Sport Psychology : Psychologic Issues and Applications

Phys Med Rehabil Clin N Am
17 (2006) 519–535
Sport Psychology: Psychologic Issues
and Applications
Christopher M. Carr, PhD, HSPP*
Methodist Sports Medicine Center, 201 Pennsylvania Parkway, Suite 200,
Indianapolis, IN 46280, USA
The ?eld of sport and exercise psychology explores the relation between
psychologic factors and optimal performance. Sport psychology is slowly
becoming an integral aspect of the holistic care of sports medicine and phys-
ical rehabilitation patients. The physician specialist should have some
knowledge regarding the various facets of sport and performance psychol-
ogy, because many of these skills are relevant to the care and management
of an athletic population. For purposes of this article, the areas of ‘‘sport’’
and ‘‘performance’’ psychology are discussed, because many sports medi-
cine and physical rehabilitation professionals ?nd their practices expanding
into other performance arenas.
Performance psychology is used in this article to represent the various
environments under which mental skills enhancement can be useful. Sport
psychology represents the use of mental skills training within the sport
and exercise domain. The author has found that many of the techniques
he uses with elite athletes have had comparable success with elite musicians,
actors, and dancers. Therefore, the skills that are addressed in this article,
although related to the sport environment, may be helpful for various forms
of performance. In fact, the author carried the title of ‘‘Performance Psy-
chologist’’ for one of the professional sports teams for which he once con-
sulted; this allowed him to expand the role of psychologic consultation
within his contracted position. The physical medicine and rehabilitation
professional can bene?t his or her understanding of the diversity of perfor-
mance issues and problems that may a?ect patients by the material pre-
sented in this article.
* Department of Neuropsychology, Indiana Neuroscience Institute, 8333 Naab Road,
Suite 270, Indianapolis, IN 46260.
E-mail address: cmcarr@stvincent.org
1047-9651/06/$ - see front matter Ó 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.pmr.2006.05.007
pmr.theclinics.com

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Topics addressed in this article include a brief review of the history and
current issues of sport psychology, a quick summary of ‘‘mental skills’’
training techniques, and a discussion of speci?c performance concerns re-
lated to the injured athlete. The author summarizes by presenting a ‘‘model’’
of psychologic practice within a sports medicine setting in which he cur-
rently functions. If a physical medicine professional is to establish a ‘‘holis-
tic’’ philosophy of care, the understanding of underlying psychologic
processes, along with a model of care, is necessary.
History and current issues
Sport psychology dates back to the turn of the twentieth century [1]. It is
a relatively young discipline, yet it has a history unappreciated by most cli-
nicians. This history is patchy at best, with roots in applied and academic
sport psychology, which are primarily housed in departments of physical
education and kinesiology. Rarely is sport psychology recognized as a spe-
cialty within psychology departments.
In the late 1800s and early 1900s, sport psychology had its beginning. It
was Norman Triplett, who conducted the ?rst experiment in sport psychol-
ogy in 1897 by investigating the performance of cyclists. After ?nding that
young children performed better on a rote motor task in the presence of
other children, he concluded that cyclists would usually perform better in
the presence of other cyclists. Other studies taking place at about the
same time included looking at motor behavior by exploring an individual’s
reaction times as well how personality development was in?uenced by sport.
None of these experiments and studies, however, were directly applied to
athletes or sporting realms [1].
Since the United States Olympic Committee (USOC) hired their ?rst full-
time sport psychologist in 1985, the applied realm of sport psychology has
continued to grow tremendously (the USOC now has four full-time licensed
psychologists representing their Sport Psychology Department within the
Division of Sport Science). Journals within the area of sport psychology be-
gan to be published. Division 47 (Exercise and Sport Psychology) in the
American Psychological Association (APA) was established, recognizing,
for the ?rst time in history, the uniqueness o?ered to the ?eld of psychology
in sport. In addition, the 1988 Olympic Games were the ?rst time that teams
were accompanied to the games by a sport psychologist. Other advance-
ments in the ?eld include the establishment of the Association for the Ad-
vancement of Applied Sport Psychology (AAASP) in 1986 and the
beginning of the Journal of Sport Psychology in 1979. In 1991, as a way
to advance this burgeoning ?eld further, the AAASP established criteria
designating a ‘‘certi?ed consultant’’ in the ?eld of sport psychology as
a way to improve the clarity and understanding of a sport psychologist.
More recently, Division 47 of the APA has begun to establish a ‘‘pro?-
ciency’’ document for members to help guide the unique training standards

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SPORT PSYCHOLOGY
521
(eg, education, training, supervision) that a psychologist would be wise
to undertake to practice in the ?eld of applied sport and performance
psychology.
The applied realm of sport psychology has been growing rapidly in use
and popularity since the 1990s. This use, however, has not been limited to
elite athletes, such as those represented at the Olympic Games. Applied
sport psychology is ?nding use not only at the Olympic and professional
levels but at the collegiate, high school, and youth levels. Many well-known
professional athletes in football, baseball, basketball, and golf have been
sharing their beliefs that sport psychology enhances performance, along
with physical and technical skills. Some collegiate athletic departments
now employ full-time psychologists for their student-athletes. The amount
of requests for sport psychology services at high school and elementary
school levels and youth camps has grown tremendously in recent years.
Applied sport psychology covers all sports, not just the more visible ones,
such as football, baseball, and basketball. Sport psychology is being used
and sought after in motor racing, mountain biking, rowing, soccer, and ri?e
and pistol shooting to name just a few. Many physicians, attorneys, and cor-
porate executives are requesting that sport psychology principles be applied
to the ‘‘performances’’ in their respective settings. The author also devel-
oped and implemented a performance psychology education and inter-
vention program with one of the US Armed Services o?cer candidate
training schools; initial results demonstrated enhanced performance in mil-
itary ‘‘skills’’ applications with the use of performance psychology skills.
The applied possibilities in performance psychology seem almost endless.
Recent growth in the area of ‘‘positive psychology’’ has heightened aware-
ness of the unique contribution of applied sport and performance psychol-
ogy techniques.
Although the ?eld has come far in the last 15 years, especially in the area
of applied sport psychology, it has not been without its controversies. Prob-
ably the largest debate in the ?eld of sport psychology involves the question
of what is a ‘‘sport psychologist’’ and who is able to identify themselves as
such. Two primary groups identify themselves as sport psychologists, one
from the academic side and the other from the applied side. There exist
the academicians and researchers in exercise and sport psychology and phys-
ical education who identify themselves as such and are concerned with how
an athlete can increase speed, motor control, or other physical capabilities
to enhance performance. The sport psychologist in applied settings, con-
versely, has typically been concerned with the mental and emotional well-
being of the athlete and uses psychologic theory and concepts in the sport
world.
A special note must be made at this point. Individuals do exist who iden-
tify themselves as sport psychologists and have had little or no training in
psychology or little or no training in exercise science. Who are these individ-
uals? Some of these individuals are persons who have coached a child’s

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basketball team, played tennis most of their life, or solely have a subscription
to Sports Illustrated. Consumers and clinicians must be aware of people
who identify themselves as sport psychologists but have little or no formal
training. Because of the popularity of sport and the money and prestige sur-
rounding it, it is quite seductive for people to attach themselves to an area
?lled with such glamour. The organizations within sport psychology are cur-
rently trying to re?ne the requirements of being a sport psychologist, and the
author of this article later discusses what he believes to be the criteria for
identifying oneself as a sport psychologist. Because most readers of this pub-
lication are physical medicine physicians or sports medicine professionals, it
should be recognized that a referral made to a nonlicensed sport psycholo-
gist may be an inappropriate referral. In this growing ?eld, it is important to
ask the referral specialist about his or her licensure status (is he or she a
‘‘licensed’’ psychologist) and training in the ?eld of sport psychology
(competency).
In 1991, the AAASP did identify requirements of being a ‘‘certi?ed con-
sultant’’ in the ?eld of sport psychology as a step toward clarifying the train-
ing required to be a sport psychologist. Murphy [2] summarizes the criteria
as follows:
1. A doctoral degree
2. Knowledge of scienti?c and professional ethics and standards
3. Three courses in sport psychology
4. Courses in biomechanics or exercise physiology
5. Courses in the historical, philosophic, social, or motor behavior bases
of sport
6. Coursework in pathology and its assessment
7. Training in counseling (eg, coursework, supervised practice)
8. Supervised experience with a quali?ed person in sport psychology
9. Knowledge of skills and techniques in sport or exercise
10. Courses in research design, statistics, and psychologic assessment
11. Knowledge of the biologic bases of behavior
12. Knowledge of the cognitive-a?ective bases of behavior
13. Knowledge of the social bases of behavior
14. Knowledge of individual behavior
Although these criteria are a step in the right direction, further work is
necessary. These criteria are still somewhat vague and, unfortunately, carry
disagreement among the ?eld. The question still remains as to what consti-
tutes a quali?ed and competent sport psychologist. The Exercise and Sport
Psychology (Division 47) group within the APA has recently advanced
a document that highlights a pro?ciency in applied sport psychology for
APA members. This author would argue that an academic sport psychology
professional would best refer to his or her applied work as a ‘‘mental train-
ing consultant’’ rather than any form of ‘‘psychologist’’ (a title requiring li-
censure in most states). Additionally, the author would argue that a licensed

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clinical or counseling psychologist who identi?es himself or herself as
a ‘‘sport’’ psychologist should be able to demonstrate competency in the
area of sport and performance psychology. This competency could be de-
?ned by academic preparation, training, supervision, and experience in
working within sport and performance psychology domains.
This brief history and review of current professional issues in sport psy-
chology should assist the physical medicine professional in making appro-
priate referrals or including psychologic services in a holistic physical
medicine and rehabilitation practice. By acknowledging the ‘‘growing
pains’’ of an ever-evolving ?eld, the further professionalism of the ?eld
can be advanced.
Mental skills in sport
This section covers some of the ‘‘basic’’ psychologic skills that are used
with mental training and performance enhancement. This overview high-
lights some of the speci?c psychologic skills that enhance con?dence, com-
posure, and focus (attention) in individuals who use these skills.
Many coaches and athletes attempt to put in more physical practice to
correct mistakes made during competition. The mistakes, however, are at-
tributable to mental breakdowns many times as opposed to physical or tech-
nical ones. The athletes actually need to practice mental rather than physical
skills. In the same way, physicians working in sports medicine or physical
medicine facilities or with athletes sometimes forget or do not realize how
mental skills can be used in their work.
Even though coaches, athletes, and sports medicine physicians agree that
more than 80% of the mistakes made in sport are mental, they still do not
attempt to learn or teach mental skills that can assist athletes on the ?eld or
during rehabilitation (C. Carr, PhD, HSPP, T. Kays, unpublished data
1997). First, sports medicine and other physicians’ lack of knowledge about
mental skills prevents them from using these mental skills in their work with
athletes (as patients). Even though physicians may tell their athletes to ‘‘just
relax’’ as they go through rehabilitation of an injury, they do not provide
them with the knowledge of how to do so. Second, mental skills in sport
are often viewed as part of an individual’s personality and something that
cannot be taught. Many physicians believe that injured athletes have or
do not have the mental toughness to progress through rehabilitation. Men-
tal skills can be learned. Injured Olympic athletes report practicing mental
training on a daily basis. Furthermore, not only can these skills be learned,
but they do not require an excessive amount of time, another reason why
physicians working with athletes neglect mental training (ie, reporting not
having enough time).
The following section brie?y discusses some of the mental skills necessary
for athletes to improve their chances of optimal performance in their sports,
whether on the ?eld or in the training room. These skills are the basics, and

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much more depth and detail than this article allows are needed to explain
and understand the power of the mind in sport completely.
Goal setting
Goal setting is one of the primary mental skills used by athletes. In fact,
this skill is helpful and even necessary to develop other mental skills. Csiks-
zentmihalyi [3] discusses goal setting as one of the necessary components of
achieving a ‘‘?ow’’ experience. He describes ?ow as an experience in which
a person achieves peak performance. Other expressions used for this ?ow ex-
perience include ‘‘in the zone,’’ ‘‘autopilot,’’ and ‘‘playing unconscious.’’
It is not typically a problem to get athletes to identify goals. The di?culty
comes in trying to help athletes set the right kind of goals: ones that provide
direction, increase motivation, and guide them to achieving optimal perfor-
mance. Athletes, and most people for that matter, do not need to be con-
vinced that goals are important. They do, however, need instruction on
setting good goals and a program that works to achieve them. This type
of skill development is essential in physical medicine, where speci?c inter-
ventions are used to enhance functioning in the injured or rehabilitative
patient.
It is demonstrated in empiric research that goal setting can enhance re-
covery from injury [4]. The research also demonstrates that certain types
of goals are most e?ective in helping athletes achieve these goals. Several
goal-setting principles that provide a strong base to building a solid goal-set-
ting program have been identi?ed:
1. Set speci?c goals.
2. Set challenging but realistic goals.
3. Set long- and short-term goals.
4. Set performance goals.
5. Write down goals.
6. Develop goal-achievement strategies.
7. Provide goal support.
8. Evaluate goal achievement.
Set speci?c goals
Research illustrates that setting speci?c goals produces higher levels of
performance than planning no goals at all or goals that are too broad [5].
Yet, many times, physicians tell patients to ‘‘do their best’’ or ‘‘give every-
thing you have’’ regarding their recovery. Although these goals are admira-
ble, they are not speci?c and do not help athletes to move toward optimal
performance. Goal setting needs to be measurable and stated in behavioral
terms. Instead of an athlete setting his or her goal to ‘‘get better,’’ physicians
can help these injured athletes to set a more appropriate goal, such as ‘‘in-
creasing leg press weight by 25% over the next 2 weeks.’’

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Set realistic but challenging goals
The research indicates that goals should be challenging and di?cult yet
attainable [6]. Goals that are too easy do not present a challenge, and
thus can lead to less than maximal e?ort. Goals that are too di?cult lead
to failure many times, which results in frustration. This frustration leads
to lower morale and motivation. Somewhere between these two extremes
are challenging and realistic goals.
Set long- and short-term goals
Many times, injured athletes discuss a long-term goal of returning to play
after a serious injury. This goal is necessary and provides the ?nal destina-
tion for the athletes. It is important, however, for physicians to help them
focus on short-term goals as a way in which to attain long-term goals.
For example, a physician can make certain that an injured athlete sets daily
and weekly goals in the rehabilitation process. One way to use this principle
is to picture a staircase with the end or long-term goal at the top of the stair-
case, the present level of performance at the base of the stairs, and the short-
term goals as the steps between.
Set performance goals
It is important for physical medicine physicians to assist patients in set-
ting goals related to performance ‘‘process’’ rather than outcomes, such as
returning to play. Murphy discusses ‘‘action goals’’ versus ‘‘result goals’’
as being extremely important and often missed by physicians [7]. With ac-
tion-focused goals, athletes concentrate their energies on the ‘‘actions’’ of
a task as opposed to the ‘‘outcome.’’ Action goals give focus to the task
at hand, are under the athlete’s control, and produce con?dence and concen-
tration. Result-focused goals, however, are not productive and often lead to
slower recovery. These types of goals give focus to irrelevant factors and
things outside the control of the athlete, and they tend to produce anxiety
and tension. For example, if a collegiate tennis player is working back after
a serious shoulder injury, physicians can help him or her by setting action
goals, such as lifting a certain weight or obtaining a certain degree of ?exi-
bility, that lead to the outcome, full recovery.
Write down goals
Sport psychologists have recommended that goals be written down and
placed where they can be easily seen on a daily basis [7,8]. Athletes may
choose to write them on index cards and place them in their locker, locker
room, or bedroom. Many times, physicians and athletes spend much time
with goal-setting strategies only to see them end up discarded in some
drawer. The manner in which goals are recorded is varied, but the important
fact is that they remain visible and available to athletes on a daily basis.

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Develop goal-achievement strategies
This aspect of goal setting is often neglected, because goals are set with-
out appropriate strategies to achieve them. An analogy to this faulty process
is taking a trip from Indianapolis to San Jose without having a map. It takes
one much longer to reach the ?nal destination without a map. For example,
physicians may encounter a patient with frequent ?u-like symptoms. This
patient needs to use appropriate strategies that can assist him or her in re-
ducing the frequency of these symptoms, such as working on improving nu-
trition, sleep hygiene, stress management, or time management.
Provide goal support
Research in the sport psychology literature has demonstrated the vital
importance that signi?cant others play in helping athletes to achieve goals
[9]. In fact, it has been shown that exercise adherence is strongly a?ected
by spousal support [10]. Physical medicine physicians need to enlist the sup-
port and help of parents, faculty, friends, and others to help athletes focus
on the actions required to achieve success (ie, returning to play).
Evaluate goal achievement
Evaluating progress toward goals is one of the most important aspects of
goal setting; yet, it is frequently overlooked. Injured athletes may spend con-
siderable time in setting goals and devising programs, but this activity is for
naught if they do not regularly monitor their progress in achieving these
goals. To draw an analogy from philosophy, just as an unexamined life is
not worth living, unexamined goal setting is not worth doing.
Arousal control
What is arousal control?
Have you ever watched the National Collegiate Athletic Association
(NCAA) basketball ?nals and wondered how a player can make a free
throw or last second shot with thousands of people screaming and millions
of people watching on television? If you are like most, we wonder in amaze-
ment at how athletes are able to remain calm during such times of high
pressure and anxiety. The fact is, however, that these athletes are actually
nervous; they do have ‘‘butter?ies’’ in their stomach. The skill, however,
that they have developed is to use this anxiety as a way to perform their
best, to make the butter?ies ‘‘?y in formation,’’ so to speak. Similarly,
when athletes become injured, they typically experience a?ective, somatic,
and cognitive anxiety. They experience physical pain, lose their place in
the line-up, and are not able to perform at their best or participate in some-
thing that is a major part of their life and identity. Sports and physical med-
icine physicians, however, can help the athletes learn to use the anxiety
surrounding their injury as way to help them recover quicker.

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The theories of arousal regulation are many but too extensive for the cur-
rent article. For a review and more explicit detail of these theories, the
reader is referred to the article by Van Raalte and Brewer [11].
Arousal regulation techniques
Breathing. Perhaps the most simple yet most important technique to regu-
lating anxiety is breathing [12]. It is common for athletes to take short quick
breaths when confronted with a stressful event or situation, such as rehabil-
itating an injury. This action may result in the muscles becoming tense and
fatigued, both of which prevent optimal performance in recovery. Taking
slow deep breaths allows athletes to enable oxygen intake and reduce their
heart rate; both can assist them in recovery.
Muscle relaxation. One of the most potentially damaging aspects of anxiety
for athletes is muscle tension [13]. If an athlete’s muscles are tense, he or she
is not able to perform the kinesthetic tasks required by his or her sport or
rehabilitation process in a free-?owing and smooth manner. Therefore,
for athletes to perform their best, they must learn to relax their muscles.
If the muscles are not relaxed, the athlete’s movements are rigid, short,
and tight.
How do athletes learn to relax their muscles? Edmund Jacobson’s pro-
gressive muscle relaxation (PMR) technique laid the groundwork for most
current relaxation procedures. His technique and other similar ones allow
athletes to become aware of di?erent muscle groups, how they hold tension
in these areas, and also how to release this tension. Physical medicine phy-
sicians can be extremely helpful by teaching these patients to perform this
mental skill as a way of making their rehabilitation less painful and return
to play quicker.
Concentration and focus skills
Knowing what to focus on and when to focus on it are essential to opti-
mal athletic performance. Highly talented athletes often fail to achieve their
best performance not because of a lack of ability but because of an inability
to focus on the ‘‘cues’’ that are necessary for optimal performance. For ex-
ample, a baseball pitcher may be able to throw an excellent 85-mph slider in
his warm-up, but if he is unable to throw it in a game situation, he is not
likely to have optimal performance.
Concentration skills can be enhanced through the use of mental skills,
such as imagery, cognitive strategies, and attentional control strategies.
For purposes of this article, a brief review of these skills is presented.
Imagery
What is the mystery in imagery that has helped elite athletes, such as Jack
Nicklaus, Tiger Woods, and Greg Louganis, to compete so well? There is no

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mystery at all. Imagery is a human capacity that many people do not know
about or have chosen not to use. It is a skill that few athletes have developed
to its full potential or realized its possible applications.
Imagery is a process by which sensory experiences are stored in memory
and internally recalled and performed in the absence of external stimuli [7].
Furthermore, imagery is more than visualization and more than just the
sense of vision. To maximize its potential, imagery must be a multisensory
event, involving as many of the senses as possible, including the sense of
sound, touch, and movement.
Imagery has many uses for athletes, including regulating arousal level
and rehabilitation from injury [4,14]. Imagery is useful for coping with
pain and injury by speeding recovery as well as keeping athletic skills
from deteriorating. It is di?cult for athletes to go through an extended lay-
o?, but instead of feeling sorry for themselves, they can imagine doing prac-
tice skills and thereby facilitate recovery.
Cognitive strategies
Self-talk is one of several di?erent cognitive strategies in sport. It occurs
whenever an individual thinks, internally or externally. Sport psychologists
are concerned with the self-talk of athletes and how it in?uences their focus
and concentration, arousal level, and performance. In general, self-talk is
the conscious and subconscious dialog that occurs in the athlete’s mind be-
fore, during, and after competition. For example, a golfer hitting his driver
may incorporate the self-talk strategy of saying ‘‘head down, hips solid, fol-
low through’’ as the internal dialog before the execution of the swing. The
literature in this area is too extensive to cover in this article, but the prepon-
derance of research supports the hypothesis that positive self-talk creates
better or ‘‘no worse’’ performance.
Self-talk has a direct impact on our emotional experience. If athletes are
engaging in negative self-talk, their a?ective experience may be one of frus-
tration, anger, or extreme anxiety. These emotional states challenge breath-
ing, increase muscle tension, and create a loss of concentration and focus,
resulting in lower performance. If an athlete’s self-talk is positive and rele-
vant, however, the resulting emotional experience is one of relaxation, calm-
ness, and centeredness; as a result, the chances of good performance increase
dramatically. Physical medicine physicians can assist patients by teaching
and discussing positive self-talk and the di?erence it can make during the
rehabilitation process.
Attentional control strategies
Concentration. Concentration is the ability to focus all one’s attention on
the task at hand. For physicians and their athletes, concentration is being
able to direct all attention to the recovery process. When athletes experience
anxiety, however, maintaining attention on the task at hand becomes more

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Document Outline

• Sport Psychology: Psychologic Issues and Applications
  • History and current issues
  • Mental skills in sport
    • Goal setting
      • Set specific goals
      • Set realistic but challenging goals
      • Set long- and short-term goals
      • Set performance goals
      • Write down goals
      • Develop goal-achievement strategies
      • Provide goal support
      • Evaluate goal achievement
    • Arousal control
      • What is arousal control?
      • Arousal regulation techniques
        • Breathing
        • Muscle relaxation
    • Concentration and focus skills
      • Imagery
      • Cognitive strategies
      • Attentional control strategies
        • Concentration
        • Improving concentration skills
  • Psychologic factors with athletic injury
    • Point of injury and immediate postinjury response
    • Treatment decision and implementation
    • Early and late rehabilitative (after surgery)
    • Return to play
  • Sport psychology services within a sports medicine setting
  • Summary
  • References

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