ROUTLEDGE HANDBOOK OF MENTAL HEALTH IN ELITE SPORT Mental health is a rapidly increasing topic in the field of sport psychology. As the relevance of athletes’ mental health has come to prominence through emerging research, there is a high demand for evidence- based practice in order to promote athletes’ mental health and prevent mental disorders as well as maladaptive syndromes. However, there is currently no comprehensive overview available that highlights the empirical evidence for the constructs of mental health, illustrating the latest developments in research, or that highlights implications for future science and practice. The Routledge Handbook of Mental Health in Elite Sports delivers such an understanding and overview for this field, offering students, researchers, mental health professionals, applied sport psychologists, and coaches a state-of-the-art and insightful summary of science in the newly emerged field of clinical sport psychology and mental health in athletes. This thorough volume covers major current and emerging topics on mental health and mental illness (e.g., depression), subclinical syndromes (e.g., burnout), as well as a comprehensive overview of research on prevention (e.g., green exercise) and treatment of mental health disorders in athletes and will be a vital resource for researchers, academics, and students in the fields of sport psychology, clinical psychology, sport coaching, sport sciences, health psychology, and physical activity and related disciplines. Insa Nixdorf is a professor of psychology at the International University of Applied Sciences, Germany. Raphael Nixdorf is a professor of health psychology at the International University of Applied Sciences, Germany. Jürgen Beckmann is a professor, Emeritus of Excellence, at Technical University of Munich, School of Medicine and Health, Munich, Germany; Honorary professor, School of Human Movement and Nutrition Sciences at the University of Queensland, Australia; an Adjunct Professor Dept. of Physical Education and Sport Sciences at the University of Limerick, Ireland. Scott B. Martin is a professor of performance psychology and Director of the Psychosocial Aspects of Sport and Exercise program at the University of North Texas, USA. Tadhg MacIntyre is an assistant professor at the Department of Psychology, Maynooth University, Ireland. ROUTLEDGE HANDBOOK OF MENTAL HEALTH IN ELITE SPORT Edited by Insa Nixdorf, Raphael Nixdorf, Jürgen Beckmann, Scott B. Martin, and Tadhg MacIntyre Designed cover image: © Getty Images First published 2023 by Routledge 605 Third Avenue, New York, NY 10158 and by Routledge 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 selection and editorial matter, Insa Nixdorf, Raphael Nixdorf, Jürgen Beckmann, Scott B. Martin, and Tadhg MacIntyre; individual chapters, the contributors The right of Insa Nixdorf, Raphael Nixdorf, Jürgen Beckmann, Scott B. Martin, and Tadhg MacIntyre to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. ISBN: 978-0-367-56786-6 (hbk) ISBN: 978-0-367-56788-0 (pbk) ISBN: 978-1-003-09934-5 (ebk) DOI: 10.4324/9781003099345 Typeset in Bembo by MPS Limited, Dehradun CONTENTS List of figures viii List of tables ix List of contributors x SECTION A Mental Health 1 Introduction to the Section 2 Tadhg MacIntyre 1 Mental Health in Athletes 3 Insa Nixdorf, Raphael Nixdorf, and Tadhg MacIntyre 2 Thriving in Elite Athletes 12 Lauren K. McHenry and Rebecca A. Zakrajsek 3 Meaning and Meaninglessness in Elite Sport 31 Jürgen Beckmann 4 Resilience and Mental Health in Competitive Sport: A Narrative Review of the Literature 45 Christopher Bryan, Jolan Kegelaers, and Mustafa Sarkar 5 The Social Network and the Coach 62 J.D. DeFreese and Christine M. Habeeb v Contents SECTION B Mental Illness 81 Introduction to the Section 82 Scott B. Martin 6 Depression in Elite Athletes 83 Insa Nixdorf and Raphael Nixdorf 7 Recognition, Prevention, and Treatment of Disordered Eating and Body Dissatisfaction in Athletes 99 Cami A. Barnes, Keely N. Hayden, and Scott B. Martin 8 Addiction (Drugs and Gambling) Disorders in Athletes 121 Claudia L. Reardon and Ryan Benoy 9 The Role of Executive Functions in Elite Athletes’ Mental Health 130 Robert S. Vaughan, Jack Brimmell, and Bjoern Krenn 10 Personality Disorders in Elite Athletes 144 Christopher M. Bader and LaTisha L. Bader 11 Anxiety Disorders Among Elite Athletes 159 Courtney C. Walton, Simon Rice, Lisa Olive, Claudia L. Reardon, and Rosemary Purcell SECTION C Subclinical and Related Challenges 175 Introduction to the Section 176 Insa Nixdorf and Raphael Nixdorf 12 Reducing Burnout in Athletes 177 Daniel J. Madigan, Henrik Gustafsson, and Luke F. Olsson 13 Depression, Athlete Burnout, and Overtraining: A Review of Similarities and Differences 188 Raphael Nixdorf, Daniel J. Madigan, Göran Kenttä, and Peter Hassmén 14 Concussion, in Athletes 201 Jingzhen Yang, Robyn Recker, and Lindsay Sullivan 15 Fear and Anxiety in Elite Sport 226 Felix Ehrlenspiel, V. Vanessa Wergin, and Jürgen Beckmann vi Contents 16 Stress in Elite Sport 244 Jennifer A. Hobson, Martin J. Turner, and Marc V. Jones 17 Stigmatisation of Mental Illness and Seeking Sport Psychology Services 267 Rebecca A. Zakrajsek, Scott B. Martin, Shane R. Thomson, and Amelia Gulliver 18 Career Transitions in Sport 287 Robert Morris, Pete Coffee, Hee Jung Hong, Chris Hartley, and Nina Verma 19 Doping and Drug Misuse in Elite Sport 300 Claudia L. Reardon and Ryan Benoy SECTION D Application and Care 311 Introduction to the Section 312 Jürgen Beckmann 20 Professional Considerations for the Clinician 313 Jack C. Watson II, Matthew Gonzalez, Brandonn Harris, and Valerie Wayda 21 Psychotherapeutic Applications in Elite Sport: Promoting Mental Health Among Athletes 329 Mark A. Stillman, Hudson Farmer, and Ira D. Glick 22 Recovery as the Centrepiece for Mental Health Promotion in Elite Athletes 339 Jahan Heidari and Michael Kellmann 23 Injury Prevention and Rehabilitation 349 Rebecca A. Zakrajsek, Alexander G. Bianco, Taylor B. Casey, Keely N. Hayden, and Scott B. Martin 24 Nature-Based Interventions in Elite Sport 374 Tadhg MacIntyre, Carina Nigg, Cassandra Murphy, and Violetta Oblinger-Peters 25 Young Athletes’ Mental Health and Well-Being 389 Rosemary Purcell, Courtney Campbell Walton, Alan Currie, and Simon Rice Index 406 vii LIST OF FIGURES 1.1 Dimensional Approach to Mental Health According to Schinke et al., 2018 4 1.2 Two-Dimensional Model of Mental Health According to Keyes (2002) 5 2.1 A Comprehensive Humanistic Model for Thriving Through Being in Elite Sport. (Adapted from Brown et al., 2017a; Rogers, 1959; Ryan & Deci, 2017; McHenry, 2021; McHenry et al., 2022.) 17 6.1 A Vulnerability-Stress Model for Athletes by Nixdorf & Nixdorf (2022) 88 7.1 Biopsychosocial Intervention and Observation of Disordered Eating (BIODE) 101 11.1 Manifestations of Anxiety as Experienced by Elite Athletes 165 11.2 Factors Influencing Anxiety among Elite Athletes. (Adapted from Reported Findings of Reardon et al. 2021 and Rice et al. 2019.) 166 13.1 A Model of Overtraining and Possible Consequences. (Adapted from Kenttä, 2001.) 191 13.2 An Integrative Model of Depression, Burnout, and Overtraining Syndrome. (Figure available from Nixdorf & Nixdorf, 2022 under a CC-BY4.0 license at https://osf.io/426rc.) 195 14.1 Post-Concussion Anxiety and Mood Mechanisms Model. (Adapted from Sandel et al., 2017.) 208 15.1 Anxiety in Elite Sport Revolves Mainly Around the Themes of Competition (“Competitive Anxiety”), Injury (“Injury Anxiety”), and of Presentation of Physical Attributes (“Social Physique Anxiety”). (Figure Available Under a CC-BY4.0 License at osf.io/et3b2/.) 228 16.1 Processes Within the TCTSA-R and How They Might Relate to Mental Health Outcomes. (Adapted from Meijen et al., 2020.) 247 17.1 Stigmatisation of Mental Health and Sport Psychology Ecological Model. (Modified from Javed et al., 2021.) 268 17.2 Multidimensional Model of Sport Psychology Service Provision-Revised (M2SP2-R) 271 23.1 Biopsychosocial Intervention and Observation Team Approach (BIOTA) 351 23.2 Ecological Model: Inter-professional Team – Spokes of the Wheel. (Adapted from Bader & Martin, 2019.) 352 23.3 iTeam Checklist 355 23.4 Interprofessional – Therapeutic, Evaluation, Appraisal, & Management (I-TEAM) Process 362 24.1 Hypothesised Modes of Nature Contact with Recommendations for Athletes 377 24.2 Hypothesised Effects of Nature-Based Therapies for Athletes 378 24.3 Examples of Indoor and Outdoor Sport Across Different Settings 381 viii LIST OF TABLES 4.1 Studies of Resilience and Mental Health 48 6.1 Symptoms of Depressive Episodes 84 7.1 Assessment Inventory of Disordered Eating Determinants (AIDED) 103 7.2 Healthy Eating and Actions for Lifetime Happiness (HEALTH) Guidelines 114 10.1 Names and Characteristics of the Personality Disorders (PD) 149 11.1 Overview of Key Anxiety Disorders 160 12.1 Meta-Analyses Examining Randomised Controlled Interventions to Reduce Burnout 181 13.1 The Different Stages Described by Meeusen et al. (2013) 190 13.2 Comparison of Symptoms of Depression, Athlete Burnout and Overtraining Syndrome 193 13.3 Summary of Symptom and Conceptual Similarities and Differences Between Depression, Burnout, and Overtraining in Athletes 197 16.1 Key Terms and Definitions 245 22.1 Guidelines for the Establishment of a Monitoring System in the Context of Sport 345 23.1 Key Biopsychosocial Determinants, Potential iTeam Members, and Optimal Athlete Outcomes Pre- and Post-Injury 368 24.1 Recommendations for a Sample of Sporting Activities 382 ix