What is Clinical Sport Psychology?

Clinical sport psychology is an approach to treating athlete performance difficulties and increasing athlete well-being. It was developed by psychologists Frank Gardner and Zella Moore and is presented in their books Psychology of Enhancing Human Performance and Clinical Sport Psychology.

Clinical sport psychology is a holistic approach which integrates short-term performance needs with long-term personal and athletic goals. It is holistic because it operates from the perspective that client functioning cannot be nearly categorized as being "clinical" or as "sport" related, but that each athlete-client's situation is a unique amalgamation of performance, psycho-social, developmental and other contextual factors.

Clinical sport psychology is based on a theory called the integrated model of athletic performance. This model is based on the empirical findings in human sexual performance, sport psychology, and self-regulation. Self-regulation (not to be confused with emotional or affective regulation) is the capacity for meta-cognitive thought processes in the service of increasing the effectiveness of behavior. Metacognition is a psychological state in which internal experiences are conceptualized in broad, distal terms (i.e. , in "big picture" terms) that foster a sense of choice instead of automaticity regarding one's behavior. As psychiatrist Viktor Frankl eloquently wrote, "Between stimulus and response, there is space. In that space is our power to choose our response. In our response is our growth and freedom." The integrated model of athletic performance proposes that, in order to perform optimally, it is important to direct attention towards task relevant, present-moment, external contingencies and not to see judgemental, worrisome, and future-oriented content. This does not mean negative content needs to be escaped from or avoided; but that attention needs to be focused on external contingencies with an accepting attitude towards negative content.



An important aspect of this model is the concept of experiential avoidance. Experiential avoidance is the attempted avoidance of internal experiences as a means of regulating affect. Research suggests that most, if not all, psychological problems in living can be conceptualized as serving the function of experential avoidance. Similarly, clincal sport psychology proposes that experiential avoidance functions as a mediator of athlete performance and overall athlete well-being. If attempts at experimental avoidance are made, the following cognitive process is believed to occur: the attempt triggers a meta-cognitive form of scanning for negative internal content. This action is ironically intended to bring into awareness any nagative content that is simultaneously trying to be avoided- the mind is actually trying to find the same content it is trying to avoid. When this happens, focus is diverted from external stimuli toward internal stimuli and behavioral repertoires )and subsequent athletic performance) decrease in effectiveness.

Clinical sport psychology relies heavily on assessment of athletic difficulties as a means of determining appropriate treatment. Athlete-clint difficulties are conceptualized as being either (1) the non-clinical need for performance enhancement; (2) sub-clinical levels of psycho-social difficulty that may or may not impact performance; (3) clinical problems that moderately/severely impact psycho-social functioning and may or may not impact performance; and (4) issues of sport termination.

The theory of clinical sport psychology has been applied to the development of a technical approach called the mindfulness-acceptance-commitment (MAC) approach to performance enhancement. Although the MAC approach is a psychological skills training program, it does not focus on controlling internal experiences as do most psychological skills training approaches. The MAC approach is based on acceptance and commitment therapy and mindfulness-based cognitive therapy (both third wave behavior therapies), and research on behavorial concepts of rule governed behavior and relational frame theory. Most traditional psychological skills training attempts to isolate athletic performance as a discrete form of functioning that is not affected by external and internal contexual variables; and it contradicts the metacognitive stance associated with optimal human performance.

For an acceptance-based model of psychological functioning, it is counter-productive to consider internal experiences as postive or negative and even more so to try to control them. Acceptance-based models promote a way of experience in which internal experiences are considered to be naturally occuring phenomenon that do not have to be labeled, evaluated, or controlled. In fact, attempts to control internal experiences may contribute to the development of hypervigilane to internal processes associated with threat scanning- just the recipe for dysfunctional performance according to the integrated model of athletic performance. From the perspective, traditional psychological skills training may trigger attention that is task-irrelevant and subsequently disrupts the self-regulation process and functionality of performance.

The therapeutic action of the MAC program is propsed to occur via client development of effective self-regulation and values-directed behavior. Values-directed behavior is a concept associated with acceptance and commitment therapy which means engaging in a life that is vital and meaningful according to one's unique beliefs about what is important. It is based on natural contigencies (i.e.m experienced consequences in the external world) as opposed to arbitrary contigiences (i.e., verbal-liguistic associations between hypothetical behaviors and outcomes). The MAC program can help athlete's improve their practice and training quality, competitive performance, and athletic enjoyment.

It is important to remember that the MAC program is a performance enhancement tool that is appropriate for use with certain athlete-clients. These clients--based on a thorough assessment of their clinical and performance needs--are deemed psycho-socially successful enough such that the work can appropriately deviate from more clinically oriented technique. This means that clients with moderate to severe pathology would be more appropriately treated with more clinically oriented interventions. In many cases, these clinical interventions then serve as inadvertent performance enhancement tools due to an increase in overall functioning.

The MAC program follows an intervention protocol which consists of five phases. These phases are as follows:

1)education phase
-->introducing the relationship between self-regulation and athletic performance
-->discussing the athlete-clients's prior performances
--> explaining the concept of experimental avoidance and its relationship to traditional forms of self-regulation
--> introducing an early cue detection which is the capacity to understand how internal and external events function as triggers for specific patterns of behavior

2)Mindfulness phase
-->introducing the concept of mindfulness
-->discussing the utility of mindfulness for facilitating the psychological state associated with enhanced performance
-->teaching mindfulness techniques
--> contrasting mindfulness with habitual, automatic tendencies to avoid negative internal experiences
-->teaching attention/refocusing skills

3)Values identification and commitment phase
-->introducing the concept of values
-->helping clients determine their values
-->fostering clients' use of behaviors that reflect their values
-->connecting these concepts to both athletic and personal domains
-->introducing the concept of cognitive defusion which is the distancing of one's behavioral repertoire from arbitrary rules

4)Acceptance phases
-->introducing rule-governed behavior in order to promote cognitive defusion
-->discussing the negative impact language can have on performance
-->integrating the ideas from each of the phases into a comprehensive package of theoretical knowledge and practical skills

5)Integration and Practice phase
-->promoting the used f the previously learned ideas and skills
-->addressing related problems or conerns