is also available online.
Cheng, W.N.K., Hardy, L. & Markland, D., 2009. Toward a three-dimensional conceptualization of performance anxiety: Rationale and initial measurement development. Psychology of Sport and Exercise, 10(2), pp.271–278.
Currie, A. & Johnston, A., 2016. Psychiatric disorders: The psychiatrist’s contribution to sport. International Review of Psychiatry, pp.1–8. Available at: http://www.tandfonline.com/doi/full/10.1080/09540261.2016.1197188.
Goodger, K. & Broadhead, S., 2016. Managing the anxiety of performance. In A. Currie & B. Owen, eds. Sports Psychiatry. Oxford: Oxford University Press, pp. 17–29.
Reardon, C.L. & Factor, R.M., 2010. Sport Psychiatry. Sports Medicine, 40(11), pp.961–980. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=med5&NEWS=N&AN=20942511\nhttp://link.springer.com/10.2165/11536580-000000000-00000.
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