June 2022

The evidence behind mental health interventions in non-elite sport

Firstly, my apologies that The Review has been a little quiet of late. We are back to summarise an article that looks at the evidence base behind mental health interventions in non-elite sport – the kind of work that Opening Up does.

The article was published by Sutcliffe and colleagues in 2021 in the journal International Review of Sport and Exercise Psychology. It is entitled ‘Mental health interventions in non-elite sport: a systematic review and meta-analysis’ (link at the bottom of the page). Systematic reviews gather all the available evidence on a given topic and review the overall picture of the scientific literature. The meta analysis element statistically analyses the findings from all these studies to see if there is an overall effect. Combining multiple studies like this is seen as the highest level of evidence in science.

A first step in reviewing the evidence on whether an intervention is effective is to clearly define what it is trying to achieve. This article focused on interventions aimed at mental health and mental health literacy in non-elite sport. Mental health is defined by the world health organisation as:
‘A state of wellbeing in which the individual realises their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to society.’

Mental health literacy is defined by Jorm in the American Psychologist as: ‘Encompassing knowledge, attitudes, and help seeking practices in an effort to prevent, identify, and manage mental health problems and disorders.’

The article looked to analyse outcome measures in previous research related to these two different definitions. Depression, anxiety, stress, and wellbeing for mental health. Stigmatizing attitudes, knowledge, and help provisioning for mental health literacy. They found 19 studies of sufficient quality that met their criteria (only 1 from the UK).

Overall, the scientific evidence so far suggested that interventions in non-elite sport settings are particularly effective in enhancing mental health literacy. The biggest effects programmes had were in developing knowledge and help-provisioning. However, effects on mental health outcomes were smaller and sometimes absent. This is positive news for developing mental health literacy, but there remains work to do in improving the efficacy and quality of interventions to impact a broader range of outcomes, including those relating to mental health. The authors suggested that support provided in elite sport may be a useful template to develop support at lower levels. However, we must be considerate of the very real practical and financial limitations experience in non-elite sport.

Opening Up aren’t the only organisation aiming to improve and support mental health in sport. There are numerous other examples taking place around the world supported by charities, governing bodies, and academic projects. It is important that all of us aiming to do this are engaging in evidence-informed practice to ensure we are having the biggest possible effect on those we are working with. There has been a significant amount of work on supporting elite athletes. However, up until the publication from Sutcliffe and colleagues there had never been an effort to develop an overall picture of the effectiveness of interventions for us non-elites.

To contribute to this evidence base and develop our own work, we are hoping to start developing some research projects to investigate the impact of Opening Up sessions soon. In the meantime, if you have any questions, need access to any research, or want to talk about this article please feel free to reach out on @OliverRunswick on twitter or [email protected].

References

Jordan T. Sutcliffe, Scott Graupensperger, Matthew J. Schweickle, Simon M. Rice, Christian Swann &

Stewart A. Vella (2021) Mental health interventions in non-elite sport: a systematic review and
meta-analysis, International Review of Sport and Exercise Psychology,
https://doi.org/10.1080/1750984X.2021.2001839

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better
mental health. American Psychologist, 67(3), 231–243. https://doi.org/10.1037/a0025957

December 2021

Mental health support in professional cricket

Welcome back to The Review after a couple months off!

Here we are chatting to Dan Ogden who is currently undertaking a PhD at Loughborough University where he is investigating mental health in cricket. Dan tells us about his findings so far on experiences of mental health and mental health support in professional cricket. We discuss elements of his findings that can help inform our work across all levels of the game and hear about his future plans for research in the field.

August 2021

Developing self awareness and coping strategies

In this edition of the review I have the pleasure of talking to Dr Phoebe Sanders. Phoebe is the Sport Psychologist for England Women and talks to us about how she supports staff and players in preparing for COVID restricted environments and what that can teach us all about developing self-awareness and our own coping strategies

July 2021

‘It’s only failure if you don’t learn from it’. Understand performance and learning to be less hard on yourself!

Cricket is often a game characterised by ‘failure’ and this can make it a tough place to be. But… ‘It’s only failure if you don’t learn from it’ said Gareth Southgate in a press conference in June. It got me thinking about a common question we get at our Opening Up Cricket workshops – ‘how can I be less hard on myself about my cricket?’. Well in this article I will explain how understanding the way that performance and learning really work can help you to not only get better, but also learn to accept when things are not going well. ‘Failure’ is a vital part of improving!

Performance will always be variable

The graph below is some real data from some motor learning research I am doing (motor learning = learning a task involving moving). It’s a simple task involving navigating a mouse around a screen as fast as you can. The graph below shows the average time taken (less is better; vertical axis) by 150 participants and the number of attempts they made (along the bottom). The people who have done the task have improved over the 20 attempts (not just on average; every individual got better). You might say they have displayed some learning.

 Now look at the next graph below. This is exactly the same data but showing everyone’s individual attempts at the task rather than the average. Every line in this shows someone getting better overall (they are faster at the end than at the start), but they go up and down all over the place on the way! This is how the learning process always looks: messy!

Each attempt is a ‘performance’, and the way in which those performances change over time is ‘learning’. Accepting that the learning process is such a messy one is a great place to start. This task just involved moving a mouse around a screen, so imagine how much more complex bowling an inducker is!

Performance will vary from day to day. Accepting the inherent variability in performance is a great first step, no one will play well every week. Learning is different, it’s the more permanent changes in your performance over time. Working out where and why you went wrong with a performance (error processing) is a key part of this. You literally cannot get better without getting it wrong!

Error Processing

When errors occur, performers (you) identify discrepancies between the actual outcome and the desired goal and use this to improve subsequent performance. Now this does take a bit of effort. An error or failure on the day (or even in one delivery) leads to greater cognitive effort due to the additional processing that it takes. In short, getting things wrong can be tiring. But the good news is, the greater effort required to understand an error increases the likelihood that your performance will improve. It’s like going to the gym; it needs to be hard, and just like the gym, you get physical responses and changes from reflecting on your errors. So next time you play don’t berate yourself for a mistake, ask yourself what you did wrong (sometimes this is a very easy question to answer), but importantly, you also need to ask yourself, what am I going to do to improve on this next time? Rather than being down on the way you performed in the past; you now have a focus moving forward.

Now this can take some practice. The challenge here is to buy in to the longer-term process. You might have a string of bad games and this can really hit your confidence, but changing the way you frame these times and thinking about how you are getting better by getting things wrong can really help you to stop being hard on yourself and enjoy you’re cricket.

Some days you will get a hundred, some days you will get a duck, but if you think about why then…

You are not failing; you are getting better.

Broadbent, D. P., Causer, J., Williams, A. M., & Ford, P. R. (2017). The role of error processing in the contextual interference effect during the training of perceptual-cognitive skills. Journal of Experimental Psychology: Human Perception and Performance, 43(7), 1329-1342. http://dx.doi.org/10.1037/xhp0000375

Holroyd, C. B., & Coles, M. G. H. (2002). The neural basis of human error processing: Reinforcement learning, dopamine, and the error-related negativity. Psychological Review, 109(4), 679–709. https://doi.org/10.1037/0033-295X.109.4.679

Understanding your values, the things that are really important to you, is part of an approach called ‘Acceptance and Commitment Therapy’ or ACT (as in the word not the acronym). You will hear a lot about ACT across the review; many leading sport psychologists (including in cricket) find it a useful approach to supporting both performance and wellbeing.

The central premise of ACT is that we don’t need to change what we think and how we feel, or judge whether those thoughts and feelings are ‘good’ or ‘bad’, but to understand how we can do things that are important to us (whether that’s performing or spending time with friends and family) even when we feel uncomfortable.

Experiencing a range of different thoughts and feelings is part of what makes us human, but often we try and fight the uncomfortable ones to try and change or get rid of them . While it can sometimes be useful to try and challenge certain patterns of thinking, this can be difficult and takes a lot of energy. ACT takes a different approach. We learn to accept that we have uncomfortable thoughts, but instead of trying to change them, we learn to accept them and expend our effort working towards our values instead of changing our thoughts (this is called psychological flexibility).

You can think about your values as being your ultimate ‘why’. Who is the person you really want to be? Why is it really that you play cricket? What is underneath the performance goals you set yourself? Think about it as peeling back the layers to explore what really keeps you coming back every week. It can be hard to get to the bottom of these questions, but if you can it can really help you enjoy your return to the game.

In the 2019 paper ‘The Values Compass: Helping Athletes Act in Accordance With Their Values Through Functional Analysis’ in the Journal of Sport Psychology in Action, Kristoffer Henriksen discusses a seven step approach to help navigate difficult situations. First you need to think about your values. Think about the questions above. Maybe you think you play cricket because you want to perform well, or because you want to spend time with your teammates. Then ask yourself, well why is it that I want to score runs? Why do I want to spend time with teammates? Keep on digging and asking why as many times as you can until you get to the very bottom! Once you have a clear picture of what is really important to you as a cricketer, you can choose to behave in a way that moves you closer to this. This might involve exploring what would make match day meaningful in addition to runs and wickets, and making sure you pay attention to those things.

In Heriksen’s paper, the second step occurs when you encounter a difficult situation. More than once in my life I’ve driven for an hour to get to a game and chipped the first ball of the match to cover… this causes certain uncomfortable thoughts (step 3)… ‘what a waste of a Saturday’ or ‘what a s**t sport’. At this stage, I encounter a fork in the road: I could either act in a values-driven way or an emotion-driven way. Acting in an emotionally driven way might involve an action (step 4; smash up the changing rooms) that offers some short-term relief (step 5), but it can have long-term negative consequences (step 6).

For example, my teammates don’t like it, or I learn a dysfunctional way of dealing with the disappointment that doesn’t align with my values or take me closer to the person I want to be. Going back to that fork in the road, I could accept the thought that I have wasted my Saturday, acknowledge that it’s normal to feel disappointed, and consider what I can do next that moves me closer to my ultimate why. Now, this might not give me the same short-term relief as smashing stuff, but it does give me the opportunity to move further towards a long-term goal to be the player and person I want to be (step 7).

Personally, I know that my real why is to have a positive impact on other people. That is why I work as a lecturer and am editing The Review! I can work towards these values after chipping the first ball to cover by going for a lap with my mates or supporting the rest of the team doing well.

If you would like to read more about the topics we cover, I will always include a couple academic papers to read the end of the content on here. Get in touch if you struggle for access and I can help.

Ollie

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Steven C. Hayes, Jason B. Luoma, Frank W. Bond, Akihiko Masuda, Jason Lillis. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy. Volume 44, Issue 1, Pages 1-25. https://doi.org/10.1016/j.brat.2005.06.006

Kristoffer Henriksen (2019) The Values Compass: Helping Athletes Act in Accordance With Their Values Through Functional Analysis, Journal of Sport Psychology in Action, 10:4, 199-207, https://doi.org/10.1080/21520704.2018.1549637