Brinjh Mtdical BulUrin (1992) Vol.48, No. 2, pp. 615-629 O The Brmih Council 1992
Psychological stress, performance, and injury in sport L Hardy University of Wales, Bangor, Gtoynedd, UK
This paper reviews the empirical literature on psychological stress in sport, and the effects that such stress may have upon performance, vulnerability to injury, and rehabilitation from injury. It also examines the strategies that sports performers could use to overcome these effects. The major sources of stress that have been reported by sports performers include fear of failure, concerns about social evaluation by others (particularly the coach), lack of readiness to perform, and loss of internal control over one's environment. Various models and theories of the effects of such stress upon performance and vulnerability to injury are reviewed, including multidimensional anxiety theory and a catastrophe model of anxiety and performance. The cognitive and physiological processes which are thought to underly these effects are also reviewed, together with the intervention strategies that are implied by these processes. Research on the psychological stress that appears to be experienced by performers when they are injured is very limited. However, that which is available suggests that many of the same psychological skills that are thought to enhance performance can also be used to reduce the risk of injury, and promote a speedy recovery from injury. These include goal-setting, imagery, self-talk, and relaxation skills.
Psychological stress is clearly very much a part of modern sport.i It has even been suggested that coping with this pressure is the fundamental challenge of sport.2 This paper reviews the empirical literature on sources of psychological stress in sport, the effects
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that such stress may have upon the performance of sports people, their vulnerability to injury, and their rehabilitation from injury. The paper also examines the strategies that performers use in order to cope with this stress. A feature of the review is its focus upon the psychological processes that are thought to underly these phenomena as well as the implications of these processes for applied sport psychologists working with performers in the field. SOURCES OF PSYCHOLOGICAL STRESS One of the first explorations in this area was a factor analytic study by Kroll.3 This identified 5 categories of psychological stress that were experienced by adult sports performers. These were fear of failure (e.g. making a foolish mistake), feelings of inadequacy (e.g. getting tired), loss of internal control (e.g. unfair officials), guilt (e.g. hurting an opponent), and current physical state (e.g. sore muscles). Following on from this work, Gould and associates conducted a series of wrestling studies. The first of these4 confirmed the first 4 of Kroll's factors, and identified social evaluation as an additional source of stress in junior wrestlers. A second study of intercollegiate wrestlers also found worry about not wrestling well, improving on the last performance, what the coach will think or say, losing, performing up to ability, and the performer's physical condition to be the most frequently experienced sources of worry. However, only concerns about what the coach would think or say, losing, and making mistakes discriminated between successful and less successful performers.5 The latest of Gould and associates wrestling studies was an in-depth qualitative study of elite performers, which identified many of the same factors as sources of stress for wrestlers at the Olympic Games.6 These included readiness and performance problems, refereeing decisions and tournament organization, coach and team-mate influences, coaching and management decisions, social support, accommodation, transportation, food, and training facilities. Other studies of elite figure skaters,7 gymnasts,8 and runners9 have confirmed the generalizability of many of these findings across sports, and have also identified the costs and time demands involved in being an elite performer, and dealing with the media as other potential sources of stress. Finally, there is also some evidence to suggest that sources of stress may be different for men compared to women.10
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To summarize, whilst there exists considerable variation in sources of stress across individuals, the most commonly reported sources include fear of failure, making mistakes, concern about the expectations of others, poor preparatory training and physical state, the media and unforeseen events. The most obvious implication of these findings seems to be that performers must have total confidence in their goals, their organization's system, and their preparation for the event, if they are to have any chance of performing relatively stress-free. STRESS AND PERFORMANCE Although stress can be perceived as either challenging or anxiety inducing, the psychological literature on stress and performance has focused almost exclusively on the effects of anxiety upon performance. Components of anxiety At least two components of the anxiety response can be identified, a cognitive component characterised by fear of the consequences of failure, and a physiological component associated with the 'fight-flight' response.11'12 Some researchers consider the actual physiological response to be less important than the performer's perception of his or her physiological response.12 However, this remains a contentious issue since 'direct hit' effects for physiological arousal upon performance may be an important factor in some sports.13'14 Regardless of this distinction, it has been shown that the cognitive and physiological (perceived or actual) components of anxiety can be evoked by different stressors and follow different time courses prior to a competition. Cognitive anxiety may be elevated as much as two weeks before an important event, and generally remains fairly stable throughout the period leading up to the event. On the other hand, physiological arousal and its perception, somatic anxiety, tend to peak late and fast, much closer to the start of the event.12'14 Multidimensional anxiety theorists12 have argued that somatic anxiety (and, presumably, the associated physiological response) is a conditioned response to entering the performance environment which should therefore disappear once performance has commenced. They have also argued that because cognitive anxiety is principally concerned with the consequences of failure, it should
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change whenever the subjective probability of success changes. Based on these arguments, multidimensional anxiety theorists initially proposed that cognitive anxiety should be the primary influence upon performance, and that this influence should be a negative one. However, there is much evidence that physiological arousal continues to fluctuate throughout performance,15 and research findings have shown both somatic anxiety and physiological arousal to be important predictors of performance under stressful conditions.1416 In the light of these findings, the multidimensional anxiety theorists seem to have adjusted their position so that they predict a negative linear effect for cognitive anxiety, and an inverted-U shaped effect for somatic anxiety, upon performance.12 Other researchers 131417 have criticized multidimensional anxiety theory on several grounds. As well as the possibility that physiological arousal may score 'direct hit' effects upon performance which are not mediated by somatic anxiety, these criticisms also include the fact that multidimensional anxiety theory only makes predictions about the separate effects of cognitive anxiety and somatic anxiety upon performance when what is really required is an explanation of how cognitive and somatic anxiety interact to influence performance. Such criticisms led to the formulation of a catastrophe model of anxiety and performance which predicts that cognitive anxiety can have a facilitating or a debilitating effect upon performance, depending upon whether physiological arousal is low or high. The model also predicts that under conditions of high cognitive anxiety and high physiological arousal performance changes are likely to be large and catastrophic, rather than small and continuous. The model has received some empirical support.13'17 In their development of the multidimensional Competitive State Anxiety Inventory-2, Martens and associates12 identified a third factor, orthogonal to cognitive and somatic anxiety, which they labelled self-confidence. Self-confidence has been regularly identified as an important predictor of performance across a wide range of sports.18'19 Furthermore, Bandura's theory of how self-efficacy (i.e. situationally specific self-confidence) influences performance has now received considerable support in the literature,20 and has important implications for the preparation of sports performers.21 The extent to which self-efficacy and cognitive anxiety covary is the subject of some debate,22 but there is a growing body of research which suggests that they may best be considered as
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relatively independent constructs.23 The possibility has also been suggested that self-efficacy might provide some son of buffer against anxiety effects.17 Mechanisms underlying anxiety effects The precise means by which anxiety exerts its influence upon performance are not well-understood and a number of different theoretical positions can be identified in the literature,24 each of which has its own implications for applied intervention. One of the earliest of these was Easterbrook's cue utilization theory, which proposed that anxious performers selectively attend to cues that are central to the task to be performed. Initially, this 'narrowing' of attention rejects cues that are irrelevant to the task, and performance is improved. However, with continued narrowing relevant cues are also ignored, and performance is impaired. Subsequent research23 refined this position by identifying that the subjective importance of the cues was the crucial factor in selectivity, rather than their spatial location. The simplest implication of cue utilization theory is that performers should considerably overlearn skills so as to reduce the number of cues to which they must attend.26'27 Another implication is that they should be taught how to set process-oriented goals to help them to selectively attend to the most relevant cues.28 A rather different theory was proposed by Wine.29 He argued that anxious performers are distracted by their own self-generated negative thoughts, which therefore use up valuable information processing resources that should be allocated to the task. According to this position, physiological arousal should not be an important determinant of performance, unless performers are so physiologically aroused that they become pre-occupied with their own physiological state. One obvious implication of Wine's approach would seem to be to use dual task paradigms to train performers to cope with distractions that are extrinsic to their primary task.28 Another is the use of cognitive relaxation to quieten the distracting influence of negative self-talk.30 A variation on Wine's theory proposes that anxiety impairs performance by clogging up the organism's information processing channels with useless and disruptive information.31 According to this position, at least two distinct channels can be identified: a cognitive channel and a somatic channel. Furthermore, it is argued that such disruptive information is best removed by employing a relaxation
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strategy which engages the most-affected channel. This is the socalled 'matching hypothesis'. Baumeister32 proposed that anxiety exerts its influence by leading performers to try to consciously control performance, rather than simply 'letting it happen'. Although this theory has received relatively little experimental support, it does have some intuitive appeal and has received indirect support from much of the literature on peak performance.33 It has also been suggested that wellestablished pre-performance routines may help performers to get into an automatic state of functioning prior to performance.14 Hockey and Hamilton25 extended Easterbrook's work on attentional selectivity to include other aspects of the information processing system, such as subjects' ability to store and retrieve relevant information when performing under stress. Whilst Hockey and Hamilton employed laboratory stressors such as noise and sleep loss for most of their studies, this approach has also been used with performance anxiety and sports tasks.14 The most reliable findings so far obtained are that cognitive anxiety enhances the speed at which information can be transferred through the system. Conversely, physiological arousal impairs movement fluidity, manual dexterity and the systems ability to make decisions (i.e. working memory), but enhances anaerobic power.14'35 At least 3 implications can be found from this research. Information processing based match analysis systems could be developed to identify specific areas of vulnerability in performers, so that individualized training programmes could be coupled with processoriented goals to help performers focus their attention where it is needed.14'28 Dual task paradigms could be used to help performers learn how to make decisions under pressure.28 Mental rehearsal could be used prior to performing to help fine-tune the activation system, so that the available resources are allocated appropriately to the task.36 Eysenck24 proposed an interesting theory of anxiety and performance diat incorporated both motivational and information processing variables. In line with the above arguments, Eysenck identified that cognitive anxiety reduced the effective capacity of working memory by wasting resources on worry. However, he also argued that because anxious performers have a greater discrepancy between their current aspirations and their perceived ability,37 they will invest more effort in the task. Consequently, performance effectiveness may be maintained (or even enhanced) but at a reduced efficiency and a greater energetic cost to the
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system. Eventually, of course, this cost will become too great, the performer will give up, and performance will break down completely—essentially because 'the tough get going when the going gets tough' but 'wise men do not beat their heads against brick walls'.38 The implications of Eysenck's approach include the use of dual task paradigms to reduce working memory impairment,28 and goal-setting training39 or positive self-talk30 to control the goal discrepancy which anxious performers are hypothesized to have.
STRESS AND INJURY Stress as a cause of injury There seems to be little doubt (although no direct supporting evidence) that the majority of injuries are eventually precipitated by biomechanical, physiological or anatomical factors; for example, poor field conditions, bad technique, overtraining and tight muscles. However, from the perspective of this paper the final precipitation of injury is not really the crucial issue. The crucial issue is whether psychological stress can act as a catalyst which causes the precipitating variable(s) to come into play. Theoretically, there is every reason to believe that stress may be an important factor in injury, since any performance decrements that arise from having to perform under conditions of high stress could very easily increase the risk of accidental injury in a wide range of sports.40 The mechanisms which are thought to underly such decrements in performance have already been described. Initial research into psychosocial factors in sports injuries used two paradigms that had been previously used in research into disease prone personalities and personality factors in sport. Both of these paradigms have been extensively criticized in the literature; the former for using unvalidated measurement devices in retrospective designs with no control groups,41 and the latter for employing a 'shotgun' approach in retrospective designs with assessment tools that were principally designed to identify people in the extremes of the population distribution.42 Perhaps unsurprisingly, much of the early research into psychosocial factors in sports injuries also suffered from these same problems. Nevertheless, there does seem to be some evidence to support the view that tough-minded performers are less likely to get injured than tenderminded performers,43'44 possibly because they experience less
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anxiety when performing under stressful conditions. Similarly, there is also some evidence that high trait anxiety may lead to a greater risk of injury.45 With the advent of the interactionist (person x situation) approach to personality, researchers became more interested in the possibility that certain environmental factors might lead to increased stress in performers, and thereby an increased risk of injury. Early studies examining the effect of life change events upon the incidence of subsequent injury amongst American football players produced quite impressive differences in injury rates for groups of players who differed in their experience of life change events.46'47 However, these studies did not make any distinction between positive and negative life events, and when such a distinction was made in subsequent studies, the results became rather more equivocal, with some studies showing a relationship between negative life events and injury risk48 but others showing no such relationship.49'30 This state of affairs led researchers to examine some of the psychosocial variables that may moderate the stressful effects of negative life change events. The results from these studies have been very encouraging, and have implicated social support and coping skills as important variables that may moderate the effect of negative life events upon subsequent injury.51'52 The results of Smith and associates study51 are particularly interesting, as the interaction which they reported was such that performers who were low in both social support and coping skills were particularly vulnerable to stress related injuries from major negative life events. A clearer picture of the magnitude of this interaction can be gained by considering the fact that without the inclusion of any of their moderator variables the stress associated with major negative life events accounted for less than 1 % of the variance in subsequent injuries. However, when the interactive effects of social support and coping skills were included in their analysis, major negative life events accounted for 22% of the variance in injuries. Injury as a source of stress It is possible to conceive of two different types of stress associated with injury; the stress of being unable to perform, and the stress associated with 'coming back' from injury. The stress associated with being unable to perform has been likened to a grief response due to the loss of one's fitness and the negation of one's perform-
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ance goals.53'54 The stress associated with coming back from injury seems most likely to result from fear of having to perform the same tasks that caused the injury with a possibly weakened body. Despite the fact that anecdotal evidence suggests that this postrehabilitation stress is a major problem for many performers, the author could find no empirical studies that addressed the question. Fortunately, there is at least a small literature that addresses the stress of being unable to perform. It has been proposed that at least three stages can be identified in the grief response to being injured; protest, hopelessness, and reorganization.5355 According to this classification, the protest stage is characterized by denial of the injury, shock that it has occurred, and anger.54 Extreme emotionality is to be expected at this stage, and is thought to help the performer accept that the injury has occurred. The hopelessness stage of the grief response is thought to be brought about by the acceptance that the injury has occurred, and the realization that it cannot be reversed. During this stage, the performer is hypothesized to become socially detached, and preoccupied with all the things that they will not be able to do as a result of the injury. During the final reorganization stage of the injury, the performer is hypothesized to come to terms with their loss and restructure their life so that they can gradually return to their normal training. Although this model could be used as a logical basis for the development of intervention programmes for injured performers, it has yet to be empirically tested in the context of sports injuries. Borrowing from the literatures on adherence to health related exercise,56 psychoimmunology,57 and psychological factors in the progression of disease,58 Wiese and Weiss59 proposed a number of psychological skills that might help performers to adhere to a programme of rehabilitation and cope with the stress of being injured. These included: goal-setting to assist motivation; imagery and positive self-talk to enhance self-efficacy; relaxation to reduce worry and excessive muscle tension around the site of the injury; and communication skills to enable them to discuss their injury and rehabilitation with the medical support team. Wiese and Weiss also suggested that social support could help the performer maintain a positive attitude towards their injury, particularly if such support was given by other performers who had recovered from similar injuries. Of these skills, a qualitative study of physiotherapist's perceptions60 offered support for the view that goal-setting, positive self-talk, and good communication skills (including a
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willingness to listen to the medical support team) were important determinants of a performer's ability to cope with the stress of being injured. Furthermore, a retrospective study of speed of recovery from soft tissue injuries confirmed the importance of goal-setting, positive self-talk, and imagery.61 Clearly, this is an important area for future research. CONCLUSION: COPING STRATEGIES AND INTERVENTIONS This final section draws together the implications of the previous sections in order to highlight some of the psychological strategies and interventions that might be used to help performers maximize the benefits that they derive from their involvement in sport. During this discussion an attempt will be made to distinguish between those implications that are well-established, and those 'implications' that are perhaps better regarded as good educated guesses. Perhaps the most fundamental implication of this whole review comes from the first section on sources of stress. It is that if performers are to have any chance of performing relatively stressfree, then they must have total confidence in their goals, the organizational system, and their preparation for the event which confronts them. This conclusion echoes previous findings with elite performers,19'62 and could probably be used as a guiding principle for much intervention work. In this context, it is possible to present quite a strong argument that the reality of whether coaching and management teams actually make the best decisions is often less important than the performer's belief that the best decision has been made. In his theory of self-efficacy, Bandura20 identified four processes by which self-confidence could be acquired: previous experience of success; vicarious experience; verbalization; and interpretation of current physiological states. Interestingly, many of the psychological skills and strategies that have already been identified in the preceding sections of this review have also been shown to exert an influence upon these processes. For example, goal-setting skills essentially determine the probability, and therefore the experience, of success. However, during the course of the present review, it has also been suggested that goal-setting training has the potential to influence the motivation required to adhere to rehabilitation programmes,61 the goal-discrepancy experienced by anxious per-
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formers,39 and the maintenance of a clear focus of attention upon performance.28 This latter suggestion may be particularly important and worthy of further investigation, as several researchers have found clear focus of attention to be a major predictor of peak performance.19-2733'62 Similarly, imagery has been proposed as a means of gaining vicarious experience,63 but has also been identified as a way of fine-tuning the information processing system in readiness for performance,36 and enhancing the speed of rehabilitation from injury.61 Unfortunately, the precise means by which imagery might exert these effects are not well-understood. Positive self-talk can be used to make self-affirmations which are thought to enhance self-confidence,64 but has also been promoted as a means of restructuring cognitive anxiety30 and enhancing the speed of rehabilitation.61 Finally, relaxation strategies seem to be one way of influencing the interpretation of the current physiological state, as well as a means of controlling cognitive anxiety and physiological arousal.11-31 Furthermore, although several different theoretical perspectives have been highlighted in the present review regarding the effects of anxiety upon performance and vulnerability to injury, they all agree that excessive cognitive anxiety and physiological arousal are highly likely to have detrimental effects. Incidentally, although no one has conclusively demonstrated that cognitive and somatic anxiety are differentially reduced by cognitive and somatic relaxation strategies, many sport psychologists seem to believe that this is the case.12'65 If this were shown to be the case, then one obvious implication would seem to be that performers may need more than one relaxation strategy to cope with the different types of anxiety that they might experience. Several other strategies that have been implicated in this review are worthy of further attention. It was suggested that wellestablished pre-performance and performance routines might help performers to maintain their concentration by encouraging them to control performance at an automatic, rather than a conscious, level.34 Although the evidence which directly supports Baumeister's theory is weak, the evidence supporting the use of preperformance, performance, and re-focusing routines is very strong.27'34'62'66 It is also possible that such routines exert their influence via different processes; for example, as an effective relaxation strategy by filling the information processing channels with something constructive rather than negative. However, little evidence is available on this issue. Regardless of this, it does seem to
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be the case that just as physical routines must be overlearned if they are to be resilient to the effects of stress,27 so must mental routines be overlearned if they are to help performers to maintain performance when under stress.67 The use of simulation training in which certain aspects of the competitive environment are replicated during practice has been described in both practical27'62 and theoretical14 studies of stress and performance. It has been argued14 that such training should desensitize performers to many potential distractions, including bad refereeing decisions, 'niggling' opponents, etc. Simulation training should also enable performers to learn how to make decisions under pressure, and selectively attend to those cues that are particularly relevant to their performing environment. Finally, the theoretical explanations that have been offered for the effects of stress upon vulnerability to injury, coupled with the finding that social support moderates the effects of stress upon vulnerability,51 appears to suggest the possibility that social support may also be an important moderating variable in the effects of stress upon performance and rehabilitation. The effectiveness of such a social support network would seem to depend upon the availability of a support group to which the performer can relate.68 The members of diis group must have good listening skills,60 and someone within this group must be able to counsel performers and help them to re-attribute negative thoughts about the causes of the stress that they are experiencing.69'70 REFERENCES 1 Jones JG, Hardy L, eds. Stress and performance in sport. Chichester: Wiley, 1990 2 Patmore A. Sportsmen under stress. London: Stanley Paul, 1986 3 Kroll W. The stress of high performance athletes. In: Klavora P, Daniel VL, eds. Coach, athlete and the sport psychologist, 2nd edn. Champaign, IL: Human Kinetics, 1979 4 Gould D, Horn T, Spreemann J. Sources of stress in junior elite wrestlers. J Sport Psychol 1983; 5: 159-171 5 Gould D, Weinberg R. Sources of worry in successful and less successful intercollegiate wrestlers. J Sport Behav 1985; 8: 115-127 6 Gould D, Ecklund RC, Jackson SA. An in-depth examination of mental factors and preparation techniques associated with 1988 US Olympic team wrestling success. Grant report to USA Wrestling, 1991 7 Scanlan TK, Stein GL, Ravizza K. An in-depth study of former elite figure skaters: III. Sources of stress. J Sport Exerc Psychol 1991; 13: 103-120 8 Feigley DA. Coping with fear in high level gymnastics. In Salmela JH, Petiot B, Hoshizaki TB, eds. Psychological nurturing and guidance of gymnastic talent. Montreal: Sport Psyche Editions, 1987 9 Jones JG, Swain A, Cale A. Antecedents of multidimensional competitve state
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anxiety and self-confidence in elite intercollegiate middle-distance runners. The Sport Psychologist 1990; 4: 107-118 Jones JG, Swain A, Cale A. Gender differences in precompetition temporal patterning and antecedents of anxiety and self-confidence. J Sport Exerc Psychol 1991; 13: 1-15 Borkovec TD. Physiological and cognitive processes in the regulation of anxiety. In: Schwartz G, Shapiro D, eds. Consciousness and self-regulation: Advances in research (vol 1). New York: Plenum, 1976: 261-312 Martens R, Vealey RS, Burton D, eds. Competitive anxiety in sport. Champaign, IL: Human Kinetics, 1990 Hardy L, Parfitt CG. A catastrophe model of anxiety and performance. Br J Psychol 1991; 82: 163-178 Parfitt CG, Jones JG, Hardy L. Multidimensional anxiety and performance. In: Jones JG, Hardy L, eds. Stress and performance in sport. Chichester: Wiley, 1990: pp 43-80 Idzikowski C, Baddeley A. Waiting in the wings: Apprehension, public speaking and performance. Ergonomics 1983; 26: 575-583 Burton D. Do anxious swimmers swim slower? Reexamining the elusive anxiety-performance relationship. J Sport Exerc Psychol 1988; 10: 45-61 Hardy L. A catastrophe model of performance in sport. In: Jones JG, Hardy L, eds. Stress and performance in sport. Chichester: Wiley, 1990: pp. 81-106 Mahoney MJ, Gabriel TJ, Perkins TS. Psychological skills and exceptional athletic performance. The Sport Psychologist 1987; 1: 181-199 Gould D, Ecklund RC, Jackson SA. 1988 US Olympic wrestling excellence II: competitive cognition and affect. 1992 (Submitted) Bandura A. Social Foundations of Thought and Action. Englcwcod Cliffs, NJ: Prentice-Hall, 1986 Feltz DL. Self-efficacy as a cognitive mediator of athletic performance. In: Straub WF, Williams JM, eds. Cognitive sport psychology. Lansing, NY: Sport Science Associates, 1984: pp. 191-198 Borkovec TD. Self-efficacy: Cause or reflection of behavioral change. In: Rachman S, ed. Advances in behavior research and therapy (vol. 1). Oxford: Pergamon, 1978: 163-170 Jones JG, Hardy L. Stress and cognitive functioning in sport. J Sports Sci 1989; 7: 41-63 Eysenck MW. Attention and arousal: Cognition and performance. Berlin: Springer-Verlag, 1982 Hockey GRJ, Hamilton P. The cognitive patterning of stress states. In: Hockey GRJ, ed. Stress and Fatigue in Human Performance. Chichester: Wiley, 1983: 331-362 Shiffrin RM, Schneider W. Controlled and automatic human information processing: II. Perceptual learning, automatic attending, and a general theory. Psychol Rev 1977; 84: 127-190 Jones JG, Hardy L. Stress in sport: Experiences of some elite performers. In: Jones JG, Hardy L, eds. Stress and performance in sport. Chichester: Wiley, 1990: 247-277 Hardy L, Nelson D. Self-regulation training in sport and work. Ergonomics 1988; 31: 1573-1583 Wine JD. Test anxiety and direction of attention. Psychol Bull 1971; 76: 92-104 Bunker L, Williams JM. Cognitive techniques for improving performance and building confidence. In Williams JM, ed. Applied sport psychology: Personal growth to peak performance. Palo Alto, CA: Mayfield, 1986: pp. 235-255 Davidson RJ, Schwartz GE. The psychobiology of relaxation and related states: a multiprocess theory. In Mostofsky D, ed. Behavioural control and modification of physiological activity. Englewood Cliffs, NJ: Prentice-Hall, 1976: pp.399-442
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32 Baumeister RF. Choking under pressure: self-consciousness and paradoxical effects of incentives on skilful performance. J Personality Social Psychol 1984; 46: 610-620 33 Ravizza K. Peak experience in sport. J Humanistic Psychol 1977; 17: 35-40 34 Boutcher SH. The role of performance routines in sport. In Jones JG, Hardy L, eds. Stress and Performance in Sport. Chichester: Wiley, 1990: pp. 231-145 35 Beuter A, Duda JL. Analysis of the arousal/motor performance relationship in children using movement kinematics. J Sport Psychol 1985; 7: 229-243 36 Ainscoe MW, Hardy L. Cognitive warm up in a cyclical gymnastics skill. Int J Sport Psychol 1987; 18: 269-275 37 Hardy L, Maidens DS, Sherry K. Goal setting and performance: The effects of performance anxiety. J Sports Sci, 1986; 4: 233-234 38 Revelle W, Michaels EJ. The theory of achievement motivation revisited: The implications of inertial tendancies. Psychol Rev 1976; 83: 394-404 39 Burton D. Winning isn't everything: Examining the impact of performance goals on collegiate swimmers' cognitions and performance. The Sport Psychologist 1989; 3: 105-132 40 Anderson MB, Williams JM. A model of stress and athletic injury: Prediction and prevention. J Sport Exerc Psychol 1988; 10: 294-306 41 Ivancevich JM, Matteson MT. Type A behavior and the healthy individual. Br J Med Psychol 1988; 61: 37-56 42 Browne MA, Mahoney MJ. Sport psychology. Annu Rev Psychol 1984; 35: 605-625 43 Jackson DW, Jarrett H, Bailey D et al. Injury prediction in the young athlete: A preliminary report. Am J Sports Med 1978; 6: 255-261 44 Valiant P. Personality and injury in competitive runners. Perceptual Motor Skills 1981; 53: 251-253 45 Lysens R, Steverlynck A, van der Auweelc Y et al. The predictability of sports injuries. Sports Med 1984; 1: 6-10 46 Bramwell ST, Masuda M, Wagner NN et al. Psychosocial factors in athletic injuries: Development and application of the social and athletic readjustment rating scale (SARRS). J Human Stress 1975; 1: 6-20 47 Cryan P, Alles W. The relationship between stress and college football injuries. J Sports Med 1983; 23: 52-58 48 Lysen R, van der Auweele Y, Ostyn M. The relationship between psychosocial factors and sports injuries. J Sports Med Physical Fitness 1986; 26: 77-84 49 Passer M, Seesc MD. Life stress and athletic injury: Examination of positive versus negative events and three moderator variables. J Human Stress 1983; 9: 11-16 50 Williams JM, Tonymon P, Wadsworth WA. Relationship of stress to injury in intercollegiate volleyball. J Human Stress 1986; 12: 38-43 51 Smith RE, Smoll FL, Ptacek JT. Conjunctive moderator variables in vulnerability and resiliency research: Life stress, social support and coping skills, and adolescent sport injuries. J Personality Social Psychol 1990; 58: 360-370 52 Hardy CJ, Kirsanoff MT, Richman JM et al. The role of social support in the life stress-injury relationship. 1992 (Submitted) 53 Wehlage DF. Managing the emotional reaction to loss in athletics. Athletic Training 1980; 15: 144-146 54 Pederson P. The grief response and injury: A special challenge for athletes and athletic trainers. Athletic Trainer 1986; 21: 312-314 55 Kubler-Ross E. On death and dying. New York: Macmillan, 1969 56 Dishman RK, ed. Exercise adherence: Its impact on public health. Champaign, IL: Human Kinetics, 1988 57 Kobasa SCO, Puccetti MC. Personality and social resources in stress resistance. J Personality Social Psychology 1983; 45: 839-850 58 Achterbcrg J, Matthews-Simonton S, Simonton OC. Pschology of the excep-
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tional cancer patient: A description of patients who outlived predicted life expectancies. Psychother: Theory Res Practice 1977; 14: 416—422 Wiese DM, Weiss MR. Psychological rehabilitation and the physical injury: Implications for the sports medicine team. The Sport Psychologist 1987; 1: 318-330 Wiese DM, Weiss MR, Yukelson DP. The Sport psychology in the training room: A survey of athletic trainers. Sport Psychologist 1991; 5: 15-24 Ievleva L, Orlick T. Mental links to enhanced healing. The Sport Psychologist 1991: 5: 25-40 Orlick T, Partington J. Mental links to excellence. The Sport Psychologist 1988; 2: 105-130 Weinberg RS, Gould D, Jackson A. Expectations and performance: An empirical test of Bandura's self-efficacy theory. J Sport Psychology 1979; 1: 320-331 Rushall BS. The content of competition thinkings. In Straub WF, Williams JM, eds. Cognitive sport psychology. Lansing, NY: Sport Science Associates, 1984: pp. 51-62 Schwartz GE, Davidson RJ, Goleman DJ. Patterning of cognitive and somatic processes in the self-regulation of anxiety: Effects of meditation versus exercise. Psychosomatic Med 1978; 40: 321-328 Gould D, Ecklund RC, Jackson SA. 1988 US Olympic wrestling excellence I: Mental preparation, precompetitive cognition and affect. 1992 (Submitted) Gould D, Ecklund RC, Jackson SA. Coping strategies used by more versus less successful US Olympic wrestlers. 1992 (Submitted) Schachter S. The psychology of affiliation. Stanford, CA: Stanford University Press, 1959 Weiner B. A theory of motivation for some classroom experiences. J Educational Psychol 1979; 71: 3-25 Abramson LY, Seligman MEP, Teasdale JD. Learned helplessness in humans: Critique and reformulation. J Abnormal Psychol 1978; 87: 49-74
Psychological stress, performance, and injury in sport L Hardy University of Wales, Bangor, Gtoynedd, UK
This paper reviews the empirical literature on psychological stress in sport, and the effects that such stress may have upon performance, vulnerability to injury, and rehabilitation from injury. It also examines the strategies that sports performers could use to overcome these effects. The major sources of stress that have been reported by sports performers include fear of failure, concerns about social evaluation by others (particularly the coach), lack of readiness to perform, and loss of internal control over one's environment. Various models and theories of the effects of such stress upon performance and vulnerability to injury are reviewed, including multidimensional anxiety theory and a catastrophe model of anxiety and performance. The cognitive and physiological processes which are thought to underly these effects are also reviewed, together with the intervention strategies that are implied by these processes. Research on the psychological stress that appears to be experienced by performers when they are injured is very limited. However, that which is available suggests that many of the same psychological skills that are thought to enhance performance can also be used to reduce the risk of injury, and promote a speedy recovery from injury. These include goal-setting, imagery, self-talk, and relaxation skills.
Psychological stress is clearly very much a part of modern sport.i It has even been suggested that coping with this pressure is the fundamental challenge of sport.2 This paper reviews the empirical literature on sources of psychological stress in sport, the effects
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that such stress may have upon the performance of sports people, their vulnerability to injury, and their rehabilitation from injury. The paper also examines the strategies that performers use in order to cope with this stress. A feature of the review is its focus upon the psychological processes that are thought to underly these phenomena as well as the implications of these processes for applied sport psychologists working with performers in the field. SOURCES OF PSYCHOLOGICAL STRESS One of the first explorations in this area was a factor analytic study by Kroll.3 This identified 5 categories of psychological stress that were experienced by adult sports performers. These were fear of failure (e.g. making a foolish mistake), feelings of inadequacy (e.g. getting tired), loss of internal control (e.g. unfair officials), guilt (e.g. hurting an opponent), and current physical state (e.g. sore muscles). Following on from this work, Gould and associates conducted a series of wrestling studies. The first of these4 confirmed the first 4 of Kroll's factors, and identified social evaluation as an additional source of stress in junior wrestlers. A second study of intercollegiate wrestlers also found worry about not wrestling well, improving on the last performance, what the coach will think or say, losing, performing up to ability, and the performer's physical condition to be the most frequently experienced sources of worry. However, only concerns about what the coach would think or say, losing, and making mistakes discriminated between successful and less successful performers.5 The latest of Gould and associates wrestling studies was an in-depth qualitative study of elite performers, which identified many of the same factors as sources of stress for wrestlers at the Olympic Games.6 These included readiness and performance problems, refereeing decisions and tournament organization, coach and team-mate influences, coaching and management decisions, social support, accommodation, transportation, food, and training facilities. Other studies of elite figure skaters,7 gymnasts,8 and runners9 have confirmed the generalizability of many of these findings across sports, and have also identified the costs and time demands involved in being an elite performer, and dealing with the media as other potential sources of stress. Finally, there is also some evidence to suggest that sources of stress may be different for men compared to women.10
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To summarize, whilst there exists considerable variation in sources of stress across individuals, the most commonly reported sources include fear of failure, making mistakes, concern about the expectations of others, poor preparatory training and physical state, the media and unforeseen events. The most obvious implication of these findings seems to be that performers must have total confidence in their goals, their organization's system, and their preparation for the event, if they are to have any chance of performing relatively stress-free. STRESS AND PERFORMANCE Although stress can be perceived as either challenging or anxiety inducing, the psychological literature on stress and performance has focused almost exclusively on the effects of anxiety upon performance. Components of anxiety At least two components of the anxiety response can be identified, a cognitive component characterised by fear of the consequences of failure, and a physiological component associated with the 'fight-flight' response.11'12 Some researchers consider the actual physiological response to be less important than the performer's perception of his or her physiological response.12 However, this remains a contentious issue since 'direct hit' effects for physiological arousal upon performance may be an important factor in some sports.13'14 Regardless of this distinction, it has been shown that the cognitive and physiological (perceived or actual) components of anxiety can be evoked by different stressors and follow different time courses prior to a competition. Cognitive anxiety may be elevated as much as two weeks before an important event, and generally remains fairly stable throughout the period leading up to the event. On the other hand, physiological arousal and its perception, somatic anxiety, tend to peak late and fast, much closer to the start of the event.12'14 Multidimensional anxiety theorists12 have argued that somatic anxiety (and, presumably, the associated physiological response) is a conditioned response to entering the performance environment which should therefore disappear once performance has commenced. They have also argued that because cognitive anxiety is principally concerned with the consequences of failure, it should
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change whenever the subjective probability of success changes. Based on these arguments, multidimensional anxiety theorists initially proposed that cognitive anxiety should be the primary influence upon performance, and that this influence should be a negative one. However, there is much evidence that physiological arousal continues to fluctuate throughout performance,15 and research findings have shown both somatic anxiety and physiological arousal to be important predictors of performance under stressful conditions.1416 In the light of these findings, the multidimensional anxiety theorists seem to have adjusted their position so that they predict a negative linear effect for cognitive anxiety, and an inverted-U shaped effect for somatic anxiety, upon performance.12 Other researchers 131417 have criticized multidimensional anxiety theory on several grounds. As well as the possibility that physiological arousal may score 'direct hit' effects upon performance which are not mediated by somatic anxiety, these criticisms also include the fact that multidimensional anxiety theory only makes predictions about the separate effects of cognitive anxiety and somatic anxiety upon performance when what is really required is an explanation of how cognitive and somatic anxiety interact to influence performance. Such criticisms led to the formulation of a catastrophe model of anxiety and performance which predicts that cognitive anxiety can have a facilitating or a debilitating effect upon performance, depending upon whether physiological arousal is low or high. The model also predicts that under conditions of high cognitive anxiety and high physiological arousal performance changes are likely to be large and catastrophic, rather than small and continuous. The model has received some empirical support.13'17 In their development of the multidimensional Competitive State Anxiety Inventory-2, Martens and associates12 identified a third factor, orthogonal to cognitive and somatic anxiety, which they labelled self-confidence. Self-confidence has been regularly identified as an important predictor of performance across a wide range of sports.18'19 Furthermore, Bandura's theory of how self-efficacy (i.e. situationally specific self-confidence) influences performance has now received considerable support in the literature,20 and has important implications for the preparation of sports performers.21 The extent to which self-efficacy and cognitive anxiety covary is the subject of some debate,22 but there is a growing body of research which suggests that they may best be considered as
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relatively independent constructs.23 The possibility has also been suggested that self-efficacy might provide some son of buffer against anxiety effects.17 Mechanisms underlying anxiety effects The precise means by which anxiety exerts its influence upon performance are not well-understood and a number of different theoretical positions can be identified in the literature,24 each of which has its own implications for applied intervention. One of the earliest of these was Easterbrook's cue utilization theory, which proposed that anxious performers selectively attend to cues that are central to the task to be performed. Initially, this 'narrowing' of attention rejects cues that are irrelevant to the task, and performance is improved. However, with continued narrowing relevant cues are also ignored, and performance is impaired. Subsequent research23 refined this position by identifying that the subjective importance of the cues was the crucial factor in selectivity, rather than their spatial location. The simplest implication of cue utilization theory is that performers should considerably overlearn skills so as to reduce the number of cues to which they must attend.26'27 Another implication is that they should be taught how to set process-oriented goals to help them to selectively attend to the most relevant cues.28 A rather different theory was proposed by Wine.29 He argued that anxious performers are distracted by their own self-generated negative thoughts, which therefore use up valuable information processing resources that should be allocated to the task. According to this position, physiological arousal should not be an important determinant of performance, unless performers are so physiologically aroused that they become pre-occupied with their own physiological state. One obvious implication of Wine's approach would seem to be to use dual task paradigms to train performers to cope with distractions that are extrinsic to their primary task.28 Another is the use of cognitive relaxation to quieten the distracting influence of negative self-talk.30 A variation on Wine's theory proposes that anxiety impairs performance by clogging up the organism's information processing channels with useless and disruptive information.31 According to this position, at least two distinct channels can be identified: a cognitive channel and a somatic channel. Furthermore, it is argued that such disruptive information is best removed by employing a relaxation
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strategy which engages the most-affected channel. This is the socalled 'matching hypothesis'. Baumeister32 proposed that anxiety exerts its influence by leading performers to try to consciously control performance, rather than simply 'letting it happen'. Although this theory has received relatively little experimental support, it does have some intuitive appeal and has received indirect support from much of the literature on peak performance.33 It has also been suggested that wellestablished pre-performance routines may help performers to get into an automatic state of functioning prior to performance.14 Hockey and Hamilton25 extended Easterbrook's work on attentional selectivity to include other aspects of the information processing system, such as subjects' ability to store and retrieve relevant information when performing under stress. Whilst Hockey and Hamilton employed laboratory stressors such as noise and sleep loss for most of their studies, this approach has also been used with performance anxiety and sports tasks.14 The most reliable findings so far obtained are that cognitive anxiety enhances the speed at which information can be transferred through the system. Conversely, physiological arousal impairs movement fluidity, manual dexterity and the systems ability to make decisions (i.e. working memory), but enhances anaerobic power.14'35 At least 3 implications can be found from this research. Information processing based match analysis systems could be developed to identify specific areas of vulnerability in performers, so that individualized training programmes could be coupled with processoriented goals to help performers focus their attention where it is needed.14'28 Dual task paradigms could be used to help performers learn how to make decisions under pressure.28 Mental rehearsal could be used prior to performing to help fine-tune the activation system, so that the available resources are allocated appropriately to the task.36 Eysenck24 proposed an interesting theory of anxiety and performance diat incorporated both motivational and information processing variables. In line with the above arguments, Eysenck identified that cognitive anxiety reduced the effective capacity of working memory by wasting resources on worry. However, he also argued that because anxious performers have a greater discrepancy between their current aspirations and their perceived ability,37 they will invest more effort in the task. Consequently, performance effectiveness may be maintained (or even enhanced) but at a reduced efficiency and a greater energetic cost to the
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system. Eventually, of course, this cost will become too great, the performer will give up, and performance will break down completely—essentially because 'the tough get going when the going gets tough' but 'wise men do not beat their heads against brick walls'.38 The implications of Eysenck's approach include the use of dual task paradigms to reduce working memory impairment,28 and goal-setting training39 or positive self-talk30 to control the goal discrepancy which anxious performers are hypothesized to have.
STRESS AND INJURY Stress as a cause of injury There seems to be little doubt (although no direct supporting evidence) that the majority of injuries are eventually precipitated by biomechanical, physiological or anatomical factors; for example, poor field conditions, bad technique, overtraining and tight muscles. However, from the perspective of this paper the final precipitation of injury is not really the crucial issue. The crucial issue is whether psychological stress can act as a catalyst which causes the precipitating variable(s) to come into play. Theoretically, there is every reason to believe that stress may be an important factor in injury, since any performance decrements that arise from having to perform under conditions of high stress could very easily increase the risk of accidental injury in a wide range of sports.40 The mechanisms which are thought to underly such decrements in performance have already been described. Initial research into psychosocial factors in sports injuries used two paradigms that had been previously used in research into disease prone personalities and personality factors in sport. Both of these paradigms have been extensively criticized in the literature; the former for using unvalidated measurement devices in retrospective designs with no control groups,41 and the latter for employing a 'shotgun' approach in retrospective designs with assessment tools that were principally designed to identify people in the extremes of the population distribution.42 Perhaps unsurprisingly, much of the early research into psychosocial factors in sports injuries also suffered from these same problems. Nevertheless, there does seem to be some evidence to support the view that tough-minded performers are less likely to get injured than tenderminded performers,43'44 possibly because they experience less
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anxiety when performing under stressful conditions. Similarly, there is also some evidence that high trait anxiety may lead to a greater risk of injury.45 With the advent of the interactionist (person x situation) approach to personality, researchers became more interested in the possibility that certain environmental factors might lead to increased stress in performers, and thereby an increased risk of injury. Early studies examining the effect of life change events upon the incidence of subsequent injury amongst American football players produced quite impressive differences in injury rates for groups of players who differed in their experience of life change events.46'47 However, these studies did not make any distinction between positive and negative life events, and when such a distinction was made in subsequent studies, the results became rather more equivocal, with some studies showing a relationship between negative life events and injury risk48 but others showing no such relationship.49'30 This state of affairs led researchers to examine some of the psychosocial variables that may moderate the stressful effects of negative life change events. The results from these studies have been very encouraging, and have implicated social support and coping skills as important variables that may moderate the effect of negative life events upon subsequent injury.51'52 The results of Smith and associates study51 are particularly interesting, as the interaction which they reported was such that performers who were low in both social support and coping skills were particularly vulnerable to stress related injuries from major negative life events. A clearer picture of the magnitude of this interaction can be gained by considering the fact that without the inclusion of any of their moderator variables the stress associated with major negative life events accounted for less than 1 % of the variance in subsequent injuries. However, when the interactive effects of social support and coping skills were included in their analysis, major negative life events accounted for 22% of the variance in injuries. Injury as a source of stress It is possible to conceive of two different types of stress associated with injury; the stress of being unable to perform, and the stress associated with 'coming back' from injury. The stress associated with being unable to perform has been likened to a grief response due to the loss of one's fitness and the negation of one's perform-
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ance goals.53'54 The stress associated with coming back from injury seems most likely to result from fear of having to perform the same tasks that caused the injury with a possibly weakened body. Despite the fact that anecdotal evidence suggests that this postrehabilitation stress is a major problem for many performers, the author could find no empirical studies that addressed the question. Fortunately, there is at least a small literature that addresses the stress of being unable to perform. It has been proposed that at least three stages can be identified in the grief response to being injured; protest, hopelessness, and reorganization.5355 According to this classification, the protest stage is characterized by denial of the injury, shock that it has occurred, and anger.54 Extreme emotionality is to be expected at this stage, and is thought to help the performer accept that the injury has occurred. The hopelessness stage of the grief response is thought to be brought about by the acceptance that the injury has occurred, and the realization that it cannot be reversed. During this stage, the performer is hypothesized to become socially detached, and preoccupied with all the things that they will not be able to do as a result of the injury. During the final reorganization stage of the injury, the performer is hypothesized to come to terms with their loss and restructure their life so that they can gradually return to their normal training. Although this model could be used as a logical basis for the development of intervention programmes for injured performers, it has yet to be empirically tested in the context of sports injuries. Borrowing from the literatures on adherence to health related exercise,56 psychoimmunology,57 and psychological factors in the progression of disease,58 Wiese and Weiss59 proposed a number of psychological skills that might help performers to adhere to a programme of rehabilitation and cope with the stress of being injured. These included: goal-setting to assist motivation; imagery and positive self-talk to enhance self-efficacy; relaxation to reduce worry and excessive muscle tension around the site of the injury; and communication skills to enable them to discuss their injury and rehabilitation with the medical support team. Wiese and Weiss also suggested that social support could help the performer maintain a positive attitude towards their injury, particularly if such support was given by other performers who had recovered from similar injuries. Of these skills, a qualitative study of physiotherapist's perceptions60 offered support for the view that goal-setting, positive self-talk, and good communication skills (including a
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willingness to listen to the medical support team) were important determinants of a performer's ability to cope with the stress of being injured. Furthermore, a retrospective study of speed of recovery from soft tissue injuries confirmed the importance of goal-setting, positive self-talk, and imagery.61 Clearly, this is an important area for future research. CONCLUSION: COPING STRATEGIES AND INTERVENTIONS This final section draws together the implications of the previous sections in order to highlight some of the psychological strategies and interventions that might be used to help performers maximize the benefits that they derive from their involvement in sport. During this discussion an attempt will be made to distinguish between those implications that are well-established, and those 'implications' that are perhaps better regarded as good educated guesses. Perhaps the most fundamental implication of this whole review comes from the first section on sources of stress. It is that if performers are to have any chance of performing relatively stressfree, then they must have total confidence in their goals, the organizational system, and their preparation for the event which confronts them. This conclusion echoes previous findings with elite performers,19'62 and could probably be used as a guiding principle for much intervention work. In this context, it is possible to present quite a strong argument that the reality of whether coaching and management teams actually make the best decisions is often less important than the performer's belief that the best decision has been made. In his theory of self-efficacy, Bandura20 identified four processes by which self-confidence could be acquired: previous experience of success; vicarious experience; verbalization; and interpretation of current physiological states. Interestingly, many of the psychological skills and strategies that have already been identified in the preceding sections of this review have also been shown to exert an influence upon these processes. For example, goal-setting skills essentially determine the probability, and therefore the experience, of success. However, during the course of the present review, it has also been suggested that goal-setting training has the potential to influence the motivation required to adhere to rehabilitation programmes,61 the goal-discrepancy experienced by anxious per-
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formers,39 and the maintenance of a clear focus of attention upon performance.28 This latter suggestion may be particularly important and worthy of further investigation, as several researchers have found clear focus of attention to be a major predictor of peak performance.19-2733'62 Similarly, imagery has been proposed as a means of gaining vicarious experience,63 but has also been identified as a way of fine-tuning the information processing system in readiness for performance,36 and enhancing the speed of rehabilitation from injury.61 Unfortunately, the precise means by which imagery might exert these effects are not well-understood. Positive self-talk can be used to make self-affirmations which are thought to enhance self-confidence,64 but has also been promoted as a means of restructuring cognitive anxiety30 and enhancing the speed of rehabilitation.61 Finally, relaxation strategies seem to be one way of influencing the interpretation of the current physiological state, as well as a means of controlling cognitive anxiety and physiological arousal.11-31 Furthermore, although several different theoretical perspectives have been highlighted in the present review regarding the effects of anxiety upon performance and vulnerability to injury, they all agree that excessive cognitive anxiety and physiological arousal are highly likely to have detrimental effects. Incidentally, although no one has conclusively demonstrated that cognitive and somatic anxiety are differentially reduced by cognitive and somatic relaxation strategies, many sport psychologists seem to believe that this is the case.12'65 If this were shown to be the case, then one obvious implication would seem to be that performers may need more than one relaxation strategy to cope with the different types of anxiety that they might experience. Several other strategies that have been implicated in this review are worthy of further attention. It was suggested that wellestablished pre-performance and performance routines might help performers to maintain their concentration by encouraging them to control performance at an automatic, rather than a conscious, level.34 Although the evidence which directly supports Baumeister's theory is weak, the evidence supporting the use of preperformance, performance, and re-focusing routines is very strong.27'34'62'66 It is also possible that such routines exert their influence via different processes; for example, as an effective relaxation strategy by filling the information processing channels with something constructive rather than negative. However, little evidence is available on this issue. Regardless of this, it does seem to
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be the case that just as physical routines must be overlearned if they are to be resilient to the effects of stress,27 so must mental routines be overlearned if they are to help performers to maintain performance when under stress.67 The use of simulation training in which certain aspects of the competitive environment are replicated during practice has been described in both practical27'62 and theoretical14 studies of stress and performance. It has been argued14 that such training should desensitize performers to many potential distractions, including bad refereeing decisions, 'niggling' opponents, etc. Simulation training should also enable performers to learn how to make decisions under pressure, and selectively attend to those cues that are particularly relevant to their performing environment. Finally, the theoretical explanations that have been offered for the effects of stress upon vulnerability to injury, coupled with the finding that social support moderates the effects of stress upon vulnerability,51 appears to suggest the possibility that social support may also be an important moderating variable in the effects of stress upon performance and rehabilitation. The effectiveness of such a social support network would seem to depend upon the availability of a support group to which the performer can relate.68 The members of diis group must have good listening skills,60 and someone within this group must be able to counsel performers and help them to re-attribute negative thoughts about the causes of the stress that they are experiencing.69'70 REFERENCES 1 Jones JG, Hardy L, eds. Stress and performance in sport. Chichester: Wiley, 1990 2 Patmore A. Sportsmen under stress. London: Stanley Paul, 1986 3 Kroll W. The stress of high performance athletes. In: Klavora P, Daniel VL, eds. Coach, athlete and the sport psychologist, 2nd edn. Champaign, IL: Human Kinetics, 1979 4 Gould D, Horn T, Spreemann J. Sources of stress in junior elite wrestlers. J Sport Psychol 1983; 5: 159-171 5 Gould D, Weinberg R. Sources of worry in successful and less successful intercollegiate wrestlers. J Sport Behav 1985; 8: 115-127 6 Gould D, Ecklund RC, Jackson SA. An in-depth examination of mental factors and preparation techniques associated with 1988 US Olympic team wrestling success. Grant report to USA Wrestling, 1991 7 Scanlan TK, Stein GL, Ravizza K. An in-depth study of former elite figure skaters: III. Sources of stress. J Sport Exerc Psychol 1991; 13: 103-120 8 Feigley DA. Coping with fear in high level gymnastics. In Salmela JH, Petiot B, Hoshizaki TB, eds. Psychological nurturing and guidance of gymnastic talent. Montreal: Sport Psyche Editions, 1987 9 Jones JG, Swain A, Cale A. Antecedents of multidimensional competitve state
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