Supporting the Psychological Wellbeing of Athletes: What Can Coaches do?

There has recently been an increasing number of athletes bravely coming forward to share their stories about the psychological distress and associated mental health challenges they experienced during their athletic careers (e.g., Michael Phelps, Gracie Gold, and Demar Derozan). Athletes are not immune to experiencing psychological distress and rates of mental illness among athletes are comparable to their non-athlete peers (Rice et al., 2016). Research has long suggested that athletes participating in sport, particularly at competitive and elite levels, may be at-risk for experiencing psychological distress and associated mental disturbance because of the various sport-specific stressors they may face, such as sustaining athletic injury, conflict with teammates, and pressures to achieve athletic success (Sudano, Miles, & Collins, 2017), as well as more personal life stressors, such as challenges with their sexuality (Kroshus & Davoren, 2016). In response to these stressors, athletes may suffer from impaired mental health including anxiety, depression, disordered eating, suicidal ideation, and alcohol or substance dependency (Rice et al., 2016).

For
help managing this distress, athletes may turn to coaches for support. Coaches
are recognized leaders within sport whose attitudes and expressed opinions
towards psychological distress and mental health can greatly influence the
likelihood of athletes coming forward and seeking help (Moreland, Coxe, &
Yang, 2018). Further, both coaches (Mazzer & Rickwood, 2015) and parents
(Brown, Deane, Vella, & Liddle, 2017) alike have expressed that coaches
should assume a role in supporting the wellbeing of athletes because of the
frequency with which coaches and athletes interact. As such, it is important that
coaches be equipped with the knowledge, skills and resources necessary to
support the psychological wellbeing of their athletes. This includes coaches being
aware of the limitations to their role and knowing to connect athletes with
professional resources when instances of psychological distress require such
intervention (e.g., suicidal ideation, severe mental illness, and substance
dependency).

Examining Coach Support of Student-Athletes

To better
understand how coaches currently support psychologically distressed athletes,
we conducted a research study exploring intercollegiate student-athletes’ experiences
disclosing distress to varsity coaches. Student-athletes are a particularly
high-risk group for psychological distress because of the combined pressures of
maintaining both athletic and academic excellence (Etzel, Watson, Visek, &
Maniar, 2006). Interviews were conducted with 15
student-athletes (2 male, 13 female) and 15 varsity coaches (11 male, 4 female),
and asked participants about the challenges surrounding athlete disclosures of
distress, and the ways in which coaches were both effective and ineffective at
providing support. Using this information, we were able to develop a stronger
understanding of the barriers that discourage athletes from disclosure, as well
as practical solutions for how coaches can overcome these barriers. Findings
also suggest effective immediate, short-, and long-term support practices for
coaches who are working with distressed athletes.

Barriers to Disclosing Distress

Five key barriers were identified by our research participants that discouraged student-athletes from disclosing psychological distress to their coaches.

1. Traditionally “Tough” Sport Cultures:

The
first barrier centered on the emphasis traditional sport cultures place on the
demonstration of mental toughness. Because of this emphasis, psychological
distress and associated mental health challenges are often stigmatized within
sport and perceived by athletes to be a sign of weakness. Consequently,
athletes fear disclosure because they do not want coaches to label them as weak.
One athlete explained:

It’s just the way that sport is kind of constructed. You have to have that toughness and not being tough just kind of makes you a lesser athlete.

2. Power of Coaches:

A
second barrier was the power coaches hold in their relationship with athletes.
Coaches determine starting line-ups, who participates on relays, and ultimately
which athletes will compete. Athletes fear disclosure because they worry coaches
will perceive their performance abilities as being impaired by their psychological
distress and subsequently lose playing time. A coach described this barrier
when they said:

I think student-athletes look at the distress they go through and wonder, will coaches look at it as a weakness and is it going to affect my position on the team? Do I really want to take this to the coach and then maybe I won’t be starting tomorrow.

3. An Athlete’s Position on the Team:

Similarly, power differentials amongst teammates and the resulting hierarchies that develop can also act as a barrier to disclosure. Some athletes possess greater athletic skill and are often rewarded for their talent by being named team captains or starters. These athletes are perceived to be at the top of team hierarchies and may face challenges disclosing distress because they fear disclosure will tarnish their reputation as team leaders. Alternatively, athletes on the lower end of their team’s hierarchies, such as bench players and younger athletes, often fear disclosure because they do not perceive themselves as valued members of the team and do not want to draw a coach’s attention away from higher ranking players. An athlete who perceived themselves to be on the lower end of their team’s hierarchy described how this impacted their ability to disclose their sexuality:

I didn’t disclose my sexuality sooner because I wasn’t starting and I wasn’t sure what the response would be based on the way the guys behaved. I didn’t want to be the guy that disrupts the culture and gets kicked off the team.

4. Previous Negative Experiences with Disclosure:

The
fourth barrier faced by athletes related to previous negative experiences with
disclosure. Athletes are sensitive and highly attuned to the responses of their
coaches when disclosing any personal challenges ranging from mild injuries to
more serious distress. If athletes perceive a negative coach response during
these instances of disclosure, it subsequently discourages them from future
help-seeking and reinforces a mindset that sport is not a welcoming environment
for distress. This barrier was best described when a coach said:

One challenge is the student-athlete’s past history where they haven’t had a good experience when telling somebody. Maybe there wasn’t support or an understanding or a willingness to help. I’ve seen that a decent amount of times. The athlete waited longer to involve the coach because they’re worried about what the coach’s reaction would be.

5. Poor Visibility of Psychological Distress:

Until
recently, the topics of psychological distress and mental health have not been widely
discussed in sport. This contributed to the barrier of poor visibility of
distress in sport and resulted in many athletes struggling to recognize their
own symptoms. Further, once athletes successfully recognized they were
experiencing distress, they had few positive role models encouraging them to
seek help. Consequently, most of the athletes resorted to hiding their distress
from their coaches. For example, one athlete explained how the poor visibility
of distress in sport discouraged them from seeking help:

There was fear in seeking support because no one talks about athletes seeking support. I also only knew one friend at the time who was in therapy, and she was not having a good experience.

Overcoming Barriers through Culture
Setting

Fortunately,
our study identified that coaches have the ability to overcome these barriers
by fostering team cultures that support the psychological wellbeing of athletes
and encourage help-seeking behaviours. Coaches in our study discussed techniques
specific to each barrier, in addition to some more general culture setting
practices.

1. Holistic Coaching Philosophy:

To
address the emphasis placed by traditional sport cultures on athlete toughness,
coaches adopted more holistic coaching philosophies that minimized the
importance of performance and winning. This was achieved through a demonstrated
focus on athlete wellness through the prioritization of such elements as
recovery, nutrition, and sleep. Further, coaches encouraged athletes to strive
for balanced lifestyles since they found this helped improve athletes’ general subjective
wellbeing, which in turn often enhanced performance abilities.

2. Invest in Coach-Athlete Relationships:

Minimizing
power differentials between athletes and coaches involved developing open and
honest coach-athlete relationships. Integral to the development of such relationships
was coaches verbally communicating to athletes that in some instances,
help-seeking may require the athlete to temporarily step away from sport.
Coaches stressed, however, that upon return, the athlete would be afforded an
opportunity to earn their position again. In addition, coaches discussed the
benefit of scheduling regular meetings with their athletes to help build
stronger relationships. One coach explained:

To make sure we get to know the athletes, we have a lot of one-on-one meetings. In these meetings, we don’t just talk about what their athletic goals are, we talk about what other life goals they have moving forward. Whether those goals are related to school or their personal lives.

3. Addressing Team Hierarchies:

Coaches were successful at reducing the negative impacts that team hierarchies can have on athlete disclosures of distress by employing the following techniques:

• Using transparent selection criteria to dispel any myths that certain athletes are treated more favourably than others.
• Designating practice time to increase the skills and confidence of athletes who receive less playing time. This may be done using small groups or in a one-on-one fashion.
• Assigning each athlete with a role that makes them feel like a valued team member who is deserving of the coach’s attention, regardless of their performance contributions to the team.

4. Observational Learning:

Overcoming
athletes’ previous negative experiences with disclosure was a slow process that
was best achieved through observational learning. This meant that coaches made
conscious efforts to respond positively when addressing any concerns brought to
them by their athletes. Over time, athletes who had previous negative
experiences with disclosure observed these positive coach-athlete interactions
and learned that it is acceptable to bring distress to the coach. A coach
explained an instance of this method:

The athlete felt comfortable disclosing their distress to me because there were other student-athletes who had experienced some distressing issues and we had done all we could to help them. So, I think it was through the observations that the athlete perceived there was a genuine caring about them as a human being and they chose to come forward.

5. Enhancing Visibility of Psychological Distress:

Greater
visibility surrounding psychological distress in sport was achieved by coaches
speaking openly with their athletes about mental health, whether through
anecdotal stories or their own personal experiences. Further, coaches taught
their athletes the importance of awareness and accountability. This meant that coaches
worked to develop athletes’ abilities to self-reflect on their emotional states
and held them accountable for taking action and addressing any sentiments that
may be negatively impacting their wellbeing.

6. General Culture Setting:

While not specific to at any one barrier, coaches also used general techniques to help develop positive team cultures surrounding psychological distress and help-seeking. Such techniques included coaches engaging in positive role modeling by tending to their own psychological wellbeing and sharing with athletes how they do so. Further, coaches remained cognizant of their words and avoided using discriminatory language that could contribute to stigma surrounding distress and mental health (to enhance mental health literacy, consider enrolling in Mental Health First Aid; for language training related to diversity and inclusion in sport, please refer to the You Can Play Project) Last, if possible, coaches tried to build diverse coaching and support staff. This was done because not every athlete will connect with their coach on an intimate level where they feel comfortable disclosing distress. However, if athletes have access to a diverse coaching and support staff (i.e., diversity in race, gender, age, sexuality, etc.), it helps increase the odds that athletes will connect with at least one individual.

Supporting Distressed Athletes

While fostering an appropriate team culture is a critical step in coaches supporting the psychological wellbeing of athletes, coaches must also be aware of how to respond safely and effectively when athletes disclose distress. Paramount is creating a safe environment, which includes a respect for current safe sport practices, such as the Rule of Two. Initiating a disclosure conversation can be difficult for athletes, which is why coaches should not fear initiating this conversation themselves. In fact, several athletes in our study reported that they appreciated coach-initiated conversations because they felt it provided an opportunity to confide in the coach and demonstrated that the coach cared. As such, coaches should address/inquire about any unusual athlete behaviours such as uncharacteristic slumps in athletic performance or poor general demeanor at practice and competition. Coaches in the present study explained that they knew their athletes well enough to know when an athlete’s behaviour warranted checking in (i.e., a negative mood at one practice was often not abnormal and did not raise concerns of underlying psychological distress). However, the coaches also acknowledged that when working with first-year and transfer student-athletes, it was always best to follow up if they perceived the athlete’s behaviours to be “off” because they were less accustomed to these athletes’ standard behavioural patterns.

During the initial disclosure of distress, coaches should engage in the following six steps to provide effective immediate support and optimize the disclosure experience for the athlete:

1. Listen to the athlete explain the situation. This can include paraphrasing what the athlete has said to demonstrate that you are being attentive.
2. Reassure the athlete that psychological distress affects everybody and help normalize the experience for them.
3. Ask questions to ensure you understand the situation in its entirety.
4. Triage the severity of the situation to determine if the issue can be managed in-house or requires professional support. Professional support should be sought in any instance when the coach does not feel adequately equipped to manage the situation, and when the athlete is an immediate risk to themselves and/or others (e.g., suicidal ideation, severe mental illness, substance dependency, etc.).
5. Connect the athlete to the appropriate support resources (e.g., student-athletes may be connected with licensed mental health professionals who are affiliated with the institution or the Athletics Department).

Following
the coach’s initial response, optimal short-term support builds on the fifth
step of connecting the athlete to resources. When athletes are in distress, it
can be challenging for them to take the first step in seeking help. As such,
coaches should offer to make the connection on behalf of the athlete and
physically take them to the support resource. Coaches should ultimately respect
the athlete’s decision in having the coach accompany them or not; however, coaches
in the present study expressed that most athletes appreciated being accompanied
by somebody because it provided a much-needed level of reassurance and
encouragement.

Once
athletes have accessed the appropriate resources, coaches should engage in the
following long-term support practices:

• Respect
  and maintain the athlete’s confidentiality. These are sensitive topics and
  should be handled as such.
• Keep
  the athlete engaged with the team (e.g., invite, but do not force athletes to
  attend practices, games, team social events, etc.).
• Follow-up
  with the athlete on a regular basis.
• Be
  available to chat with the athlete on an as-needed basis.
• Be
  flexible with sport-related demands, such as training times, to accommodate the
  athlete’s needs (i.e., therapy, appointments, required days off, etc.)
• Be
  patient and sensitive to the fact that dealing with distress takes time, similar
  to physical injuries.

Concluding Remarks

Traditional perceptions around psychological distress and mental health in sport are often stigmatizing and discourage athletes from seeking help. Coaches, however, can play a significant role in changing these perceptions and creating sport environments that support the psychological wellbeing of their athletes. To do so, coaches can adopt and implement the techniques and suggested support practices outlined above. Since these suggestions are based on research in an intercollegiate sport setting, coaches involved at different levels of sport may need to modify these materials to fit the specific needs of their teams.

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