Lecture 7- Depression in Sport Flashcards
Define Performance Impairement classification
- Clinical issues do exist (emotional distress/ behavioural dysregulation)
- possible reduced performance or forced to stop
- Impairement in one life domain (not a break down of all aspects of life)
What did Schaal et al (2011) do?
French survey of about 200 athletes, looking at the prevalence of mental health issues in sport
What were Schaal’s findings?
- 1/4 of men had an eating disorder
- 1/3 women had an eating disorder
- Anxiety disorders were next prevalent
- Then its depression
- Women were pretty much always more prevalent than men
Why do women report more mental health issues?
More stigma for a man to admit to mental health issues, so women report them more. But women could just suffer more?
What is the prevalance of anxiety disorders in aesthetic sports?
38.9% in aesthetic sports will get an anxiety disorder at some point
7% of men in combat sports will get an eating disorder - higher than other sports - due to weight classifications, e.g. taekwondo
How can an SP deal with this?
- may have to refer them to a different professional
- have to get them to agree that performance is secondary - can be hard
Whats the benefits of using a Sports psychologist?
- They understand the sports context and the pressurising environment more. Can use their knowledge of the area to help
Outline performance impairement 1
Clinical issues that show impairement across all life domains. Impair overall life functioning.
Outline performance impairment 2
More behavioural. Inhibits performance, perhaps through forced non-participation. Not transferred across all life domains. E.g. performing fine on the pitch then going home and domestic abuse
Give exampls of some mental health issues that come under Pi-1
- Anxiety disorders
- eating disorders
- mood disorders
Cant have these in just one situation. Cant just have an eating disorder at home
Give exampls of some mental health issues that come under Pi-2
- Anger & impulse control disorders
– Alcohol & drug use disorders
– Personality disorders
Certain contexts/ people can trigger these
What was the prevalence of depression in athletes, shown by Schaal et al (2011) 8 doubled
Male: 8.7%
Female: 16.3%
What do Proctor & Boan-Lenzo, 2010 show?
In non-elites, playing sport relieves depressive symptoms
Outline MAjor depressive disorder in sport
onset period
**
- Unipolar - just the lows all the time, no highs
- Peak period of onset: 15-29 (peak career for an athlete)
- 60-70% will get additional episodes if untreated
What are the symptoms of MDD? - suicide
- Almost daily dysphoric mood - low/lethargic
- Psychomotor agitation/retardation - either physically lathargic, or physically hyperactive
- Weight change -
- Fatigue
- Disturbed sleep
- Worthlessness
- Suicide ideation - just thinking about it, but not planning
Need to have 5, for 2 weeks (DSM)
What does DSM say that the symptoms must be?
***
- musnt be caused by subtances/ medical conditions
- must impair life significantly or cause distress
- can know be caused by bereavement
How do depressive symptoms manifest in training?
- irritability with team mates
- loss of interest (hard to spot, could just be today he is tired etc)
- Lethargy
- loss of concentration
What is the prevalence of suicide in MDD?
14% - clearly performance is not important, this is
What are the symptoms of Bipolar? health risking?
Unipolar/ MDD plus this stuff when they are high:
- Inflated self-esteem or grandiosity
– less need for sleep
– More talkative
– Racing thoughts
– Distractibility
– Increased goal-directed activity or psychomotor
agitation
– Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. drugs)
if they have had it for 2 years, what does bipolar become?
Cyclothymic disorder
If they have had it for 2 years, what does unipolar become?
Persistant depressive disorder
what are the subcategories of unipolar? ***
- Premenstrual dysphoric disorder
- Seasonal affective disorder
- Post-partum disorder
Men cannot have the first and third one, so more chances for women to get depression
What stage do we gather this information?
in the first stage, the clinical assessment phase
What do you do in the clinical assessment phase to get this information? - Structure clinical interview
Comprehensive interview and client history
– Structure Clinical Interview for DMS-V Disorders
- very hard to classify, lots of overlapping symptoms
- e.g. unipolar and Bipolar have the same negative symptoms
- eating disorders overlap with anxiety disorders
Whats Beck’s (1976) theory about where depressive symptoms come from (aetiology)
Emphasises cognitions and schemas a lot
Outline Becks cognitions theory of depression
- Early experiences
- Form depressogenic schema - lay dormant until:
- critical incident- a traumatic experience triggers them
- Schema activated
- Negative automatic thoughts, which lead to
- Negative symptoms:
- Behavioural, motivational, somatic, affective, cognitive
What did Appanael et al (2009) do?
Looked at the onset of clinical symptoms of depression following a traumatic event - injury
What were Appanael et al (2009)’s findings?
- In first week, those injured athletes rose above the threshold of being classified as clinically depressed
- after that though they got better than healthy controls, suggesting a rebound effect - that once you get past the first week youll be fine
Outline some examples of traumatic events that could trigger the onset of depression
•Inury
•bereavement (family, coach or team mate)
• relegation
•loss of contract
• retiring (e.g. after olympics the % of athletes with depression may increase as loads
are retiring)
Outline the viscious circle of depressive symptoms from Beck et al (1976) ******* perceptions get skewed, validate schema
Depressogenic schema + Cognitive bias + negative cognitive triad
- all interact and cause depression
- perception of life becomes bias, which validates schema and the cycle continues
Outline the negative cognitive triad
Negative views of the self
Negative views of the world (or about your world)
Negative views of the future
Outline all of the types of cognitive bias’, there are 7
Selective abstraction
Arbitray inference
Magnification and minimisation
Overgeneralisation
Should and must statements
Absolutist dichotomous thinking
Personalisation
Outline Arbitrary inference as a cognitive bias
“My team mate didn’t pass the ball to me, he must think I’m rubbish”
Outline Selective Abstraction as a cognitive bias
**
Despite evidence to the opposite, occasional negative signals are made salient.
Outline Overgeneralisation as a cognitive bias
“He didn’t pass to me, that must mean everyone thinks I’m rubbish”
Outline magnification and minmisation as a cognitive bias
“I had a bad competition, that must mean I’m awful”,
vs
“I won but it’s because my opponents didn’t try”
Outline personalisation as a cognitive bias
*****
“We lost because of me”
Outline Absolutist dichotomous thinking as a cognitive bias *****
“If I don’t win, my life is ruined”
Outline Should and must statements as a cognitive bias
“I must be the best at all facets of my match”, “I must be liked by my team mates”
What is the second cognitive theory about depression, from Seligman (1975) ****
Learned Helplessness
Outline the theory of Learned Helplessness
**
- Objective non-contingency - something happens that is objectively out of your control, e.g. coach abusing you
- Negative perception of non-contingency - as expected you see this as a bad thing, anyone would
- Attribution to the non-contingency - problem comes in here as you attribute the reason for this act as your fault
- Expectation of future non-contingency - you expect this to happen again and again, as it is because of who you are. You cant change it so you’re helpless
- Depression
What are the limitations of cognitive theories?
ethics?
X - can never validate these models as showing cause and effect, because it’s unethical to follow them and give someone depression
X - are cognitive symptoms the cause of depression? Or are they caused by depression?
Briefly outline Monamine theories
- When you are depressed, you have less monamines in your brain/ synaptic gap
- E.g. serotonin, dopamine, norepinephrin
- Absorbed too much - by axon or dendrites
- SSRI’s can prevent this
Outline Didehbani et al., 2013 - did he head bangy
Found that NFL players with more than 2 concussions in there lifetime, were more likely to have abnormal levels of depression
X - cause and effect?
What are the different types of clinical interventions for MDD? ****
- Behaviour therapy
- Interpersonal psychotherapy
- CBT
Outline Behaviour therapy as an intervention for MDD
Focuses more on behaviour, less so on cognitions and mood
- says whatever behaviours make you feel less depressed - do them
- Activity logs
- Graded behavioural assingments - rate how high/ low something makes you, so you can avoid the bad stuff
- Social and problem solving skills training
Outline Interpersonal psychotherapy as an intervention for MDD
Made of two components:
- Interpersonal stuff - focuses on relationships
- Psychothreapy stuff - focuses on early experiences, often about unresolved grief
If: Unresolved grief, interpersonal relations, role changes are causing depression, this is a good therapy for you
Outline CBT as an intervention for MDD - 6 things
Recognising how cognitions influence behaviour
Techniques include:
•thought catching - help to recognise these negative/ biased thoughts, whcih are so deep in a persons cognitions that they dont notice them
•Task assingement (seperate card)
•Reality testing - comparing beliefs with an alternative version of reality
• Cognitive rehersal - help them develop strategies to overcome stuff they struggle with, Discuss barriers
•Alternative therapy - think of new problematic situations and see how they cope there
•Deal with underlying schema
Outline Task assingement as a strategy of CBT for MDD
If depression regularly occurs in certain places/ contexts, get that person to:
- Plan the next time they are in that context
- Predict - what they think will happen
- Engage - in the context, with your support
- Examine - look at how the depressive symptoms either didnt manifest, or were managed when they did
Outline drug treatments for MDD
All these drugs influence monoamines in the synaptic gap
- Tricyclic antidepressants (TCA’s) (Serotonin and Norepinephrine
- SSRI’s
- Serotonin-Norepinephrine reuptake inhibitors (SNRI’s)
- Monamine oxidase inhibitors (MAOI) - oxidase is an enzyme that breaks down monamine’s, this drug stops them doing it too much, slows them down
What treatment is best for Significant Dysfunctional beliefs? - schemas
IPT - interpersonal psychotherapy, as its about early events/ relationships and dysfunctional schemas
What treatment is best for severe interpersonal difficulties?
CBT!!!! - if you struggle in social situations, changing thoughts is effective
What treatment is best for low levels of depression?
CBT again
What is the effectiveness of CBT? **
66% - fewer, but a few side effects
What is effectives of TCA?
60-70% - but has lots of side effects
What evidence is there for Drugs and CBT combined?
No evidence that this works
