PSYCHOLOGY OF INJURY:

THEORY, RESEARCH AND

PRACTICE

Leah Lou B. Palacio

• Contact and high-risk sports have been identified
with research reporting injury rates two to five
higher times higher than those found in non-contact
sports (NCAA 1992).

• Initial national injury surveys have consistently

found greater incidence of injury among boys than
girls (Kraus & Conroy 1984)
FACTORS WHY ATHLETES BECOME INJURED
Individual factors
• Age
• previous injuries
• body type
• fitness level
Environmental factors
• Type of sport
• Playing condition
• Equipment
• Over the past 30 years, psychological and social factors
(psychosocial factors) have been implicated in the
genesis of physical injuries. Initial investigation in this
area focused on the effects of life-event stress, finding
that injured football players often experienced higher
level of stress in the year leading up to their season than
players who did not become injured (Bramwell, Masuda,
Wagner & Holmes 1975; Holmes 1970; Coddington &
Troxell 1980; Cryan & Alles 1983).
• In 1988, Andersen and Williams addressed these
limitations and provided direction to the future research.
They presented a dynamic, multidimensional stress-injury
model. In this model, Andersen and Williams
acknowledged the importance of life stress, yet argued
that it was only one of the three important psychosocial
factors to consider.
• In addition to assessing athletes’ history of stressors (e.g.
life-event stress), researchers also needed to consider
personality (e.g competitive trait anxiety, locus of control)
and coping resources (e.g social support, psychological
coping skills)

• Andersen and williams hypothesized that the influence of

these factors on athletic injury was not direct. Their effects
were mediated through a mechanism referred to as the “stress
response”.
THE STRESS-INJURY MODEL: INTRODUCTION
• Andersen and Williams (1998) suggested that the relationship
between psychosocial variables and athletic injury was neither direct
nor limited to life stress.
• Andersen and Williams (1998) suggested that the three
psychosocial factors had directly influences on an athlete’s stress
response, the mechanism hypothesized to directly influence injury
risk. They further suggested that personality and coping resources
affected the stress response by moderating the influence of an
athlete’s history of stressors.
 Personality History of Stressors Coping Resources

Potentially Stress Response

stressful athletic Injury
situation Cognitive appraisals
Physiological/
attentional change

Interventions

Figure 21.1 Revised Stress-injury Model

• A more recent formulation of the stress-injury model,
however, recognized the bidirectional influences that life
stress is likely to have on the other psychosocial factors
and that coping resources and personality are likely to
influence one another (Williams and Andersen 1988).
• The central mechanism in this model is the stress response,
a bidirectional relationship between athlete’s cognitive
appraisals of demands, consequences and resources in the
athletic situation and their psychological reactions and
attentional responses.

• They suggested that the stress response mediated the

relationship between the psychosocial variables and
athletic injury.
 Personality History of Stressors Coping Resources

Potentially Stress Response

stressful athletic Injury
situation Cognitive appraisals
Physiological/
attentional change

Interventions

Figure 21.1 Revised Stress-injury Model

THE STRESS-INJURY MODEL:
OVERVIEW OF PSYCHOSOCIAL
FACTORS
 History of stressors

 Coping resources

 Personality
History of Stressors
• Andersen and Williams (1988) identified life-event
stress (hereafter referred to as life stress), daily hassles
and prior injury.
• Early life-stress research examined the extent to
which football players who had experienced high
levels of life stress during the one to two years before
their seasons were more susceptible to injury than
their low-stress counterparts.
• Previous injury was thought to influence subsequent injury in
one or two ways (Andersen & Williams 1988; Williams 2001)

o First, if athletes were not fully recovered from their

injuries but returned to play anyway, their risk of re-
injury was increased.
o Second, if athletes may be physically recovered but not
psychologically ready to return to competition,
increasing the likelihood of their making negative
appraisals.
Coping Resources
• Broadly, coping resources are the internal cognitions,
behaviors and emotions, and the external social support
networks that assist individuals in effectively handling
the events, problems and stressors they experience in
life (Andersen & Williams 1988; Williams 2001).
• According to Williams, these external and internal
resources can decrease injury susceptibility either
directly, by influencing how an athlete appraises a
situation, or indirectly by attenuating the negative effects
associated with life stress or certain personality traits,
such as competitive anxiety.
Personality
• Andersen and Williams identified hardiness, locus of
control, sense of coherence, competitive trait anxiety and
achievement motivation as measures worth consideration.

• According to Williams (2001), however, only

achievement motivation, locus of control and trait anxiety
have been examined in life stress-injury studies.
• Concerning motivation, the one study examining the effects
of achievement motivation reported no relationship with
injury (Van Mechelen et al. 1996).

• With self-motivation, McClay, Appleby and Plascak (1989)

found a significant relationship with severe injuries. They
suggested that self-motivated athletes might be more likely
to overload themselves when training than less than
motivated athletes, thus setting up the condition of physical
vulnerability.
• Sport Competition Anxiety Test (SCAT) – assess somatic
anxiety

• Sport Anxiety Scale (SAS) – measure somatic, worry and

concentration disruption
STRESS-INJURY MODEL: THE STRESS
RESPONSE

• Central to this model is the bidirectional relationship

between athlete’s cognitive appraisals of life events
and their stress responses.
Cognitive Appraisals
• A stressor acquires a valence (positive or negative) to
the degree that the stressor is perceived as threatening,
overwhelming or simply challenging to a person’s
wellbeing. This process is called the ‘primary
appraisal’. The stressor achieves a level of intensity in
relation to the person’s perceived ability to cope or
respond to the threat (called the ‘secondary appraisal’)
(Folkman, Lazuras, Dunkel-Schetter, Delongis & Gruen 1986).
Stress Response
• Andersen and Williams (1988) conceptualized the stress
response as being physiological and attentional in nature.

• Perna and colleagues argued that to fully understand an

individual’s stress response, one must consider effects to
cognitive, emotional, behavioral and physiological
systems.
Affective responses
• Common negative affective states include anxiety,
depression and anger. Fatigue also frequently included
as emotional response.

• College athletes with high negative life stress reported

experiencing significantly more depressed, angry and
anxious moods than college athletes with low life stress
(Perna et al. 1998b).
Cognitive responses
• Cognitive stress response are those symptoms that
interfere with thought and information processing, and may
include disruptions in attention, concentration, speed at
processing visual cues, rumination, and the experience of
racing unwanted thoughts.
• Williams and colleagues (1990,1991) reported that in
comparison to to low-life-stress athletes high-life-stress
athletes experienced more state anxiety and PN in the high
demand situation.
• Thompson and Morris (1994) found an increased athletic
injury rate among athletes with high life stress and low
vigilant attention.
 Behavioral responses

• Behavioral responses are symptom such as disruptions to

sleep and self-care routines that may predispose an athlete
to injury or illness.

• Sleep deprivation and interrupted sleep are also known to

cause decrements in attention and concentration, and in some
cases athletic performance, that may also predispose
individuals to athletic injury (Savis 1994).
Physiological responses

• An assumption of biopsychosocial models, such as

the Andersen and Williams (1988) model, is that
psychosocial stressors and accompanying distress
cause activation of the autonomic nervous system
(ANS) (i.e. cortisol).
 PSYCHOLOGICAL INTERVENTIONS TO
FACILITATE EXERCISE TRAINING
ADAPTATION AND ATHLETE HEALTH

• Perna et al. 1988b) have suggested that one way sport

psychology interventions may enhance performance is by
facilitating athlete health.
• Cognitive Behavioral Stress Management (CBSM) –
interventions employing relaxation training, imagery and
cognitive restructuring have been shown to buffer
psychological distress and immune function decrements
(Antoni et al. 1991)
• Psychological skills training, a form of CBSM, has been
widely used to decrease competitive anxiety and improve
performance among athletes (Daw & Burton 1994; Greenspan
& Feltz 1998; Maynard & Cotton 1993).