SPRINGFIELD COLLEGE LIBRARY MANUSCRIPT THESIS
The manuscript copies of master’s theses and doctoral dissertations deposited in the Library of Springfield College are available for appropriate usage. If passages are copied, proper credit must be given to the author in any written or published work. Extensive copying or publication of materials should be done only with the con¬ sent of the Director of the School of Graduate Studies. William N. Miller This thesis or dissertation by has been used accordingly by the persons listed below. (Librarians are asked to secure the signature of each user.)
Name and Address College Date SPRINGFIELD COLLEGE SCHOOL OF GRADUATE STUDIES
December, 1997
Dissertation We Recommend that the prepared under our direction by William N. Miller
ATHLETIC INJURY: MOOD DISTURBANCES AND HARDINESS entitled OF INTERCOLLEGIATE ATHLETES
be accepted as fulfilling the research requirement for the degree of Doctor of Physical Education ATHLETIC INJURY: MOOD DISTURBANCES
AND HARDINESS OF INTERCOLLEGIATE ATHLETES
A Dissertation
Presented to
the Faculty of Springfield College
In Partial Fulfillment
of the Requirements for the Degree
Doctor of Physical Education
by
William N. Miller
December 1997 IX
DEDICATION
This dissertation is dedicated to the memory of my
mother, Barbara N. Connolly, whose inspiration and
encouragement instilled in me the desire to always pursue my
goals and dreams in life.
/I'D m iwi up- 3 Ill
ACKNOWLEDGMENTS
First and foremost, I would like to express my
sincerest gratitude to the members of my dissertation
committee for all of their help and guidance: Dr. Mimi
Murray, Chairperson, Dr. Mary Ann Coughlin, and Dr. William
Sullivan. I would also like to extend a special thank you to
Professor Charlie Redmond for his input and insight as both
a professor and as an athletic trainer. I would like to
thank Dr. Christa Winter and Dr. Daryl Arroyo for their
assistance and comments while serving as my readers. I would
like to thank Dr. Betty Mann for her support and guidance
throughout my three years in the doctoral program. I would
also like to thank Dr. Britt Brewer for his suggestions
and insight regarding my dissertation, and Dr. Ken Wall for
his interest and concern throughout my doctoral studies.
Behind the scenes of any dissertation or thesis at
Springfield College is the library staff. For me, their
assistance.and support was a tremendous asset. The
assistance provided by Mr. Bill Stetson was insurmountable
regarding my review of literature, not to mention the
detective work he did regarding the hardiness construct. In
addition, I would also like to extend my appreciation to Jim
Del Re, Ron Jackson, Mike Kennedy, Bob Kudlay, Linda Matson,
Rachael Naismith, Sheri Sochrin, and Diane Walsh for all of
their assistance, support, and encouraging words. IV
To two very special friends and peers, Tracey D.
Fogarty, and Craig Poisson. Thank you both so very much for your humor, assistance, encouragement, and emotional support (which included lending me an ear when necessary)!
Thank you to my two closest friends and confidants back in
California, Craig Castle, and Paul Salazar. Without "Boots", you know how much your friendship has meant to me! And to
Paul, you will always stand tall in my mind.
Thank you to all of the student-athletes who agreed to participate in my study, and to the athletics directors and coaches who gave me the necessary permission. A very special thank you to the athletic trainers who served as liaisons throughout my study, and also for helping me collect the posttest data when necessary. I only wish I could mention you by name, but you know who your are. Also, to the student-athletes I worked with over the years at St. Ambrose
University and Cal State Northridge. You helped inspire me to learn more about the psychological consequences associated with athletic injury.
Most of all, I would like to thank my grandmother,
Maxine Nathanson, and my father, William R. Miller, for their unconditional love and support!
December 1997 W.N.M. V
Table of Contents
Page
Dedication ii
Acknowledgments iii
List of Tables viii
List of Figures x
Abstract 2
Introduction 3
Method 9
Participants 9
Measuring Instruments 10
Profile of Mood States 10
Personal Views Survey 12
Procedures 15
Statistical Analyses 17
Results 18
Profile of Mood States 18
Personal Views Survey 23
Relationship between POMS and PVS 25
Discussion 27
References 40
Appendix A. RESEARCH DESIGN 62
Statement of the Problem 63
Definition of Terms 63
Delimitations 67 VI
Page
Appendix A. RESEARCH DESIGN (continued)
Limitations 68
Hypotheses 68
Appendix B. REVIEW OF LITERATURE 71
Psychological Response to Athletic Injury 75
Models of Athletic Injury 79
Stage Models 80
Cognitive Appraisal Models . . 82
Interactive Models 87
Emotional Response to Athletic Injury 93
Profile of Mood States 104
Test Development 105
Validity and Reliability of the POMS 106
POMS and Athletic Injury 110
The Hardiness Construct 118
Definition and Theory of Hardiness 118
Hardiness and Executives 124
Hardiness in Sport and Exercise 131
Personal Views Survey 137
Validity and Reliability of the PVS 141
Appendix C. INFORMED CONSENT 146
Appendix D. PROFILE OF MOOD STATES 148
Appendix E. PERSONAL VIEWS SURVEY 152
Appendix F. LETTER TO THE ATHLETICS DIRECTORS .... 157 vii
Page
Appendix G. LETTER TO THE COACHES 159
Appendix H. LETTER TO THE ATHLETIC TRAINERS 161
Appendix I. DEMOGRAPHIC FORM 163
Appendix J. ATHLETIC INJURY QUESTIONNAIRE 164
Appendix K. RAW DATA 165
Appendix L. ADDITIONAL STATISTICAL TABLES 180
BIBLIOGRAPHY 190 Vlll
List of Tables
Table Page
1. Demographic Information for the Overall Sample . 50
2. Demographic Information for the Posttest Sample 51
3. Observed Means and Standard Deviations on the POMS Subscales for Injured and Noninjured Athletes Pre and Posttest . . 52
4. Observed Means and Standard Deviations on the PVS Subscales and Total Hardiness for Injured and Noninjured Athletes 53
5. Description of the Specific Injuries for the Injured Group 180
6. Mean T Scores and Minimum and Maximum T Scores on the POMS Subscales for Injured and Noninjured Athletes Pre and Posttest ...... 181
7. Basic Assumptions for the Two-Way, Mixed Factorial MANOVA 182
8.2x2 MANOVA Comparing Scores on the 6 POMS Subscales for Injury Status and Time of Assessment for Intercollegiate Athletes 183
9. Posttest Univariate F Ratios Comparing Injured and Noninjured Intercollegiate Athletes on the Six Subscales of the POMS 184
10. Injured Group Univariate F Ratios Comparing Scores on the Pretest and Posttest Administrations of the Six POMS Subscales .... 185
11. 2x2 ANOVA with Repeated Measures on One Factor Comparing POMS Total Mood Disturbance Scores for Injured and Noninjured Athletes at Pretest and Posttest 186
12. Simple Effects Tests for Total Mood Disturbance Across Time of Assessment (A Factor) and Injury Status (B Factor) 187 IX
List of Tables (continued) Page
13. Basic Assumptions for the One-Way, Independent Groups MANOVA 188
14. Independent Groups i-Test'Comparing Hardiness for Injured and Noninjured Intercollegiate Athletes-- 189 X
List of Figures
Figure Page
1. A line graph depicting the profile of POMS scores for injured and noninjured athletes at pretest and posttest 54
2. The interaction chart of the mean 'Vigor-Activity' scores 55
3. The interaction chart of the mean 'Anger-Hostility' scores 56
4. An interaction chart for the mean POMS Total Mood Disturbance Scores 57
5. A scattergram depicting the relationship between the baseline measurements of Total Mood Disturbance and Hardiness among athletes in the sample 58
6. A scattergram depicting the relationship between postinjury Total Mood Disturbance and Hardiness among injured athletes 59
7. A scattergram excluding the outlier data, depicting the relationship between postinjury Total Mood Disturbance and Hardiness among injured athletes 60
8. A line graph depicting the profile of POMS scores for the total pretest sample of athletes in the present study, compared to the typical iceberg profile 61 Athletic Injury 1
Running head: MOOD DISTURBANCES AND HARDINESS OF ATHLETES
Athletic Injury: Mood Disturbances
and. Hardiness of Intercollegiate Athletes
William N. Miller
Springfield College Athletic Injury 2
Abstract
In a prospective study, postinjury mood disturbances, in, addition to levels of hardiness, and the relationship between hardiness and mood disturbances, were examined.
Among 244 male and 92 female intercollegiate athletes from the sports of lacrosse and track and field, 24 sustained injuries lasting a minimum of 2 days. The participants completed a demographic form, the POMS, and the PVS during the early season. Following injury of at least two days in length, the POMS was completed again by the injured athletes in addition to noninjured athletes selected to serve as a comparison. Following a multiple comparison analysis for a significant 2x2 mixed factorial MANOVA interaction, injured athletes were found to incur decreased levels of
'Vigor-Activity' from pretest to posttest, in addition to lower levels than noninjured athletes at posttest. Injured athletes also incurred increased levels of 'Anger-Hostility' from pretest to posttest. However, the noninjured group reported similar scores on these constructs from pretest to posttest assessments. No differences were found in levels of hardiness, or the three subscales of hardiness of injured and noninjured athletes. Regarding the relationship between hardiness and mood disturbances, as individual levels of hardiness increased levels of mood disturbance decreased for the total sample (n = 336). Athletic Injury 3
Athletic Injury: Mood Disturbances
and Hardiness of Intercollegiate Athletes
Injury is common in sport with an estimated 12 million sport related injuries treated annually by physicians in the t United States (Steele, 1996). The prevention and care of athletic injuries has historically emphasized physical attributes (Petitpas & Danish, 1995; Rose & Jevne, 1993;
Wiese-Bjornstal, Smith, & LaMott, 1995). The assumption has been made that when an athlete is physically rehabilitated, he/she is fully prepared to safely return to physical activity. However, in addition to physical injury, athletes are at risk for suffering psychological consequences attributable to injury (Pero, 1995), and in fact, rehabilitation can be hampered by the emotional state of the athlete (Pearson & Jones, 1992). Larson, Starkey, and
Zaichkowsky (1996) reported that 47% of 482 athletic trainers surveyed, postulated that every injured athlete suffers from psychological as well as physiological trauma.
Several researchers have indicated that physical and psychological aspects of rehabilitation must be addressed in the future (Rotella & Heyman, 1986; Wagman & Khelifa, 1996;
Wiese & Weiss, 1987), with athletic trainers playing a central role in this relationship (Smith & Milliner, 1994).
Researchers have postulated that athletes experience a variety of emotional responses following injury. The Athletic Injury 4 emotions may include anger (Danish, 1986; Gordon, Milios, &
Grove, 1991; LaMott, 1994; Quackenbush & Crossman, 1994), alienation (Ermler & Thomas, 1990; Thomas & Rintala, 1989), anxiety (Astle, 1986; Petitpas & Danish, 1995), depression
(Brewer, 1993; Brewer, Linder, & Phelps, 1995; Gordon et al•, 1991), disbelief (Wagman & Khelifa, 1996; Weiss &
Troxel, 1986), fear (Pearson & Jones, 1992; Petitpas &
Danish, 1995), frustration (Wagman & Khelifa, 1996; Wiese- t Bjornstal et al., 1995), decreased self-esteem (Brock &
Kleiber, 1994; Smith, Scott, O'Fallon, & Young, 1990), decreased levels of vigor (Albert, McShane, Gordin, &
Dobson, 1988; Chan & Grossman, 1988; Smith et al., 1993), among others. Researchers have attempted to synthesize and elaborate on the preceding emotional responses to athletic injury with various models (Weiss & Troxel, 1986; Wiese-
Bjornstal et al., 1995; Wiese & Weiss, 1987).
Several models proposing to explain the emotional consequences of athletic injury have been reported in the literature. LaMott (1994) and Wiese-Bjornstal et al. (1995) suggested that earlier research on the emotional responses to injury was described in terms of stage models. Several researchers have implied that injured athletes pass through a sequence of predictable psychological reactions similar to the grief response outlined in 1969 by Ktibler-Ross (Danish,
1986; Gieck, 1990; Gordon et al., 1991; Rotella, 1988; Athletic Injury 5
Rotella & Heyman, 1986). Brewer (1994) suggested that cognitive appraisal models explain individual differences not accounted for by stage models. Several researchers have proposed cognitive appraisal models relevant to athletic injury (Moos & Tsu, 1977; Rose & Jevne, 1993; Weiss &
Troxel, 1986; Wiese & Weiss, 1987). A recent trend in models of emotional response to injury, focus on the complex interaction of variables affecting the injured athlete
(Wiese-Bjornstal et al., 1995). In addition to cognitive appraisal, additional factors such as moderating and mediating variables are considered (Wiese-Bjornstal et al.,
1995). Wiese-Bjornstal et al. (1995) considered moderating variables "antecedent conditions (e.g., personality, gender, race, socioeconomic class), which interact with other conditions (e.g., injury) to produce an outcome (e.g., negative emotional response)" (p. 18). They explained that
"mediating variables are generated in the encounter (e.g., positive interactions with the sportsmedicine team) and change the relation between the antecedent (e.g., anxious personality) and outcome variables (e.g., positive emotional response)" (p. 18).
Several investigations have retrospectively found that athletes indicated some degree of negative emotional response following injury. LaMott (1994) reported significant emotional response at presurgery, and at 12 Athletic Injury 6 weeks postsurgery for athletes who had torn anterior cruciate ligaments. McDonald and Hardy (1990), Brock and
Kleiber (1994), and Smith et al. (1990) recognized significant negative emotions for athletes who had incurred serious injuries. Negative emotional responses have also been reported retrospectively for intercollegiate athletes
(McGowan, Pierce, Williams, & Eastman, 1994; McDonald &
Hardy, 1990), recreational athletes (Quackenbush & Crossman,
1994), highly competitive athletes (Gyurcsik, 1995), and various combinations of athletic level and team affiliations
(Chan & Grossman, 1988; Smith et al., 1990; Uemukai, 1993).
Smith et al. (1993) and Leddy, Lambert, and Ogles (1994) eluded to the importance of prospective research designs, indicating that little association can be made between injury and subsequent emotional responses without preinjury data comparisons. To date, only a few investigations have been conducted prospectively, whereby preinjury data were collected prior to injury. Of the prospective designs, in three studies some degree of negative emotional response following injury was identified (Albert et al., 1988; Leddy et al., 1994; Smith et al., 1993).
The degree of emotional response following athletic injury will vary from athlete to athlete (Gieck, 1990; Rose
& Jevne, 1993; Wiese, Weiss, & Yukelson, 1991). Some researchers have postulated that certain personality Athletic Injury 7 variables such as hardiness may impact the emotional response following injury (Brewer, 1994; Grove, 1993; Wiese-
Bjornstal et al., 1995). Athletes possessing higher levels of hardiness may demonstrate lower emotional responses following injury (Grove, 1993). The relationship between hardiness and emotional response following athletic injury, may have practical relevance when implementing rehabilitation programs for injured athletes.
The concept of hardiness was introduced by Kobasa
(1979). As suggested by Maddi and Hess (1992), hardiness is
"a configuration of beliefs about self and world, involving a sense of control, commitment, and challenge, that could protect physical health despite stressful circumstances" (p.
360). From retrospective (Kobasa, 1979) and prospective
(Kobasa, Maddi, & Kahn, 1982) investigations, Kobasa (1979) and Kobasa et al. (1982) indicated that hardiness may have a buffering effect against illness for individuals under stress. Hardiness has been proposed to affect the stress response by altering the appraisal of a stressor (Kobasa,
1982), and by effective transformational coping (Maddi,
1987). A majority of the research on hardiness has focused on stressful life events and illness among various groups
(Goss, 1994). Investigations of hardiness in the sport and exercise literature have been sparse. Stress resistance
enhancing effects of fitness and hardiness (Roth, Wiebe, Athletic Injury 8
Fillingim, & Shay, 1989), performance effectiveness of hardiness in basketball players (Maddi & Hess, 1992), hardiness and precompetitive mood state temporal patterning among, rifle shooters (Prapavessis & Grove, 1994), hardiness and mood disturbances in overtrained swimmers (Goss, 1994), and hardiness level and emotional response to athletic injury (Grove, 1993) have been previously reported.
Since research dealing with hardiness and athletic injury has been limited, and coupled with the lack of prospective designs assessing emotional response to injury, the present investigation was warranted. Several substantive hypotheses were examined in the present study. Injured athletes would experience a greater amount of mood disturbance following injury than noninjured athletes. The postinjury group was hypothesized to experience a greater amount of mood disturbances than the preinjury group. An
interaction was hypothesized between injury status and time of assessment. Injured athletes would report lower levels of
'Challenge', 'Commitment', and 'Control', than noninjured
athletes. Injured athletes would report lower levels of hardiness than noninjured athletes. A negative relationship was anticipated between levels of hardiness and mood
disturbances for the total sample of athletes at the early
season assessment. A negative relationship was anticipated
between levels of hardiness and mood disturbances for Athletic Injury 9 injured athletes after the postinjury assessment.
Method
The Profile of Mood States (McNair, Lorr, & Droppleman,
1971) was utilized to determine postinjury mood disturbances of intercollegiate track and field, and lacrosse athletes.
In addition, the role of hardiness as assessed by the
Personal Views Survey (Maddi, 1987), was examined regarding the postinjury mood disturbances of athletes. The research design was twofold including quasi-experimental and correlational procedures. The following section will elaborate further on the participants, measuring instruments, procedures, and statistical analyses of the investigation.
Participants
The Blue Book of College Athletics (1996) was used to assist the researcher in inviting athletes from schools within a 45 mile radius from Springfield, Massachusetts to participate in the study. The colleges and universities within the closest proximity were first invited to participate. As several schools declined to participate, the radius increased progressively to an 80 mile radius from
Springfield. Participants for the study consisted of 240
(148 male, 92 female) intercollegiate track and field
athletes, and 96 men's intercollegiate lacrosse athletes
from nine colleges and universities throughout Connecticut Athletic Injury 10 and Massachusetts. Of the total pretest sample of 336, 135
(113 male, 22 female) represented National Collegiate
Athletic Association (NCAA) Division I institutions, 13 (all male) represented NCAA Division II institutions, and 188
(118 male, 70 female) represented NCAA Division III institutions. Demographic information for the overall sample is listed in Table 1. A 7.1% injury rate was observed including 24 injured and 312 noninjured athletes. Noninjured athletes were randomly matched to comprise a control group of 24 participants. Demographic information for the posttest sample is listed in Table 2. Participants were all between the ages of 18 and 24 years old. The participants were volunteers, with each participant completing an informed consent form prior to the data collection (Appendix C).
Measuring Instruments
Instrumentation for the study consisted of two psychological measures. Mood disturbances of intercollegiate athletes were measured by the outpatient version of the
Profile of Mood States (POMS) (McNair, Lorr, & Droppleman,
1971). Hardiness of intercollegiate athletes was measured by the Personal Views Survey (PVS) (Maddi, 1987).
Profile of Mood States. The outpatient version of the
POMS (Appendix D) is a 65-item measure which assesses the
six mood characteristics of 'Tension-Anxiety', 'Depression-
Dejection', 'Anger-Hostility', 'Vigor-Activity', 'Fatigue- Athletic Injury 11
Inertia', and 'Confusion-Bewilderment' (McNair et al.,
1971). The POMS items are rated on a 5-point rating scale with response choices ranging from 0 "not at all" to 4
"extremely". McNair, Lorr, and Droppleman (1992) acknowledged that the POMS is easily administered, with most participants completing the inventory in a short period of time. Besides the six subscale scores, a Total Mood
Disturbance (TMD) score may be obtained by adding the negative mood factors of 'Tension-Anxiety', 'Depression-
Dejection', 'Anger-Hostility', 'Fatigue-Inertia', and
'Confusion-Bewilderment' and subtracting the score of the positive mood factor of 'Vigor-Activity' from the sum
(McNair et al., 1992).
The POMS was selected for use in this study for two reasons. The POMS has been used frequently in sport psychology research (Henderson, Bourgeois, LeUnes, & Meyers,
1995; Snow & LeUnes, 1994), with Leddy et al. (1994) adding that, for the most part, quantitative measurement regarding the emotional impact of athletic injury has been assessed by the POMS. A few of the studies in which the POMS has been utilized in such a capacity are Chan and Grossman (1988),
McDonald and Hardy (1990), Smith et al. (1990), and Smith et al. (1993).
Secondly, the POMS has demonstrated evidence of validity and reliability (McNair et al., 1992; Peterson & Athletic Injury 12
Headen, 1984). Peterson and Headen (1984) reported that six factor analysis investigations revealed that the factor loadings of the six POMS subscales loaded consistently on the proposed factors, demonstrating factorial validity.
McNair et al. (1992) stated that the items for each subscale support the content validity of the factor scores. LeUnes,
Hayword, and Daiss (1988) added to the face validity by reporting that 56 publications used the POMS with the sport population between 1975 and 1988. McNair et al. (1992) implied that evidence for construct validity has accumulated as the fields of research commonly using the POMS has grown.
In addition, McNair et al. (1992) implied that the POMS has been correlated with similar measures, illustrating concurrent validity. Regarding reliability, McNair et al.
(1992) reported internal consistency reliability ranged from
.84 to .95, and test-retest reliability ranged from .65 to
.74. Although the test-retest reliability values appear somewhat low, McNair et al. (1992) commented that the values are difficult to assess since state measures are expected to be inconsistent over two test administrations.
Personal Views Survey (PVS). The PVS (Appendix E), or third generation hardiness measure, emerged while improving upon the validity and reliability of the first and second generation measures (Maddi, 1987, 1990; Orr & Westman,
1990). The PVS is composed of 50 items of which 17 measure Athletic Injury 13 the subscale of 'Challenge', 17 measure the subscale of
'Control', and 16 measure the subscale of 'Commitment'
(Kelley, 1994) . A Total Hardiness score is obtained by summing the scores from each of the three subscales. The format of the PVS is that of a Likert scale ranging from 0
(not at all) to 3 (completely true). Each dimension of hardiness has positive and negative indicators (Maddi, 1987,
1990). Coinciding with what was done previously by Maddi and
Hess (1992), six items of the PVS were slightly modified to accommodate the specific sample of intercollegiate athletes.
Generally, the wording for six questions was changed from
"spouse" to "teammate", and from "work" to "school/work". In addition, two items were changed from "he" to "he/she", and
"him" to "him/her" to equally recognize both genders in the sample.
Ouellette (1993) suggested that the PVS is presently
the most psychometrically sound hardiness instrument
available. Several researchers have reported that factor
analysis has consistently revealed the proposed three
factors of hardiness: commitment, control, and challenge
(Bartone, 1989; Kelley, 1994; Maddi, 1987; Ouellette, 1993).
In addition, Campbell, Amerikaner, Swank, and Vincent (1989)
added that commitment explained 23% of the variance, control
64% of the variance, and challenge 13% of the variance.
Campbell et al. (1989) provided evidence for construct Athletic Injury 14 validity by comparing the PVS to the Personal Orientation
Inventory (POI) (Knapp, 1976). Campbell et al. (1989) reported a significant correlation of .35 between the PVS and the 'Time Competence' subscale of the POI, suggesting that the PVS and POI are measuring some similar aspects of personality. In addition, Maddi and Khoshaba (1994) stated that the PVS has correlated at .93 with the second generation hardiness measure, and at .71 when only nonredundant items were used.
Ouellette (1993) noted that the PVS has internal consistency and stability. Alpha coefficients ranging between .70 and .84 for the three subscales of the PVS have been reported (Bartone, 1989; Maddi, 1987; Maddi & Khoshaba,
1994; Okun, Zautra, & Robinson, 1988), and between .84 and
.90 for the Composite Hardiness score (Campbell et al.,
1989; Kelley, 1994; Maddi, 1987; Okun et al., 1988; Orr &
Westman, 1990). Stability coefficients have been reported in
the ,60's over periods of 2 weeks or more (Falb, 1995;
Thompson, 1992), and with a 6-week time interval (Kelley,
1994). Moreover, the instrument correlates well with previous measures of hardiness, and provides replications of
the results from earlier studies which utilized different measures (Ouellette, 1993). In addition, with the slightly modified wording of the PVS, Maddi and Hess (1992) reported
alpha coefficients of .81, .77, .83, and .81 for Athletic Injury 15
'Challenge', 'Commitment', 'Control', and the Composite
Hardiness score, respectively.
Procedures
The names for the athletics directors, coaches, and athletic trainers to be contacted were obtained from the
Blue Book of College Athletics (1996). The athletics director, track and field coach/coaches, and men's lacrosse coach for each institution selected were sent a letter
(Appendices F, G) requesting permission to conduct the investigation at their respective institution, and with their respective team. Once permission was granted, the researcher contacted by telephone the head coach/coaches to set up a time to meet with the team. As soon as permission was obtained from the athletics director and head coach/coaches, the researcher contacted by letter (Appendix
H) and follow-up telephone call the appropriate athletic trainers. The athletic trainers were asked if they were willing to assist with the investigation. Essentially, the athletic trainers served as the liaisons throughout the investigation, and were offered a small honorarium for their assistance. The initial data collection period occurred during the first few weeks of official practice for the respective teams. Upon completion of the informed consent form (Appendix C), the participants completed a demographic form (Appendix I), the POMS (Appendix D) (McNair et al., , Athletic Injury 16
1971), and the PVS (Appendix E) (Maddi, 1987). To be eligible for the study, the participants had to be free from any time-loss injury which limited them from full participation with their team. The injury status for each participant was obtained from the demographic form. If a participant acknowledged a current injury limiting full participation, he/she was eliminated from the study.
Participants who completed the preseason inventories, and subsequently missed 2 consecutive days from full sport participation due to athletic injury, completed the POMS
(McNair et al., 1971) once again as soon after the 2 days missed as feasible. The responsible athletic trainer completed the athletic injury questionnaire (Appendix J) during the postinjury data collection. Once an injured athlete had met the delimitation criterion, the investigator or athletic trainer had the participant complete the second
POMS administration as soon after the 2 days following injury as feasible. Additionally, a noninjured participant was randomly selected at this point to complete the POMS for a second time, in order to serve as a noninjured comparison.
For a sport such as track and field, the control participant was randomly selected from a similar event (distance, sprints, field events) as the injured participant. Once an injured and noninjured pair of participants completed the second POMS administration, they were eliminated from any Athletic Injury 17 further data collection.
Statistical Analyses
The statistical analyses followed the procedures contained in the Statistical Package for the Social Sciences
(SPSS) for Windows software programs (Norusis, 1993; 1994).
A 2 x 2 mixed factorial multivariate analysis of variance
(MANOVA) was used to compare the mean vector of the six POMS
(McNair et al., 1971) subscale scores for two independent variables. The two independent variables were injury status
(injured and noninjured), and time of assessment (preinjury and postinjury). A 2 x 2 mixed factorial analysis of variance (ANOVA) was used to compare the mean Total Mood
Disturbance scores between injury status and'time of assessment. A one-way MANOVA was used to compare the mean vector of the three PVS (Maddi, 1987) subscale scores for injured and noninjured athletes. An independent groups t- test analysis was used to compare the mean Hardiness scores between injured and noninjured athletes. A Pearson product moment correlation analysis was used to determine the relationship between Hardiness level and baseline measurements of Total Mood Disturbance among intercollegiate athletes. A Pearson product.moment correlation analysis was used to determine the relationship between baseline
Hardiness level and postinjury Total Mood Disturbance among injured intercollegiate athletes. Athletic Injury 18
Results
A total of 244 male and 92 female intercollegiate
athletes from the sports of track and field and lacrosse
participated in the investigation. Of the 336 participants, Uv .. , 48 (24 injured, 24 noninjured) were included in the posttest
data analysis. Raw data for the study are presented in
Appendix K. Descriptive statistics for the demographic
variables of age, previous injuries, class year, gender,
sport, and division level for the overall sample are
presented in Table 1. Descriptive statistics for the
demographic variables of class year, gender, sport, and
division level for the posttest sample are presented in
Table 2. A description of the specific injuries for the
injured group are listed in Table 5 of Appendix L.
Profile of Mood States
A 2. x 2 mixed factorial MANOVA was utilized to compare
the mean vector of the six POMS (McNair et al., 1971)
subscale scores for the two independent variables of injury^
status and time of assessment. The observed means and
standard deviations on the POMS subscales for injured and
/ ' noninjured athletes at pretest and posttest are listed m / \ / Table 3. The mean T scores and minimum and maximum T scores V ' on the POMS Subscales fqr injured and noninjured athletes at
pretest and posttest^are\isted in Table 6 of Appendix L. A
summary Table with the MANOVA basic assumption tests are Athletic^Injury 19 presented in Table 7 of Appendix L. The LBattiett-Box test was computed to test the basic assumption of univariate homogeneity of variance for each of the six subscales of the ^ POMS (McNair et al.> 1971). The univariate Bart-iett-Bex £ ratios for both the pretest and posttest assessments of the six POMS subscales comparing the variances of injured to / ... noninjured athletes were net significant (p ^..05),^ indicating that homogeneityiity of variance for she- two groups (fa Mi* -W had been met. The Box M JT^ratio was 1.497 (p = .003) indicating heterogeneity oMlt\4^variince-covariance matrices of injured and noninjured athletes. The Bartlett Test of
Sphericity for the correlation matrix of the six dependent variables was significantly different (p = ,.000) from the 4* identity matrix, indicating the correlations among the six C* dependent variables were significantly different from zero, violating the assumption of sphericity. The results of the
MANOVA are presented in Table 8 of Appendix L. A line graph depicting the profile of POMS scores for injured and noninjured athletes at pretest and posttest is presented in
Figure 1. The Wilks' Lambda for the interaction between injury status and time of^assessment was significant (p =
. J ' .046). The effect size for /fihe interaction indicated that
of the variability of^/the POMS (McNair et al., 1971) scores were explained by/thS cell mean differences.
\ Due to the significant interaction on the 2x2 mixed v\ Athletic Injury 20 factorial MANOVA, two separate independent groups MANOVA's, and two separate repeated measures MANOVA's, were conducted in order to find where the significant interaction occurred comparing injury status and time of assessment. The independent groups Wilks' Lambda value for the six subscales of the POMS comparing injured and noninjured athletes at pretest was not significant. Thus, no.significant differences were found in the mean vector of scores for injured and noninjured athletes at the POMS pretest, A =
.81, F = 1.61, Table F (6, 41) - 2.33, p = .168, cc2= .191.
The independent groups Wilks' Lambda value for the six subscales of the POMS comparing injured and noninjured athletes at posttest was significant. Thus, significant differences were found in the mean vector of scores for injured and noninjured athletes at the POMS posttest, A =
.74, F = 2.36, Table F (6, 41) = 2.33, p = .048, cc2= .257.
The individual univariate F ratios for five of the six subscales were not significant (p > .05). However, the univariate F ratio for the subscale of 'Vigor-Activity' was significant (p = .017), with injured athletes reporting less
'Vigor-Activity' than noninjured athletes. The posttest univariate F ratios comparing injured and noninjured athletes on the six POMS subscales are presented in Table 9 of Appendix L. The interaction chart of the mean 'Vigor-
Activity' scores is presented in Figure 2. Athletic Injury 21
The repeated measures Wilks' Lambda value computed for the six subscales of the POMS comparing pretest to posttest
for noninjured athletes was not significant. Hence, no
significant differences were found in the mean vector of
scores between pretest and posttest administrations of the
POMS for noninjured athletes, A = .71, F = 1.25, Table F (6,
18) = 2.66, p = .328, cc2 = .294. The repeated measures
Wilks' Lambda value computed for the six subscales of the
POMS comparing pretest to posttest for injured athletes was
significant. Hence, significant differences were found in
the mean vector of scores between pretest and posttest
administrations of the POMS for injured athletes, A = .47, F
= 3.33, Table F (6, 18) = 2.66, p = .022, cc2 = .526. In
addition, the individual univariate F ratios for four of the
six subscales were not significant. However, the univariate
F ratios for the subscales of 'Anger-Hostility' (p = .003)
and 'Vigor-Activity' (p = .027) were significant. 'Anger-
Hostility' increased, whereas 'Vigor-Activity' decreased
following injury. The injured univariate F ratios comparing
scores from the pretest and posttest administrations of the
six POMS subscales are presented in Table 10 of Appendix L. ■■
The interaction chart of the mean 'Vigor-Activity' scores is
presented in Figure 2. The interaction chart of the mean
'Anger-Hostility' scores is presented in Figure 3.
A 2 x 2 mixed factorial ANOVA comparing POMS Total Mood Athletic Injury 22
Disturbance (TMD) scores for injured and noninjured athletes at pretest and posttest was utilized. The following basic \ ^ assumptions for the ANOVA were tested. The Bartlett-Box test was computed to examine the basic assumption of homogeneity of variance of TMD scores for injured and noninjured athletes. The Bartlett-Box F ratios for both the pretest (F
= .115; p = .735) and posttest (F = .001; p = .972) assessments of TMD comparing the variances of injured to noninjured athletes were not significant, indicating that homogeneity of variance for the two groups had been met. The
Box M F ratio was 1.551 (p = .199) indicating homogeneity of the variance-covariance matrices of injured and noninjured athletes. The results of the ANOVA are summarized in Table
11 of Appendix L. The interaction between injury s'tatus and time of assessment with regard to POMS TMD scores was significant (p = .024). The omega-squared value for the interaction (co2 = .013), indicated that 1.3% of the variability of the POMS TMD scores were explained by the interaction of injury status and time of assessment.
Due to the significant interaction on the 2x2 mixed factorial ANOVA, two separate simple effects tests were calculated to determine specifically where the significant interaction occurred. A summary of the simple effects tests for the interaction analysis are presented in Table 12 of 0 ;A » ' \ Appendix L. The simple effects test for time Of-^ssessment r Athletic Injury 23 according to levels of injury status—was not significant (p ^ 1 , - > .05). The simple effects test for- injury-status according to levels of time of assessment was not significant (p > ■
.05). An interaction chart for the mean POMS Total Mood
Dirsturbance Scores is presented in Figure 4. Overall, no significant differences were found from'the/simple effects tests across the four comparisons. Although the overall explained variability from the 2 x 2 mixed factorial ANOVA was significant, no significance was found from the pairs in the post hoc simple effects tests. As interpreted from the omega-squared value, 1.3% of the variability of the POMS TMD scores were explained by the interaction of injury status and time of assessment. Since the total amount of variation in TMD scores is due to the treatment effect plus random factors (Grimm, 1993), 98.7% of the variation in the present analysis was attributable to random factors. ,
Personal Views Survey
A one-way MANOVA was utilized to determine the differences in the mean vector of scores for the three PVS
(Maddi, 1987) subscales of 'Challenge', 'Commitment', and
'Control' with respect to injured and noninjured athletes.
The observed means and standard deviations on the PVS subscales and total hardiness for injured and noninjured athletes are presented in Table 4. Various basic assumptions for the MANOVA were tested. The Bartlett-Box test was Athletic Injury 24 computed to examine the basic assumption of homogeneity of variance for each of the three subscales for injured and noninjured athletes. For the three subscales, the Bartlett-
Box F ratios were not significant (p > .05), indicating homogeneity of variance for the scores of injured and noninjured athletes. The Box M F value was 1.917 (p = .074), indicating that the variance-covariance matrices for injured and noninjured athletes were not significantly different from one another. The value for the Bartlett Test of
Sphericity was 37.113 (p = .000), indicating that the correlation matrix for the three dependent variables was significantly different from the identity matrix, violating the assumption of sphericity. The basic assumptions tests are summarized in Table 13 of Appendix L. The Wilks' Lambda value computed for the three PVS (Maddi, 1987) subscales of
'Challenge', 'Commitment', and 'Control' was not significant indicating that no differences were found in the mean vector of scores for injured and noninjured athletes, A = .94, F =
.95, Table F (3, 44) = 2.82, p = .423, cc2= .061. The effect size indicated that 6.1% of the variability of the
PVS (Maddi, 1987) scores were explained by the group differences.
An independent groups £-test analysis was utilized to determine the mean difference in the PVS Composite Hardiness scores between injured and noninjured athletes. No Athletic Injury 25 significant mean difference (p = .174) was found between injured and noninjured athletes. The results of the
independent groups i-ratio analysis are presented in Table
14 of Appendix L.
Relationship Between POMS and PVS
A Pearson product moment correlation analysis was used !' to determine the relationship between the baseline measurements of-Total Mood Disturbance and Hardiness among
the athletes in the sample (N = 336). A significant negative
correlation was found*,/' r = -.57, Table r (334) = .195, p =
.oilo'. A scattergram depicting the relationship between the
baseline measurements of Total Mood Disturbance and
Hardiness among the athletes in the sample is displayed in
Figure 5. A Pearson product moment correlation analysis was
\ used to determine the relationship between postinjury Total
Mood Disturbance and Hardiness among injured athletes (n =
24). A significant negative correlation was found, r = -.50,
Table r (22) = .423, p = .014. A scattergram depicting the
relationship between postinjury Total Mood Disturbance and
Hardiness among injured athletes is displayed in Figure 6.
Upon review of the scattergram an outlier was noted. The
dilemma of the researcher was what to do with such an
outlier. As noted by Grimm (1993), outliers should not
simply be discarded due to their inconsistency with other'
data. But as Grimm (1993) advised, "if the outlier does make Athletic Injury 26 a difference, the researcher may be justified in basing conclusions on the analysis conducted without the outlier"
(p. 387). The raw data for the outlier was reviewed by the researcher in order to see if any errors had been made when entering the data onto the data chart. When no errors were found, a Pearson product moment correlation analysis was conducted after removing the data of the specific participant. After removing the data from the outlier, the negative correlation was not significant, r = -.27, Table r
(21) = .423, p = .220. A scattergram excluding the outlier data, depicting the relationship between postinjury Total
Mood Disturbance and Hardiness among injured athletes is displayed in Figure 7. As demonstrated by the correlation analyses with and without the outlier, the strength of association between postinjury Total Mood Disturbance and
Hardiness varies considerably. The relatively small number in the sample magnifies the concern, along with the restricted range of scores for the injured group. As noted by Grimm (1993), "restricted ranges have a tendency to reduce the correlation" (p. 383) . In the present study, the outlier appears to have a rather large effect on the analysis, so the conclusions for this study will be based on the results without the outlier. Out of curiosity, the researcher contacted by telephone the coach of the respective athlete whose data represented the outlier. First Athletic Injury 27 of all, the coach did not feel the specific injury, nor the
athletes' history of injuries, had an effect on the
responses to the POMS and PVS instruments. The coach mentioned that the athlete has an extreme personality and
added that the athlete tends to catastrophize over most
events in life. The coach summarized by stating that this
particular individual "makes mountains out of molehills".
Discussion
Mood disturbances of intercollegiate athletes both
before and after injury were assessed in this study. In
addition, levels of hardiness,- and the relationship between
hardiness and mood disturbances, were evaluated. The
findings of the study may be summarized as follows. The
f'' interaction of injury status (injured, noninjured) and time
of assessment (pretest, posttest) regarding mood
disturbances was significant. Following a multiple
comparison analysis, the significant interaction was found
to be attributable to the subscales of 'Vigor-Activity' and
'Anger-Hostility'. At posttest, 'Vigor-Activity' was lower
for the injured group in comparison to the noninjured group.
'Vigor-Activity' was also found to decrease between pretest
and posttest for the injured group. In addition, 'Anger-
Hostility' increased between pretest and posttest for the
injured-group. No significance was found between groups,
within groups, or from the interaction for the subscales of Athletic Injury 28
'Tension-Anxiety', 'Depression-Dejection', 'Fatigue-
Inertia', and 'Confusion-Bewilderment'. Regarding hardiness,
the Total Hardiness score and the PVS subscales of
'Challenge', 'Commitment', and 'Control' were similar for
injured and noninjured athletes. In addition, as individual
levels of hardiness increased there was a tendency for mood
disturbance levels to be lower for the total sample of
intercollegiate athletes. interaction was found to have occurred, al'ttraughr-i1r'is dif fi-cult~to.-draw~fr.om- these - results-specific-conclusions for—th-e—present_.study. The quandary was determining where the significant interaction occurred. The interaction chart presented in Figure 4, may—illuminate-this-concern. The premise for the hypothesis that an interaction would occur on the 2x2 mix-ed factorial ANOVA was based on two issues drawn from the literature. First, the pretest POMS TMD scores were expected to be similar between groups. Secondl-y, the posttest POMS TMD scores were expected to be similar tq pretest POMS TMD scores for noninjured athletes, but would (H^crease for injured athletes'. The hypothesis suggested an ordinal interaction. With the lines crossing, the resulting interaction was disordinal. An explanation may be that the interaction, although significant, was not significant enough for significance to be found when isolated post hoc Athletic Injury 29 simple effects tests were conducted. As indicated from the omega-squared value, 1.3% of the variability of the POMS TMD scores were explained by the interaction of injury status and time of assessment. The remaining variability of 98.7% was found to be attributable to random factors. The present findings regarding mood disturbance associated with athletic injury are similar to those of ( ! previous studies. Several investigators have retrospectively ' ' . - * indicated some degree—of negative affect following injury (Brock & Kleiber, 1994; LaMott, 1994; McDonald & Hardy, 1990; Smith et al., 1990). In addition, of the few prospective designs conducted, within three there was reported some degree of negative affect following injury (Albert et al., 1988; Leddy et al., 1994; Smith et al., 1993). When looking at the variables individually, increased 'Tension' (Albert et al., 1988; Chan & Grossman, 1988), 'Depression' (Chan & Grossman, 1988; Leddy et al., 1994; Pearson & Jones, 1992; Smith et al., 1990; Smith et al., 1993; Uemukai, 1993), 'Anger' (Chan & Grossman, 1988; Smith et al., 1990; Smith et al., 1993; Uemukai, 1993), 'Fatigue' (Albert et al., 1988), 'Confusion' (Chan & Grossman, 1988), and decreased levels of 'Vigor' (Albert et al., 1988; Chan & Grossman, 1988; Smith et al., 1993) have been documented. In the present investigation, the subscale of 'Vigor- Activity' changed significantly between the injured and Athletic Injury 30 noninjured athletes, and also between pretest and posttest for injured athletes. The finding of decreased 'Vigor- Activity' for the athletes who sustained injury in the l ’ • present study, has been documented in investigations (Albert et al., 1988; Chan & Grossman, 1988; Smith^et al., 1993). The subscale of 'Anger-Hostility' was also found to change significantly between pretest and posttest for injured \ athletes. The finding of increased 'Anger-Hostility' for the athletes who sustained injury in the present study, has been reported (Chan & Grossman, 1988; Smith et al., 1990; Smith et al., 1993; Uemukai, 1993). \ - As eluded to, the significant interaction for Total c Mood Disturbance is difficult to explain. This finding has not been documented in the literature. Although the tendency has been for injured athletes to have increased TMD following injury (Chan & Grossman, 1988; McDonald & Hardy, 1990), the question here arises with the noninjured groups' decrease in TMD between the pretest and posttest administrations of the POMS. In speculating, there may be a few reasons for this finding. First, the sample size (n = 48) was not as large as may have needed to be. Second, the pretest assessments were administered during the early portion of the lacrosse and outdoor track and field seasons, which may be a chaotic period of time for student-athletes. The present findings regarding hardiness are difficult Athletic Injury 31 to compare with other investigations since hardiness has been assessed in four other studies with athletes, and more specifically, once with injured athletes. No significant differences were found between injured and noninjured athletes regarding Total Hardiness or the three subscales of 'Challenge', 'Commitment', and 'Control'. This appears to be somewhat inconsistent with what has been reported in the stress-illness literature regarding the hardiness construct. As noted by Kobasa (1979) and Kobasa et al. (1982), in these studies individuals under stress with low levels of hardiness appear to be more prone to illness. On the basis of the stress-illness literature, it could be surmised that athletes with lower levels of hardiness would be more prone to injury than athletes with higher levels of hardiness. As acknowledged by Goss (1994), individuals with higher levels of hardiness are less apt to suffer detrimental effects associated with stress. Several researchers have theorized that detrimental effects of stress may contribute to the incidence of athletic injury (Andersen & Williams, 1988; LaMott, 1994; Wiese-Bjornstal et al., 1995). The literature suggests that differences in levels of hardiness should exist between injured and noninjured athletes, although this was not found in the present investigation. The relationship between hardiness and mood disturbances was consistent with previous findings. The Athletic Injury 32 significant negative correlation of -.57 for the total pretest sample of athletes was similar to what was reported (-.61) by Goss (1994) with 253 swimmers. As reported in the present study, the negative correlation was not significant between hardiness and mood disturbances for injured athletes. However, the trend was similar to what was reported by Grove (1993), where injured athletes with higher levels of hardiness reported significantly less overall mood disturbance than those with lower levels of hardiness. In conclusion, 'Vigor-Activity' decreases and 'Anger- Hostility' .increases following athletic injury. In addition, no differences in levels of hardiness existed between injured and noninjured athletes. For.athletes in general, mood disturbances tend to decrease as levels of hardiness increase. These findings demonstrate partial consistency with those reported by previous investigators. • The limitations of the investigation will be elaborated upon in the following. As recommended by Smith et al. (1990), the present investigation was an improvement upon previous methodology. A limitation of previous investigations was the collection of postinjury data with no baseline comparison. In the present study, preinjury data were collected to compare to the postinjury data. The concern that developed with the collection of pretest data, was the inherent shortcoming in establishing a large sample Athletic Injury 33 of injured athletes. For example, 336 participants completed the pretest administration of the questionnaires, with 24 meeting the 2 day injury delimitation. To gather an optimal posttest sample size, researchers may have to collect pretest data from 1000 or more athletes. In this study, in order to provide a stronger association between postinjury mood disturbances and athletic injury, posttest data were compared with a noninjured control group. The methodological issue of assessing such a unique and complex subjective phenomenon of mood disturbances, with objective psychometric instruments may be limiting. Although Leddy et al. (1994) acknowledged that, for the most part, quantitative measurement regarding the emotional impact of athletic injury has been assessed by the POMS, there still appear to be some drawbacks associated with such an approach. A better way to address such a complex and dynamic issue in the future may be accomplished by incorporating qualitative methodology in conjunction with the use of quantitative measurements such as the POMS for this type of study. The appropriateness of using the POMS may also be considered. Upon visual inspection of some of the pretest data, it appeared as if many of the participants had mood disturbances. The data was collected during the early portion of the lacrosse and outdoor track and field seasons. Athletic Injury 34 The term 'early season' was used rather than 'preseason' since preseason does not accurately reflect track and field because their outdoor season, in many cases, is an extension of their indoor season. Depending on when permission was granted to conduct the study, and the availability of the team to meet with the researcher, the pretest data were collected from the first week to the third week of official practice. In addition, some teams completed the questionnaires after practice, whereas others completed them before practice. The earlier portion of the season seems to be an extremely chaotic period of time for student-athletes, and may not serve as a valid time for pretest or baseline comparisons. In the future, attempts to control assessment time, perhaps a more appropriate alternative for a baseline comparison, such as during the off-season, could be selected. The POMS appears extremely sensitive to other issues which may also be influencing the individual, such as family concerns, relationship issues, examinations, etc. An observation apparent from the line graph depicting the profile of POMS scores for injured and noninjured athletes at pretest and posttest is in Figure 1. The typical profile of POMS scores for the athletic population reflect what Morgan (1980a) termed the 'iceberg profile', due to the inverted V or iceberg shape. With the iceberg profile, athletes typically score below the 50th T score on the Athletic Injury 35 subscales of 'Tension-Anxiety', 'Depression-Dejection', 'Fatigue-Inertia', and 'Confusion-Bewilderment', and above the 50th T score on the subscale of 'Vigor-Activity', when compared to normative data for nonathletes of comparable age and educational background (Morgan, 1980b). No mention was made of the 'Anger-Hostility' subscale and its role in the iceberg profile (McNair et al., 1992; Morgan, 1980a). As illustrated in Figure 1, the iceberg profile was not present in the posttest sample of athletes in the present study. Since Figure 1 represents the posttest sample (n = 48), a line graph depicting the profile of POMS scores for the total pretest sample of athletes in the present study (n = 336), compared to the typical iceberg profile (McNair et al., 1992) is presented in Figure 8. Similar to the posttest sample, the iceberg profile was not present in the pretest sample. A concern in this study relates to the nature of injuries that occurred to the participants during the investigation. The majority of the injuries were not serious. In addition, the posttest injury data were collected after an athlete missed the second day of his/her sport from injury. Due to logistic concerns, the posttest injury data may have been collected anytime from the second day to one week following injury. Also, the researcher was dependent upon the prevailing philosophy and evaluation Athletic Injury 36 skills of each athletic trainer. For example, a conservative athletic trainer may remove an athlete from participation due to a particular injury for one week, whereas another athletic trainer may treat the same type of injury while the athlete continues to participate. This will vary greatly, and much of this may also be attributable to the head coach, and the competitive level of the program. The present study contributes to the available literature regarding the inquiry of mood disturbances following athletic injury. In addition, the role of hardiness was examined with athletes in general, and specifically with injured athletes. The findings may also add some insight regarding the interactive emotional response to athletic injury model (Wiese-Bjornstal et al., 1995). One aspect of the model calls for additional research assessing personality variables such as hardiness and emotional response to injury. In the past decade more research has focused on the psychological ramifications associated with athletic injury. To date, a portion of understanding has been revealed. The variables influencing an individual's response to injury are numerous and need to be addressed separately before total understanding will occur. Some of the variables influencing the emotional response to injury include personality, coping resources, history of stressors, interventions, injury Athletic Injury 37 characteristics (severity, history, type), individual differences, sport specific situational factors and interactions with the sports medicine team (Wiese-Bjornstal et al., 1995). In addition, longitudinal approaches addressing these variables at various periods throughout recovery may provide further insight. A principal objective of the investigator was to provide insight to members of the sports medicine team concerning the psychological consequences associated with athletic injury. By better understanding the psychological aspects of athletic injury, treatment and rehabilitation of athletic injuries in the future will include psychological interventions in conjunction with the traditional physical rehabilitation. An additional consideration may be that not all injured athletes need psychological intervention. As stated by Udry (1997) "walking into a sports medicine clinic or athletic training room, . . . some athletes seem to take injuries 'in stride' and are able to put their injuries in perspective. In contrast, other individuals struggle more with the pain, loss of mobility, and sense of frustration that accompanies injuries" (p. 71). In this study, the finding of the pretest data whereby athletes with higher levels of hardiness had less total mood disturbances, may help explain the aforementioned quote. Although the posttest correlation for injured athletes was not significant, Grove Athletic Injury 38 (1993) reported that injured athletes with higher levels of hardiness incurred significantly less (p < .05) overall mood disturbances. If hardy athletes in general have less total mood disturbances as reported by Goss (1994), and also found in the present study, one may postulate a similar expectation for injured athletes. This may be valid since the personality construct of hardiness is considered a trait. Athletes with greater levels of resiliency, or hardiness, may be less traumatized psychologically with the injury experience, and resultingly have less negative affect associated with their injury. Athletes with lower levels of hardiness may benefit to a greater extent from psychological interventions. Sports medicine practitioners should be able to identify these athletes in order to implement a more effective, appropriate and complete rehabilitation program. As eluded to by Grove (1993), knowledge of the hardiness of an injured athlete, "will be useful to the extent that it helps practitioners anticipate and deal with the athlete's thoughts, emotions, and behaviors during rehabilitation" (p. 116). One recommendation for future research would be to focus on a practical assessment method whereby sports medicine practitioners would be able to readily identify injured athletes needing greater psychological assistance throughout their rehabilitation program. To date, no such Athletic Injury 39 assessment method exists. In addition, an assessment method to evaluate if a recovered athlete is psychologically ready to return to his/her sport seems warranted. Future research should aim at highlighting the practical application of research findings towards injured athletes in sports medicine clinics and/or athletic training rooms. Athletic Injury 40 References Albert, N. J., McShane, D., Gordin, R., & Dobson, W.. (1988). The emotional effects of injury on female collegiate gymnasts. Paper presented at the Seoul Olympic Scientific Congress, Seoul, South Korea. Andersen, M. B., & Williams, J. M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10, 294-306. Astle, S. J. (1986). The experience of loss in athletes. Journal of Sports Medicine, 26, 279-284. Bartone, P. T. (1989). Predictors of stress-related illness in city bus drivers. Journal of Occupational Medicine. 31(8). 657-663. Blue book of college athletics (1996-1997 ed.). (1996). Montgomery, AL: Athletic. Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed mood. Journal of Personality. 61(3), 343-364. Brewer, B. W. (1994). Review and critique of models of psychological adjustment to athletic injury. Journal of Applied Sport Psychology, 6. 87-100. Brewer, B. W., Linder, D. E., & Phelps, C. M. (1995). Situational correlates of emotional adjustment to athletic injury. Clinical Journal of Sport Medicine, 5, 241-245. Brock, S. C., & Kleiber, D. A. (1994). Narrative in Athletic Injury 41 medicine: The stories of elite college athletes' career¬ ending injuries. Qualitative Health Research, 4(4), 411-430. Campbell, J. M., Amerikaner, M., Swank, P., & Vincent, K. (1989). The relationship between the hardiness test and the personal orientation inventory. Journal of Research in Personality. 23. 373-380. Chan, C. S., & Grossman, H. Y. (1988). Psychological effects of running loss on consistent runners. Perceptual and Motor Skills. 66. 875-883. Danish, S. J. (1986). Psychological aspects in the care and treatment of athletic injuries. In P. F. Vinger & E. F. Hoerner (Eds.), Sports injuries: The unthwarted epidemic (2nd ed.)(pp. 345-353). Littleton, MA: PSG. Ermler, K. L., & Thomas, C. E. (1990). Interventions for the alienating effect of injury. Athletic Training, 25(3), 269-271. Falb, M. E. (1995). Psychological hardiness as a predictor of academic performance and its relationship to stress and health status of community college transfer students. Unpublished doctoral dissertation, Florida State University, Tallahassee, Florida. Gieck, J. (1990). Psychological considerations of rehabilitation. In W. E. Prentice (Ed.), Rehabilitation techniques in sports medicine (pp. 107-122). St. Louis, MO: Times Mirror/Mosby. Athletic Injury 42 Gordon, S., Milios, D., & Grove, J. R. (1991). Psychological aspects of the recovery process from sport . injury: The perspective of sport physiotherapists. The Australian Journal of Science and Medicine in Sport, 23.(2) , 53-60. Goss, J. D. (1994). Hardiness and mood disturbances in swimmers while overtraining. Journal of Sport and Exercise Psychology. 16. 135-149. Grimm, L. G. (1993). Statistical applications for the behavioral sciences. New York, NY: John Wiley & Sons. Grove, J. R. (1993). Personality and injury rehabilitation among sport performers. In D. Pargman (Ed.), Psychological bases of sport injuries (pp. 99-120). Morgantown, WV: Fitness Information Technology. Gyurcsik, N. (1995). Athletes' retrospectives on serious sports injuries. Presentation at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Henderson, J., Bourgeois, A. E., LeUnes, A., & Meyers, M. C. (1995). Group cohesiveness, mood disturbance, and stress in female basketball players. Manuscript submitted for publication. Kelley, B. C. (1994). A model of stress and burnout in collegiate coaches: Effects of gender and time of season. Research Quarterly for Exercise and Sport. 65(1), 48-58. Athletic Injury 43 Knapp, R. R. (1976). Handbook for the personal orientation inventory. San Diego, CA: Education and Industrial Testing Service. Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Personality and Social Psychology, 37(1), 1-11. Kobasa, S. C. (1982). Commitment and coping in stress resistance among lawyers. Journal of Personality and Social Psychology. 42(4). 707-717. Kobasa, S. C., Maddi, S. R., & Kahn, S. (1982). Hardiness and health: A prospective study. Journal of Personality and Social Psychology. 42(1). 168-177. Kubler-Ross, E. (1969). On death and dying. New York, NY: Macmillan. LaMott, E. E. (1994). The anterior cruciate ligament injured athlete: The psychological process. Unpublished doctoral dissertation, University of Minnesota, Minneapolis, MN. Larson, G.' A., Starkey, C., & Zaichkowsky, L. D. (1996). Psychological aspects of athletic injuries as perceived by athletic trainers. The Sport Psychologist, 10(1), 37-47. Leddy, M. H., Lambert, M. J., & Ogles, B. M. (1994). Psychological consequences of athletic injury among high- level competitors. Research Quarterly for Exercise and Athletic Injury 44 .Sport. 65(4). 347-354. LeUnes, A., Hayword, S. A., & Daiss, S. (1988). Annotated bibliography on the Profile of Mood States in sports, 1975-1988. Journal of Sport Behavior. 11, 213-240. Maddi, S. R. (1987). Hardiness training at Illinois Bell Telephone. In J. P. Opatz (Ed.), Health promotion evaluation (pp. 101-115). Stevens Point, WI: National Wellness Institute. Maddi, S. R. (1990). Issues and interventions in stress mastery. In H. S. Friedman (Ed.), Personality and disease (pp. 121-154). New York, NY: John Wiley & Sons. Maddi, S. R., & Hess, M. J. (1992). Personality hardiness and success in basketball. International Journal of Snort Psychology. 23. 360-368. Maddi, S. R., & Khoshaba, D. M. (1994). Hardiness and mental health. Journal of Personality Assessment. 63(2). 265-274. McDonald, S. A., & Hardy, C. J. (1990). Affective response patterns of the injured athlete: An exploratory analysis. The Snort Psychologist, 4, 261-274. McGowan, R. W., Pierce, E. F., Williams, M. & Eastman, N. W. (1994) . Athletic injury and self diminution. The Journal of Sports Medicine and Physical Fitness, 34(3). 299- 304 . McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Athletic Injury 45 Profile of Mood States. San Diego, CA: Educational and Industrial Testing Services. McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). Manual for the Profile of Mood States (Revised Ed.). San Diego, CA: Educational and Industrial Testing Service. Moos, R. H., & Tsu, V. D. (1977). The crisis of physical illness: An overview. In R. H. Moos (Ed.), Coping with physical illness (pp. 3-21). New York, NY: Plenum. Morgan, W. P. (1980a, July). Test of champions: The iceberg profile. Psychology Today. 14(2). 92-93, 97-99, 102, 108. Morgan, W. P. (1980b). The trait psychology controversy. Research Quarterly for Exercise and Sport. 51(1), 50-76. Norusis, M. J. (1993). SPSS for Windows: Base system user's guide (Release 6.0). Chicago, IL: SPSS. Norusis, M. J. (1994). SPSS for Windows: Advanced statistics guide (Release 6.1). Chicago, IL: SPSS. Okun, M. A., Zautra, A. J., & Robinson, S. E. (1988). Hardiness and health among women with rheumatoid arthritis. Personality and Individual Differences. 9. 101-107. Orr, E., & Westman, M. (1990). Does hardiness moderate stress, and how?: A review. In M. Rosenbaum (Ed.), Learned resourcefulness: On coping skills, self-control, and adaptive behavior (pp. 64-94). New York, NY: Springer. Athletic Injury 46 Ouellette, S. C. (1993). Inquiries into hardiness. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd Ed.)(pp. 77-100). New York, NY: The Free Press. Pearson, L., & Jones, G. (1992). Emotional effects of sports injuries: Implications for physiotherapists. Physiotherapy. 78(10), 762-770. Pero, S. F. (1995, January). Sport psychology and athletic training. Workshop presented at the 47th annual meeting of the Eastern Athletic Trainers Association, Philadelphia, PA. Peterson, R. A., & Headen, S. W. (1984). Profile of mood states. In D. J. Keyser & R. C. Sweetland (Eds.), Test critiques: Volume I (pp. 522-529). Kansas City, MO: Test Corporation of America. Petitpas, A., & Danish, S. J. (1995). Caring for injured athletes. In S. M. Murphy (Ed.), Sport psychology interventions (pp. 255-281). Champaign, IL: Human Kinetics. Prapavessis, H., & Grove, J. R. (1994). Personality variables as antecedents of precompetitive mood state temporal patterning. International Journal of Sport Psychology. 22. 347-365. Quackenbush, N., & Crossman, J. (1994). Injured athletes: A study of emotional responses. Journal of Sport Behavior. 17 (3), 178-187. Athletic Injury 47 Rose, J., & Jevne, R. F. J. (1993). Psychosocial processes associated with athletic injuries. The Sport Psychologist. 7. 309-328. Rotella, R. J. (1988). Psychological care of the injured athlete. In D. N. Kulund (Ed.), The injured athlete (2nd ed.Mpp. 151-164). Philadelphia, PA: J. B. Lippincott. Rotella, R. J., & Heyman, S. R. (1986). Stress, injury, and the psychological rehabilitation of athletes. In J. Williams (Ed.), Applied snort psychology (pp. 343-364). Palo Alto, CA: Mayfield. Roth, D. L., Wiebe, D. J., Fillingim, R. B., & Shay, K. A. (1989) . Life events, fitness) hardiness, and health: A simultaneous analysis of proposed stress-resistance effects. Journal of Personality and Social Psychology, 57(1), 136- 142 . Smith, A. M., & Milliner, E. K. (1994). Injured athletes and the risk of suicide. Journal of Athletic Training. 29(4). 337-341. Smith, A. M., Scott, S. G., O'Fallon, W. M., & Young, M. L. (1990). Emotional responses of athletes to injury. Mayo Clinic Proceedings. 65. 38-50. Smith, A. M., Stuart, M. J., Wiese-Bjornstal, D. M., Milliner, E. K., O'Fallon, W. M., & Crowson, C. S. (1993). Competitive athletes: Preinjury and postinjury mood state and self-esteem. Mayo Clinic Proceedings, 68, 939-947. Athletic Injury 48 Snow, A., & LeUnes, A. (1994). Characteristics of sports research using the profile of mood states. Journal of Sport Behavior. 17 (4). 207-211. Steele, M. K., III. (1996). Sideline help. Champaign, IL: Human Kinetics. Thomas, C. E., & Rintala, J. A. (1989). Injury as alienation in sport. Journal of the Philosophy of Sport. XVI. 44-58. Thompson, S. M. (1992). Hardiness as a predictor of gains in estimated functional aerobic capacity among university students. Unpublished doctoral dissertation, University of Houston, Texas. Udry, E. (1997). Coping and social support among injured athletes following surgery. Journal of Sport & Exercise Psychology. 19(1). 71-90. Uemukai, K. (1993). Affective responses and the changes in athletes due to injury. In S. Serpa, J. Alves, V. Ferreira, & A. Paula-Brito (Eds.), Proceedings of the 8th World Congress of Sport Psychology (pp. 500-503). Lisbon, Portugal: International Society of Sport Psychology. Wagman, D., & Khelifa, M. (1996). Psychological issues in sport injury rehabilitation: Current knowledge and practice. Journal of Athletic Training. 31 (3). 257-261. Weiss, M. R., & Troxel, R. K. (1986). Psychology of the injured athlete. Athletic Training. 21(2). 104-109, 154. Athletic Injury 49 Wiese-Bjornstal, D. M., Smith, A. M., & LaMott, E. E. (1995). A model of psychologic response to athletic injury and rehabilitation. Athletic Training; Sports Health Care Perspectives. 1(1). 17-30. Wiese, D. M., & Weiss, M. R. (1987). Psychological rehabilitation and physical injury: Implications for the sportsmedicine team. The Sport Psychologist. 1, 318-330. Wiese, D. M., Weiss, M. R., & Yukelson, D. P. (1991) . Sport psychology in the training room: A survey of athletic trainers. The Sport Psychologist, 5, 15-24. Athletic Injury 50 Table 1 Demoaranhic Information for the Overall Sample (n = 336) Variable Mean £D Min Max Age 19.82 1.29 18 24 Previous Injuries 1.76 2.32 0 30 Variable Frequency Percentage Class Year Freshman 117 34.80 Sophomore 88 26.20 Junior 76 22.60 Senior 55 16.40 Gender Male 244 72.60 Female 92 27.40 Sport Men's Lacrosse 96 28.57 Track & Field 240 71.43 Division NCAA I 135 40.20 NCAA II 13 3.90 NCAA III 188 56.00 Men's Lacrosse Division I 52 54.17 Division II 13 13.54 Division III 31 32.39 Track & Field Male 148 61.67 Female 92 38.33 Division I 83 34.58 Division III- 157 65.42 Div. I - Male 61 73.49 Div. I - Female 22 26.51 Div. Ill - Male 87 55.41 Div. Ill - Female 70 44.59 Athletic Injury 51 Table 2 Demographic Information for the Posttest Sample (n - 48) Variable Frequency Percentage Injured Noninjured Class Year Freshman 8 4 25.00 Sophomore 9 6 31.30 Junior 3 8 22.90 Senior 4 6 20.80 Gender Male 20 20 83.30 Female 4 4 16.70 Sport Men's Lacrosse 10 10 41.70 Track & Field 14 14 58.30 Division NCAA I 7 7 29.20 NCAA II 1 1 4.20 NCAA III 16 16 66.70 Men's Lacrosse Division I 4 4 40.00 Division II 1 1 10.00 Division III 5 5 50.00 Track & Field Male 10 10 71.43 Female 4 4 28.57 Division I 3 3 21.43 Division III 11 11 78.57 Div. I - Male 3 3 100.00 Div. I - Female 0 0 0.00 Div. Ill - Male 7 7 63.64 Div. Ill - Female 4 4 36.36 Athletic Injury 52 Table 3 Observed Means and Standard Deviations on the POMS Subscales for Injured and Noniniured Athletes Pre and Posttest Variable Injured i SD Noninjured ± SD Pre Tension 10.833 7.2 63 12.500 5.618 Post Tension 10.833 5.223 11.333 4.546 Pre Depression 10.417 8.182 13.458 11.538 Post Depression 12.208 9.917 10.125 9.580 Pre Anger 7.792 7.407 13.667 8.874 Post Anger 12.208 8.738 11.500 9.222 Pre Vigor 18.667 5.866 19.333 6.343 Post Vigor 14.958 6.154 19.375 6.177 Pre Fatigue 9.917 6.129 10.208 6.769 Post Fatigue 8.625 4.835 9.917 5.934 Pre Confusion 7.958 5.393 9.667 4.188 Post Confusion 8.083 4.791 8.667 5.522 Athletic Injury 53 Table 4 Observed Means and Standard Deviations on the PVS Subscales and Total Hardiness for Injured and Noniniured Athletes Variable Injured ± SD Noninjured + SD Challenge 34.875 5.74 34.167 7.30 Commitment 37.750 6.80 34.750 5.83 Control 39.417 6.13 37.167 4.87 Total Hardiness 112.042 15.34 106.083 14.55 Athletic Injury 54 Figure Caption Figure 1. A line graph depicting the profile of POMS scores for injured and noninjured athletes at pretest and posttest. T Scores O 0) Vi o co 3 I 'c ~o CL 3 o o tn O w Pretest Noninjured D " Posttest Noninjured Athletic Injury 55 Figure Caption Figure 2. The interaction chart of the mean 'Vigor-Activity' scores. Mean Vigor-Activity Scores Injured • Noninjured Athletic Injury 56 Figure Caption Figure 3. The interaction chart of the mean 'Anger- Hostility' scores. Mean Anger-Hostility Scores CM o ~T~ If) O T If) O i Injured I Noninjured Athletic Injury 57 Figure Caption Figure 4. An interaction chart for the mean POMS Total Mood Disturbance Scores. Mean TMD Scores O O IT) ^CO CMt- Q. o V) O (A ■ Injured —'— Noninjured Athletic Injury 58 Figure Caption Figure 5. A scattergram depicting the relationship between the baseline measurements of Total Mood Disturbance and Hardiness among athletes in the sample. 200 m o Total MoodDisturbance o m in o o o o CO M- o CM o CO o CO O O O Hardiness Athletic Injury 59 Figure Caption Figure 6. A scattergram depicting the relationship between postinjury Total Mood Disturbance and Hardiness among injured athletes. 200 LO O 10 o o Total MoodDisturbance Hardiness Athletic Injury 60 Figure Caption Figure 7. A scattergram excluding the outlier data, depicting the relationship between postinjury Total Mood Disturbance and Hardiness among injured athletes. 200 mom m o o Total MoodDisturbance Hardiness Athletic Injury 61 Figure Caption Figure 8. A line graph depicting the profile of POMS scores for the total pretest sample of athletes in the present study, compared to the typical iceberg profile (n = 336). T Scores (/> Present Study 1 Iceberg Profile 62 Appendix A RESEARCH DESIGN When rehabilitating athletic injuries, athletic trainers generally focus on the physical attributes Of the rehabilitation (Weiss & Troxel, 1986). Minimal concern is placed on the postinjury psychological status of athletes. In part, this may be due to athletic trainers lacking sport psychology knowledge (Wiese & Weiss, 1987), and a lack of understanding of the complexity of mood disturbances athletes experience following injury. Moreover, the responses an athlete has following injury may vary according to their levels of personality hardiness (Grove, 1993). Those who are higher in hardiness may demonstrate less mood disturbances following injury (Grove, 1993). For many athletes, optimal rehabilitation would incorporate physiological and psychological measures. Therefore, by understanding and addressing the mood disturbances associated with athletic injury, athletic trainers would help enhance the overall effectiveness of each rehabilitation program. Additionally, some knowledge of the hardiness level of each athlete, may help the sports medicine clinician implement the appropriate rehabilitation program for each injured athlete (Grove, 1993). As eluded to by Grove (1993), knowledge of the hardiness of an injured athlete, "will be useful to the extent that it helps 63 practitioners anticipate and deal with the athlete's thoughts, emotions, and behaviors during rehabilitation" (p. 116). Athletic trainers may need to provide greater individualized attention with the nonhardy injured athlete, in order to assist them through the transition process associated with injury. Statement of the Problem The intent of the researcher was fivefold. The difference between the mood disturbances of injured and noninjured intercollegiate athletes were examined. The difference between preinjury and postinjury mood disturbances were examined. In addition, the researcher assessed the interaction between injury status and time of assessment for intercollegiate athletes. Moreover, the difference between hardiness was compared for injured and noninjurgd athletes. Finally, the researcher determined the relationship between hardiness, and mood disturbances of intercollegiate athletes both before and after athletic injury. Definition of Terms The following terms were defined to help clarify the purpose of this study: Athlete Athlete was defined operationally as a member of a National Collegiate Athletic Association (NCAA) varsity 64 track and field team or varsity lacrosse team. Athletic Injury Injury was defined operationally as physical damage to the body resulting from athletic participation which restricts an athlete from full sport participation for greater than 2 days. Hardiness Hardiness is a personality disposition composed of the three traits of commitment, control, and challenge which are believed to act as a resistance resource during stressful life events (Kobasa, 1979). Hardiness was operationalized as the Composite Hardiness score on the Personal Views Survey (Maddi, 1987). The Composite Hardiness score was obtained by summing the three subscales of 'Challenge, ’Commitment', and ’Control’. Mood Disturbances Mood disturbances were defined operationally as the cognitive appraisal of the injury by the injured athlete, and the subsequent affective reaction to injury. Mood disturbances in the present investigation were assessed by the six mood states measured by the Profile of Mood States (POMS) (McNair, Lorr, & Droppleman, 1971) in addition to a Total Mood Disturbance score. Personal Views Survey The Personal Views Survey (PVS) (Maddi, 1987) was used 65 to assess hardiness and is composed of the three subscales of 'Challenge, 'Commitment', and 'Control'. Commitment. As defined by Dale (1992), "the characteristic of commitment is the ability of an individual to be deeply involved in or committed to the activities in their lives versus feeling alienated" (p. 7) . Commitment was operationalized by the score on the 'Commitment' subscale of the PVS (Maddi, 1987). Control. As defined by Grove (1993), "control involves a sense of personal power over the events in one's life" (p. 105). Control was operationalized by the score on the 'Control' subscale of the PVS (Maddi, 1987). Challenge. As defined by Dale (1992), "challenge is viewing the changes in one's life as exciting or challenging and leading to further personal development. Such changes are not viewed as being a threat" (p. 7). Challenge was operationalized by the score on the 'Challenge' subscale of the PVS (Maddi, 1987). Profile of Mood States Mood disturbances were assessed with the POMS (McNair et al., 1971) which includes the six subscales of 'Tension- Anxiety', 'Depression-Dejection', 'Anger-Hostility', 'Vigor- Activity', 'Fatigue-Inertia', and 'Confusion-Bewilderment', in addition to a Total Mood Di :e score. Tension-Anxietv. Tension-Anxiety is characterized by 66 "heightened musculoskeletal tension" (McNair et al., 1992, p. 4). Tension-Anxiety was operationalized by the score on the 'Tension-Anxiety' subscale of the POMS (McNair et al., 1971) . Depression-Deiection. Depression-Dejection "appears to represent a mood of depression accompanied by a sense of personal inadequacy" (McNair et al., 1992, p. 4). Depression-Dejection was operationalized by the score on the 'Depression-Dejection' subscale of the POMS (McNair et al., 1971) . Anaer-Hostilitv. Anger-Hostility "appears to represent a mood of anger and antipathy towards others" (McNair, Lorr, & Droppleman, 1992, p. 4). Anger-Hostility was operationalized by the score on the 'Anger-Hostility' subscale of the POMS (McNair et al., 1971) . Vigor-Activity. Vigor-Activity is "a mood of vigorousness, ebullience, and high energy" (McNair et al., 1992, p. 5). Vigor-Activity was operationalized by the score on the 'Vigor-Activity' subscale of the POMS (McNair et al., 1971) . Fatiaue-Inertia. Fatigue-Inertia "represents a mood of weariness, inertia, and low energy level" (McNair et al., 1992, p. 5). Fatigue-Inertia was operationalized by the score on the 'Fatigue-Inertia' subscale of the POMS (McNair et al., 1971). 67 Confusion-Bewilderment. Confusion-Bewilderment "appears to be characterized by bewilderment and muddleheadedness" (McNair et al., 1992, p. 5). Confusion-Bewilderment was operationalized by the score on the 'Confusion-Bewilderment' subscale of the POMS (McNair et al., 1971). Total Mood Disturbance. Total Mood Disturbance ~(TMD) "may be obtained from the POMS by summing the scores across all six factors (weighting vigor negatively)" (McNair et al., 1992, p. 6). Delimitations The study was conducted with the following delimitations: 1. The participants were delimited to intercollegiate athletes from men's and women's varsity track and field teams, and men's varsity lacrosse teams, who completed the preseason administration of the measuring instruments. 2. The POMS (McNair et al., 1971) was used to measure the mood disturbances of the participants. 3. The PVS (Maddi, 1987) was used to measure the hardiness level of the participants. 4. Injury was delimited to physical damage to the body resulting from athletic participation, which restricted an athlete from full sport participation for at least 2 consecutive days. 68 Limitations This study was conducted with the following limitations: 1. The researcher was competent in the administration of the measuring instruments. 2. The participants answered openly and honestly on the POMS (McNair et al., 1971), and the PVS (Maddi, 1987). 3. The athletic trainers were qualified and honest in defining length of injury. 4. The results of the study were limited to the validity and reliability of the POMS (McNair et al., 1971), and the PVS (Maddi, 1987) . 5. No attempt was made to control extraneous situations which may have affected the mood state of the participants at the time of the POMS administration (McNair et al., 1971) . Hypotheses The following hypotheses were tested in the investigation: 1. No significant difference in the mean vector of POMS (McNair et al., 1971) scores for injured and noninjured intercollegiate athletes would be found. 2. No significant difference in the mean vector of POMS (McNair et al., 1971) scores for the pretest and posttest administrations of the instrument for intercollegiate 69 athletes would be found. 3. No significant interaction between injury status and time of assessment with respect to the mean vector of POMS (McNair et al., 1971) scores for intercollegiate athletes would be found. 4. No significant differences in the mean POMS (McNair et al., 1971) TMD scores for injured and noninjured intercollegiate athletes would be found. 5. No significant differences in the mean POMS (McNair et al., 1971) TMD scores for the pretest and posttest administrations of the instrument for intercollegiate athletes would be found. 6. No significant interaction between injury status and time of assessment with respect to the mean POMS (McNair et al., 1971) TMD scores for intercollegiate athletes would be found. 7. No significant difference in the mean vector of PVS (Maddi, 1987) scores for injured and noninjured intercollegiate athletes would be found. 8. No significant difference would be expected between the mean hardiness scores as measured with the PVS (Maddi, 1987) for injured and noninjured intercollegiate athletes. 9. A negative relationship would be predicted between hardiness level as measured by the PVS (Maddi, 1987), and baseline measurements of TMD as measured by the POMS (McNair 70 et al., 1971), among intercollegiate athletes. 10. A negative relationship would be predicted between baseline hardiness level as measured by the PVS (Maddi, 1987), and postinjury TMD as measured by the POMS (McNair et al., 1971), among injured intercollegiate athletes. 71 Appendix B REVIEW OF LITERATURE Injury is common in sport with an estimated 17 million sport related injuries occurring each year in the United States (Booth, 1987), with 12 million injuries being treated annually by physicians in the United States (Steele, 1996). Smith and Milliner (1994) added that in 1989 the National Athletic Trainers Association (NATA) reported that 37% of high school football players were injured at least once, and that 1 million high school injuries occur each year. According to Kirkby (1995), sport injuries have grown to the point of being considered a "major public health problem" (p. 456) . The care and prevention of athletic injuries has historically emphasized physical attributes (Ford & Gordon, 1993; Green, 1992; Rotella, 1985; Smith et al., 1993; Wiese- Bjornstal, Smith, & LaMott, 1995). The assumption has been made that when an athlete is physically rehabilitated, he/she is fully prepared to safely return to activity. Rotella and Heyman (1986) indicated that this assumption may not be true for all athletes since they may not be prepared mentally to return. Pearson and Jones (1992) added that "many physical symptoms after injury are exacerbated by psychological factors" (p. 762), whereby rehabilitation is hampered by the emotional state of the athlete (Steadman, 72 1993). Weiss and Troxel (1986) implied that significant emotional responses following injury are normal, since a highly active individual is rendered inactive thus becoming uncertain about their immediate future. Several researchers have suggested that the greater the identity of the athlete with sport, the more difficult the transition from athlete to nonathlete, resulting in a greater loss (Ford, Gordon, & Horsley, 1993; Henschen & Shelley, 1993; Petitpas & Danish, 1995; Petrie, 1993). Sports medicine practitioners now recognize psychological factors which may help facilitate the response to injury, and aid in the rehabilitation process (Rose & Jevne, 1993; Smith et al., 1993; Wagman & Khelifa, 1996) . The future will demand both physical and psychological components to rehabilitation (Mainwaring, 1992; Rotella & Heyman, 1986; Wagman & Khelifa, 1996; Wiese & Weiss, 1987). As health care providers, "athletic trainers are central to the athlete's care from the onset of injury until the return to sport" (Smith & Milliner, 1994, p. 337). However, most athletic trainers have a limited background in sport psychology (Henderson & Carroll, 1993; Kenow, 1995; Pero, 1995b; Wiese & Weiss, 1987), and few resources available to acquire sport psychology skills (Pero, 1995a). In fact, athletic trainers have experiential knowledge about psychological response to injury, but often lack systematic 73 and specific educational preparation (Kenow, 1995; Larson, Starkey, & Zaichkowsky, 1996; Pero, 1995b). Wiese, Weiss, and Yukelson (1991) and Larson et al. (1996) suggested that athletic trainers acknowledge the importance of psychological skills use in the training room, but reportedly lack the proper qualifications to implement many of the interventions. Weiss and Troxel (1986) illustrated that athletes with similar injuries would all heal in a comparable manner, if not for the mental aspect of athletic injury. Larson et al. (1996) reported that 47% of 482 athletic trainers surveyed, postulated that every injured athlete suffers psychological as well as physiological trauma. Future education of athletic trainers should incorporate the psychological aspect of injury treatment and rehabilitation, specifically designed for athletic trainers (Kenow, 1995; Larson et al., 1996; Wiese et al., 1991). In addition, the availability of a sport psychology consultant to assist with injury rehabilitation is highly recommended (Wiese et al., 1991). The importance of the sports medicine team approach to athletic injury care must be stressed in order to treat the whole athlete most effectively (Rotella & Heyman, 1986; Wiese & Weiss, 1987; Wiese et al., 1991). The topic of sport psychology and athletic injury has gained tremendous interest and grown considerably over the 74 past decade (Brewer, 1994; Gordon, Milios, & Grove, 1991; Heil, Zemper, & Carter, 1993; Udry, 1995). In support of the recent interest, an extensive number of journal articles and textbook chapters have been devoted to the subject (LaMott, 1994; Laubach, Brewer, Van Raalte, & Petitpas, 1996). In conjunction with rehabilitation adherence, prediction of athletic injury, and perceptions of sport rehabilitation professionals, a recent and relatively new focus of empirical investigations has been the emotional responses to athletic injury (Brewer, 1994; Laubach et al., 1996; Quackenbush & Crossman, 1994; Rose & Jevne, 1993). Regarding the psychological response to athletic injury, certain personality variables may affect cognitive appraisal which would subsequently affect the ensuing emotional response (Brewer, 1994; Grove, 1993; Wiese- Bjornstal et al., 1995). The present investigation will address the personality variable of hardiness which may minimize the negative emotions associated with injury. An understanding of the hardiness concept may best be approached in athletics by addressing the alienating effect that has been associated with injury (Ermler & Thomas, 1990; Thomas & Rintala; 1989). With both constructs having existential origins, elements of the alienation construct are essentially the opposite of hardiness. As Maddi (1987) eluded to, the 75 measurement of hardiness has traditionally been accomplished through the use of negative indicators, suggesting that hardiness is measured by its absence. An absence of hardiness has been recognized by several investigators as indicating alienation and external locus of control. Alienated athletes appear to have serious negative emotional responses to injury (Ermler & Thomas, 1990; Thomas & Rintala, 1989), whereas Andersen and Williams (1988) proposed that hardy athletes would be less likely to be injured. Wiese-Bjornstal et al. (1995) added that the antecedent characteristics proposed by Andersen and Williams (1988), appear to extend into the postinjury emotional response to injury model, suggesting that hardy athletes would have decreased negative emotional responses to injury in comparison to their nonhardy counterparts. In fact, athletes higher in hardiness may demonstrate less emotional responses following injury (Grove, 1993). Research has been reviewed regarding psychological response to athletic injury, the Profile of Mood States, and the hardiness construct. Psychological Response to Athletic Injury Physical injury which limits activity in sport, may be cognitively, emotionally, and behaviorally challenging (Henschen & Shelley, 1993; Mainwaring, 1992; Pedersen, 1986). As explained by LaMott (1994), "just as the nature of 76 the injury differs, so does the response to injury" (p. 1). With an injury of similar severity, one athlete may continue to play whereas another may act as if the world had come to an end. Some athletes may find injury as a welcome relief from the embarrassment of poor performance, lack of playing time, or a losing season (Gieck, 1990; Rotella, 1988). For others, being injured and undergoing treatment and rehabilitation can be highly stressful (Danish, 1986). In fact, being injured can be quite stressful, and may threaten the self-concept, belief system, goals, social and occupational functioning, values, commitments, sense of personal identity, relationship with others, and emotional equilibrium of the athlete (Danish, 1986; Gyurcsik, 1995; LaMott, 1994). Athletes may experience a wide variety of emotions such as aggression (Henschen & Shelley, 1993), alienation (Ermler & Thomas, 1990; Thomas & Rintala, 1989), anger (Astle, 1986; Danish, 1986; Gordon et al., 1991; LaMott, 1994; Pearson & Jones, 1992), anxiety (Deutsch, 1985; Pedersen, 1986; Petitpas & Danish, 1995; Wagman & Khelifa, 1996), blame (Pedersen, 1986), decreased body image (Astle, 1986; Pearson & Jones, 1992), boredom (Wiese- Bjornstal et al., 1995, poor concentration (Pearson & Jones, 1992), confusion (LaMott, 1994), loss of control (Bowman, 1995; Danish, 1986; Weiss & Troxel, 1986), inability to cope (Weiss & Troxel, 1986), denial (Astle, 1986; Gordon et al., 77 1991; Steadman, 1993), depression (Bowman, 1995; Brewer, 1993; Brewer, Linder, & Phelps, 1995; Smith & Milliner, 1994; Wagman & Khelifa, 1996; Wiese-Bjornstal et al., 1995), disbelief (Wagman & Khelifa, 1996; Weiss & Troxel, 1986), discouragement (Wiese-Bjornstal et al., 1995), envy (Henschen & Shelley, 1993), fatigue (Gordon et al., 1991), fear (LaMott, 1994; Petitpas & Danish, 1995; Steadman, 1993; Wagman & Khelifa, 1996; Wiese-Bjornstal et al., 1995), frustration (Astle, 1986; Wagman & Khelifa, 1996; Wiese- Bjornstal et al., 1995), guilt (Gordon et al., 1991; Pedersen, 1986; Quackenbush & Crossman, 1994; Weiss & Troxel, 1986), helplessness (Bowman, 1995), hopelessness (Pedersen, 1986), hostility (Henschen & Shelley, 1993), identity loss (Brock & Kleiber, 1994; Gieck, 1990; Quackenbush & Crossman, 1994), feelings of inadequacy (Weiss & Troxel, 1986), irrational thinking (Gieck, 1990; Quackenbush & Crossman, 1994), loneliness (Astle, 1986; Petitpas & Danish, 1995; Quackenbush & Crossman, 1994) , a sense of loss (Astle, 1986), powerlessness (Ermler & Thomas, 1990; Thomas & Rintala, 1989), rage (Henschen & Shelley, 1993; Weiss & Troxel, 1986), resentment (Henschen & Shelley, 1993), restlessness (Pearson & Jones, 1992), sadness (Astle, 1986), decreased self-confidence (Weiss & Troxel, 1986), scariness (Weiss & Troxel, 1986) , decreased self-esteem (Brock & Kleiber, 1994; Pearson & Jones, 1992; Smith, Scott, 78 O'Fallon, & Young, 1990), decreased self-image (Astle, 1986), shock (Gordon et al., 1991), increased tension (Wiese-Bjornstal et al., 1995), decreased vigor (Albert, McShane, Gordin, & Dobson, 1988; Chan & Grossman, 1988; Smith et al., 1993), and uncertainty about their future (Danish, 1986; Pedersen, 1986; Weiss & Troxel, 1986). Astle (1986) suggested that the experience of loss associated with injury, is not recognized and the grieving process ignored or misunderstood. Lynch (1988) characterized the grief experienced by many injured athletes: Life is absurd. Just when I begin to put it all together, I pull this muscle. I'm so depressed. . . Why me? Why now? I'll never be able to get to this place again. I'm so afraid I'll never fully recover. Is there any doctor who can help me to get going? The stress is unbearable, to say nothing of the physical pain itself. It's just not fair. I feel like dying. A terrible loss. (p. 161) These words came from a runner and client of Lynch (1988) following a severe groin strain 2 weeks prior to participating in the 1984 Olympic Trials. Sports medicine practitioners may experience this type of behavior on a daily basis. What adds to the challenge is that no single 79 human response to loss exists (Evans & Hardy, 1995). Injured athletes vary by different individual, social and cultural backgrounds (Evans & Hardy, 1995; Nixon, 1996), in addition to varying levels of socialization, social support, and social status, leading to different experiences when injured (Nixon, 1996). With this in mind, Ford et al. (1993) suggested that all individuals in contact with injured athletes need to understand the emotional factors associated with injury in order to facilitate recovery. As described by Brewer et al. (1995), "because emotional distress may intensify perceptions of somatic symptoms and prolong the course of physical rehabilitation, it is important to identify factors that are related to emotional adjustment (and maladjustment) to athletic injury" (p. 241). In review of the psychological response to athletic injury, models of athletic injury and emotional response to athletic injury will be addressed. Models of Athletic Injury As eluded to by Wagman and Khelifa (1996), models relating to the psychological response to athletic injury generally fall into the categories of either stage models, cognitive models, or interactive models. The researchers noted that "stage models hypothesize that an injured athlete responds to injury by sequentially passing through various stages before positive adjustment occurs" (p. 258). 80 Cognitive models account for greater individual variance, with the primary focus being how the athlete perceives the injury (Wagman & Khelifa, 1996). As a recent trend of models of emotional response to injury, interactive models have aimed the focus on the complex interaction of variables affecting the injured athlete (Wiese-Bjornstal et al., 1995). In addition to cognitive appraisal, additional factors such as moderating and mediating variables are considered (Wiese-Bjornstal et al., 1995) In the present review of models of injury, stage models, cognitive appraisal models, and interactive models will be reviewed. Stage models. LaMott (1994) and Wiese-Bjornstal et al. (1995) suggested that early research on the emotional responses to injury were described in terms of stage models. A stage model assumes that people respond to injury in a specific and predictable manner. Several researchers have associated this sequence of predictable psychological reactions to the grief response outlined by Kiibler-Ross (1969) in her text On Death and Dying (Danish, 1986; Gordon et al., 1991; McGowan, Pierce, Williams, & Eastman, 1994; Quackenbush & Crossman, 1994; Rotella, 1988; Rotella & Heyman, 1986). Injury instills a sense of loss within the athlete which is characterized by "a state of being deprived of or being without something one has had" (Astle, 1986, p. 81 279). Painful emotions are often associated with a sense of loss. As Pedersen (1986) stated, "a grief response or grief reaction is a whole syndrome of feelings that occur as a result of that separation" (p. 312). Grief has previously been associated with death, but may also be applicable to other forms of loss (Pedersen, 1986) . While continuing to remain hopeful of the eventual return to competition, the reactions proposed by Kubler-Ross (1969) include each of the following: (a) disbelief, denial, and isolation; (b) anger; (c) bargaining; (d) depression; and (e) acceptance (Rotella, 1988; Rotella & Heyman, 1986). For many athletes, personal injury is the most significant loss they have ever experienced in their life (Gieck, 1990). Rotella (1988) suggested that athletes initially respond to injury by saying that there is no damage, that the injury is less severe, or that the injury will be better tomorrow. When tomorrow comes and the injury remains, the athlete feels isolated and lonely. Anger and irritability will follow as they work to recover. Anger is followed by a true sense of loss and depression. Eventually, the athlete accepts the injury and hopes for return to competition (Rotella, 1988). The grief response stage model has been supported by several researchers (Gordon & Lindgren, 1990; Henschen & Shelley, 1993; McDonald & Hardy, 1990; Pedersen, 1986; Rotella, 1988), and opposed by others (Brewer, 1994; Brewer & Petrie, 82 1996; Pearson & Jones, 1992; Smith et al., 1990; Wiese- Bjornstal et al., 1995). Brewer (1994) reviewed research supporting psychological adjustment to athletic injury. In response to the Kubler-Ross stages of loss, Brewer (1994) stated that "the prevailing notion that injured athletes proceed sequentially through a series of stages on the way to recovery lacks empirical support" (p. 88). He reported that the stages have not held up to empirical scrutiny, and noted no substantial evidence exists for the assumption. In summary, behaviors consistent with stage models have been observed, "but a common sequence of discrete emotional reactions to athletic injury has not been documented" (p. 90). In some regards, much of this may be attributable to the fact that the Kubler-Ross (1969) model was developed from data of over 200 terminally ill patients (Brewer, 1994; Evans & Hardy, 1995). To conceptualize the loss associated with death to that of athletic injury appears to be an unrealistic comparison (Brewer, 1994; Evans & Hardy, 1995). Emotional reactions to injury appear to be more global in nature, with individual differences varying to the degree that stage models do not apply (Brewer, 1994; Wagman & Khelifa, 1996; Wiese-Bjornstal et al., 1995). Cognitive appraisal models. Brewer (1994) suggested that cognitive appraisal models help explain individual 83 differences that are not accounted for in stage models. The cognitive appraisal models specific to athletic injury have their origins in stress and coping, which considers injury a stressor. The researcher "proposed that the way in which the individual interprets (appraises) an athletic injury determines the emotional response" (p. 90). Perception of injury is a critical factor in cognitive appraisal models, which was not addressed with stage models. In addition, the interaction of personal factors and situational factors may affect cognitive appraisals (Brewer, 1994). An early account of a cognitive appraisal model can be traced to Moos and Tsu (1977). The researchers proposed a model based on current approaches to coping with physical illness, which developed into crisis theory. Rotella (1985) indicated that the model may be applicable for injured athletes. Moos and Tsu (1977) appeared to be interested in finding the answer to the question of why people differ in response to a similar crisis? Crisis theory was defined as how people cope with major life crises and transitions, and proposed to help maintain balance or equilibrium when dealing with a crisis. As suggested by Moos and Tsu regarding crisis theory, stress itself is not the critical factor following physical illness, but rather the cognitive appraisal of the situation by the individual. Cognitive appraisal may be influenced by background and personal 84 factors, illness-related factors, and physical and social environmental factors of an individual. The basic premise regarding physical illness and injury, implies that through cognitive appraisal of an event, an individual sets forth basic adaptive tasks in which various coping skills can be applied. The researchers introduced seven groups of adaptive tasks which are "generally encountered with every illness, but their relative importance will vary widely depending on the nature of disease, the personality of the individual involved, and the unique set of environmental circumstances" (p. 11). The adaptive tasks help establish the major coping skills that the individual will utilize. The outcome of the crisis connotating the emotional and behavioral response, is the final product of the model (Moos & Tsu, 1977). Rotella (1985) provided a specific account of how the model proposed by Moos and Tsu (1977) would apply with an injured athlete. The crucial factor for injured athletes is how to cope with the crisis of injury, and the subsequent thoughts and emotions. Factors such as background and personal characteristics, illness-related factors, and features of the physical and sociocultural environment influence the cognitive appraisal of injury by the athlete, the perception of the tasks required, and the selection of relevant coping skills. The aforementioned description accounted for by the researcher, will ultimately determine 85 whether the response to athletic injury will be adaptive or maladaptive (Rotella, 1985). Weiss and Troxel (1986) examined the impact of injuries on self-perceptions of athletes, and offered possible solutions in facilitating their rehabilitation. Weiss and Troxel theorized that the issues presented would provide beneficial information to health care providers. The psychophysiological model of stress was proposed, with injury acting as the role of stressor. The model is an adaptation of a stress model proposed by Passer (1982). The model is comprised of four parts. The first step of the model consists of a situation or sensory stimulus which amounts to the stressor or injury. Step two is the cognitive appraisal where Weiss and Troxel explained the "person evaluates and interprets the stressor as threatening or nonthreatening" (p. 105). Cognitive appraisal sets the stage for the next step. Step three is the resulting emotional response which may also include some physiological symptoms such as increased muscular tension. Step four is "the consequence which can be performance, health or psychological-related" (p. 105). An example incorporating the model may include an athlete with serious mood disturbance following injury, who may also be encountering increased anxiety and physiological symptoms. Personality and motivation may have an influence on each of the three 86 steps. Since stress is viewed as a process in the model, situational variables of injury such as time of season or time of career that the injury occurs, type of sport, and external pressure from significant others, will interact with personality and impact the stress sequence (Weiss & Troxel, 1986). Wiese and Weiss (1987) discussed sport psychology issues that may assist members of the sports medicine team in the treatment and rehabilitation of injured athletes. In regards to the psychological response to injury, Wiese and Weiss proposed that the extent of psychological injury in association with physical injury, varies greatly with the personal attributes of the athletes themselves, and the context in which the injury occurred. In addition, situational factors such as nature and extent of injury, type of sport, time of season, and perceived context of the injury situation may influence the response to injury. Wiese and Weiss suggested that injured athletes similarly pass through the following four phases of response to injury: (a) what?; (b) think?; (c) feel?; and (d) do? The what phase deals with the role of injury as a stressor. The think phase deals with the cognitive appraisal of injury, and how the positive or negative appraisal will influence the next stage. The third phase deals with how the athlete feels about what happened, which is a direct result of the 87 cognitive appraisal. And finally, the fourth phase deals with the behavioral rehabilitation consequence. The four- stage stress response to athletic injury model is essentially a simplification of the Weiss and Troxel (1986) model. The second through fourth stages of the model may change frequently during the rehabilitation program. The model was developed to assist the sports medicine team understand the psychological process associated with injury, in a very practical manner (Wiese & Weiss, 1987). Recently, Wagman and Khelifa (1996) proposed an uncited cognitive model which appears to be the same model reported by Brewer (1994) . Essentially, Brewer (1994) formulated the model by synthesizing common components from five preexisting cognitive based models, all having their origins in stress and coping. In the model, injury is seen as a stressor. As Brewer (1994) extrapolated upon, "cognitive appraisals are postulated to be influenced by the interaction of personal factors and situational factors" (p. 90). Cognitive appraisal helps determine the emotional response of the injured athlete and, in turn, the behavioral response (Brewer, 1994; Wagman & Khelifa, 1996). Interactive models. As noted by Wagman and Khelifa (1996), "even though the cognitive model is one step closer to how individuals may actually respond to injury, it does not address the stress response as an antecedent to injury 88 in any great detail" (p. 258). Another shortcoming is that cognitive models do not account for the inclusion of mediating factors such as psychological interventions. Andersen and Williams (1988) proposed the model of stress and athletic injury, which attempted to interconnect psychosocial factors of stress and their impact on injury outcome. According to LaMott (1994), "since its inception, the Andersen and Williams model (1988) has been the focal point of injury research in sport psychology" (p. 4). Andersen and Williams (1988) stated that the study was designed "to propose an interactional theoretical model of injury and the cognitive, physiological, attentional, behavioral, intrapersonal, social, and stress history variables that may influence injury occurrence and prevention" (p. 296). Although the Andersen and Williams model examines the role of stress and psychosocial factors regarding prediction of athletic injury, the model provides a foundation that will be addressed frequently with postinjury models (Andersen & Williams, 1988) . As Anderson and Williams (1988) noted, the model, based on stress-illness, stress-injury, and stress-accident literature, has four central components: (a) potentially stressful athletic situation; (b) cognitive appraisal of events of that situation; (c) physiological and attentional responses; and (d) potential for injury outcome. Above the 89 central component of the model, three major areas exist: (a) personality factors; (b) history of stressors; and (c) coping resources. Andersen and Williams hypothesized that "stress history contributes directly to the stress response while personality factors and coping resources may act on the stress response either directly or through the effects of the history of stressors" (p. 298). Personality factors and coping resources may moderate the stress response rather than merely buffering the effects of life stress. To illustrate personality factors, Andersen and Williams suggested that "certain personality variables may make some individuals less likely to perceive situations and events as stressful or may predispose one to be less susceptible to the effects of stressors" (p. 301). One example given was the personality construct of hardiness. Hardiness was mentioned as a moderator of the stress-illness relationship with the researchers adding that "although the relationship between hardiness and injury has not been established, the Jackson et al. (1978) finding that tough-minded football players were less likely to be injured than tender-minded ones seems to be addressing issues very similar to hardiness" (p. 301). Below the central component of the model are two groups of interventions hypothesized to lessen the stress response. The interventions address either the cognitive appraisal, the physiological, or the attentional 90 aspects associated with stress. The intervention techniques may be used directly to influence the mediator variables of coping resources and personality factors (Andersen & Williams, 1988). Wiese-Bjornstal and Smith (1993) proposed a preliminary postinjury emotional response model which was further elaborated upon by Wiese-Bjornstal et al. (1995). The model is an extension of the Andersen and Williams (1988), Weiss and Troxel (1986), and Wiese and Weiss (1987) models. The Wiese-Bjornstal et al. (1995) investigation presented conceptual and operational forms of a psychological response to athletic injury model. In describing the conceptual model, the researchers conveyed: This model combines elements of earlier models and is a dynamic model to reflect the evolving, complex athlete response to injury. At the heart of the model is the cyclic stress-response process, with recovery at the core. Cognitive, emotional, and behavioral responses continuously interact to influence recovery throughout the rehabilitation process and operate in an environment of changing mediators, which influence these responses, (pp. 17-18) Wiese-Bjornstal et al. (1995) operationalized the model with specific pathways of predictions. The objective was to stimulate further research regarding emotional responses to 91 injury, and to provide practitioners with an understanding of the responses. The first part of the model reflects the moderators of personality, coping behaviors, history of stressors, and interventions from the Andersen and Williams (1988) model. The present model addresses the moderating impact for both preinjury and postinjury. Whereas the Andersen and Williams (1988) model stops when injury occurs, the Wiese-Bjornstal et al. (1995) model extends the stress response to postinjury, where the injury itself is considered the stressor. The extent that injury is perceived as a stressor will depend on the cognitive appraisal abilities of each athlete. Wiese-Bjornstal et al. (1995) suggested "that a number of factors mediate the postinjury cognitive, emotional, and behavioral stress responses experienced by athletes, both immediately postinjury and throughout the rehabilitation and recovery process" (p. 18). To clarify the difference between moderators and mediators, Wiese-Bjornstal et al. (1995) stated: Moderating variables might be considered as being antecedent conditions (e.g., personality, gender, race, socioeconomic class), which interact with other conditions (e.g., injury) to produce an outcome (e.g., negative emotional response). Mediating variables are generated in the encounter (e.g., positive interactions with 92 the sports medicine team) and change the relation between the antecedent (e.g., anxious personality) and outcome variables (e.g., positive emotional response), (p.18) Personal mediators consisting of injury characteristics and individual differences, and situational mediators consisting of sport specific situational factors and interactions with the sports medicine team, provided the broad conceptual framework for the mediators. The final aspect of the model consists of the physical and psychologic recovery process. Athletes will cycle through the recovery process continuously throughout their rehabilitation, while achieving different outcomes along the way. The ultimate goal would be to achieve total recovery, both physically and psychologically. To allow for some setbacks or reinjury, the model has a feedback loop returning to the cognitive response box. As implied by Wiese-Bjornstal et al. (1995), "the feedback precipitates a new cognitive, emotional, and behavioral process in a dynamic system" (p. 27). As demonstrated by the proposed model, the emotional responses can be seen as a complex series of interactive processes. The present model is the most recent and advanced model regarding emotional responses to injury. The model incorporates the most applicable principles from previous models and investigations (Wiese-Bjornstal et al., 1995) . 93 Emotional Response to Athletic Injury Astle (1986) conducted a case study to fully investigate the gamut of emotional losses which are frequently experienced by athletes. Several short interviews were conducted with an injured female dancer, while she was a patient at a sports medicine clinic. The researcher explored the types of losses that occur, and the reaction to such losses following injury. The emerging emotions found were injury denial, depression, sadness, frustration, anger, and eventually acceptance. The aforementioned losses were similar to the grief responses outlined by Kiibler-Ross (1969) . Gordon and Lindgren (1990) conducted a case study of an elite fast bowler who had surgery for a serious back injury. Qualitative retrospective interviews of the psychological effects of the injury and rehabilitation were gathered. The stages of response to injury by athletes were similar to the stages proposed by Kiibler-Ross (1969) . The athlete went through sequential stages resembling denial, anger, depression and acceptance. The data from the present investigation support the stage response of grief. The eventual recovery of the athlete was directly attributable to constructive psychological adjustments made by the athlete, in response to the physical and psychological demands of the injury and recovery (Gordon & Lindgren, 94 1990) . The alienating effect of athletic injury was discussed by Ermler and Thomas (1990) who explained that "the word 'alienation' signifies separation, or distance, between two or more entities" (p. 269), which may include negative emotions associated with a loss such as serious depression. Three important concepts of alienation were described, which together "constitute social forms of alienation and represent negations of the psychological needs for control, affiliation and direction": (a) powerlessness; (b) anomie; and (c) isolation (p. 269). Powerlessness referred to an athlete unable to control his/her own destiny. To become a spectator due to injury renders an athlete powerless as a team contributor. Injury also places an athlete in a role of dependency. A role such as this is unfamiliar for the athlete who is normally accustomed to the power role. Anomie referred to the athlete questioning what his/her role with the team is following injury. The athlete may wonder what the standard of behavior is for a noncontributing member of the team (Ermler & Thomas, 1990). Isolation was described by Ermler and Thomas (1990) as follows: In many athletic situations, the training, the traveling, and the conditions associated with the common goal and the common quest create a social microcosm of primary value. 95 When injury intervenes, the athlete is no longer part of this world and has little to share in what had become an important social relationship, (p. 270) In a two-part investigation, Gordon et al. (1991) utilized qualitative methodology to investigate psychological aspects of sport injury, from the perspective of sport physiotherapists. The researchers interviewed 14 sport physiotherapists in a pilot-study to develop a questionnaire. The interviews consisted of four content areas: (a) responses to sport injury; (b) rehabilitation and return to competition; (c) environmental and/or external factors affecting the rehabilitation process; and (d) therapist functions and the athlete/therapist relationship. The generated questionnaire was used to survey 66 physiotherapists in Australia and New Zealand. The respondents reported observable postinjury behavioral reactions similar to the grief response stages of Kiibler- Ross (1969), and symptoms of both negative and positive attitudes towards rehabilitation. Factors affecting the degree of psychological adjustment to injury included severity of injury, intensity of sport involvement, injury prior to a major competition, and aspects of personality (Gordon et al., 1991). In a comparable exploration, the emotional effects of 96 sports injuries, and the implications for physiotherapists were examined (Pearson & Jones, 1992). The methodology consisted of both qualitative and quantitative techniques. Quantitatively, the Sportsmen's Feelings After Injury Questionnaire (Pearson & Jones, 1992), the Sporting Details Questionnaire (Pearson & Jones, 1992), and the Bi-polar Profile of Mood States (Lorr & McNair, 1984), were utilized. Qualitatively, six injured athletes from the quantitative group participated in an in-depth interview aimed at elaborating on the questionnaire responses. The interview questions were structured in format, with open-ended responses varying in length from 30-60 min. From the quantitative measures, the researchers reported injured athletes commonly felt frustrated, depressed, bored, tense, hostile, unsure, tired, confused, and exhibited greater negative mood profile than the noninjured group. They confirmed from the interviews that injury has detrimental emotional effects (Pearson & Jones, 1992). In addition, Pearson and Jones (1992) revealed that "physiotherapists had considerable potential to influence mood state during rehabilitation, and that the use of psychological knowledge during rehabilitation would expedite recovery" (p. 769). Ford and Gordon (1995) conducted a similar investigation whereby the perceptions of physiotherapists and sport/athletic trainers from Australia, Canada, and New 97 Zealand were addressed. One of the primary objectives of the study was to find out the most commonly observed emotional responses of injured athletes. In part one of the study, 257 physiotherapists completed the questionnaire packet. The most frequently occurring emotions reported by physiotherapists were: (a) anxiety regarding consequence of injury and return; (b) frustration resulting from prolonged recovery or reinjury; (c) feelings of fear and anxiety concerning possible reinjury; (d) fear of losing position on the team; and (e) depression and sense of loss from the injury. The physiotherapists also reported denial and bargaining behavior somewhat similar to the Kiibler-Ross (1969) model, but clarified that the behavior did not occur in any sequential pattern. In part two of the study, 96 sport/athletic trainers returned the questionnaire packet. Regarding emotional and behavioral responses of injured athletes, the sport/athletic trainers reported: (a) athletes wanting to return prematurely to competition; (b) anxiety and frustration about losing place on the team; (c) anxiety about the injury and returning to the sport; (d) depression and sense of loss due to injury; and (e) fear of reinjury. The sport/athletic trainers report of fear, anxiety, and depression was similar to the viewpoint of physiotherapists, as was denial and bargaining behavior. Both groups appeared to recognize the importance of understanding the 98 psychological response to athletic injury, with future recommendations including the use of psychological skill. strategies to facilitate the recovery process (Ford & Gordon, 1995). LaMott (1994) assessed longitudinally among several other variables, the emotional response to anterior cruciate ligament (ACL) injury. An experimental group of 40 participants (25 male, 15 female) requiring knee surgery were followed from presurgery to 12 weeks postsurgery. The experimental group was compared to a matched control group of 40 participants. The Emotional Response of Athlete's to Injury Questionnaire (ERAIQ) (Smith, Scott, & Wiese, 1990) was used to assess the emotional responses of the two groups across the following 4 time periods: (a) time one was presurgery; (b) time two was at 1 week postsurgery; (c) time three was a 6 weeks postsurgery; and (d) time four was at 12 weeks postsurgery. LaMott reported that negative emotions were generally higher presurgery and gradually dissipated between 1 and 6 weeks postsurgery, but rose again at 12 weeks postsurgery. The researcher described the finding as an emotional U where negative emotions were high presurgery and at 12 weeks postsurgery, but relatively low between 1 and 6 weeks postsurgery. The 12 week finding was somewhat surprising, but since many postsurgery ACL patients hit a plateau during that period, the finding would seem 99 reasonable (LaMott, 1994). McGowan et al. (1994) conducted a study to document changes in self-worth from baseline values to postinjury values. They hypothesized that feelings of self-worth would decrease following injury. The participants consisted of 16 football players who were unable to participate for 1 week due to injury. The Coopersmith Inventory (Coopersmith, 1990) was completed preinjury, after each week of nonparticipation due to injury, and then 1 week following the completion of the season. Significant decreases were reported in global self-worth following injury. From follow-up interviews, McGowan et al. (1994) suggested that the injured athletes felt lower levels of self-worth, including alienation, in situations where it became clear that the team would still do well without them (McGowan et al., 1994). Quackenbush and Crossman (1994) examined the emotional phenomena experienced through four stages of athletic injury. Competitive and recreational athletes (16 male, 9 female) who had recovered from an athletic injury in the last year, served as the sample for the study. The athletes were classified according to level of athlete: (a) international, national, provincial or regional; (b) intercollegiate or club; and (c) recreational or intramural. Demographic forms, specific injury information, and an adjective checklist assessing emotions were completed. Each 100 participant completed the adjective checklist on four occasions, pertaining to the four identified stages of their injury (initially, the following day, during rehabilitation, and when returning to practice). The researchers found that negative emotions decreased from the onset of injury to returning to play. Conversely, positive emotions increased through the four stages. Negative emotions were found to be the highest the day following the injury, when compared to the other three stages. Female athletes expressed more negative and positive emotions during the four stage process (Quackenbush & Crossman, 1994). Brock and Kleiber (1994) conducted narratives of 17 former college athletes whose careers were ended by injury. Decreased self-esteem in conjunction with troubling effects to identity were common among all participants. Several of the participants appeared to have foreclosed identities due to their overidentification with sport. Identity foreclosure leaves an athlete vulnerable to psychological distress during the transition that follows injury. The participants noted different responses to what they termed 'acceptable' and 'unacceptable' injuries. Acceptable injuries were described as highly visible acute injuries. The unacceptable injuries were described as chronic, and often difficult to explain to others since there are normally no significantly visible symptoms. Due to the presence of visible symptoms, 101 the acceptable injury was reported to gather greater social recognition and support than the unacceptable injury. The researchers implied that negative emotional responses were associated to a greater extent, with unacceptable injuries. Attributable to minimal physical evidence of injury, the unacceptable injury places more pressure on their identity increasing the frustration level (Brock & Kleiber, 1994). Leddy, Lambert, and Ogles (1994) mentioned that no prospective study has been conducted with both injured and noninjured athletes. Due to the inherent weakness of previous retrospective designs, no causal relationships between injury and emotional response can be made. The aim of Leddy et al. was to investigate the psychological effects of athletic injury while improving on previously used methodologies. The researchers hypothesized that injury status groups would not differ in levels of depression prior to injury. Postinjury, they hypothesized that injured athletes would experience higher levels of depression than noninjured athletes, and that athletes injured at follow-up would also report higher levels of depression than those who had recovered by follow-up, or were never injured (Leddy et al., 1994) . Leddy et al. (1994) described the participants as 343 male athletes from 10 different intercollegiate athletic teams. Time of testing included pretest, postinjury, and a 102 follow-up test. Depression was assessed utilizing the Beck Depression Inventory (BDI) (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). Injury was defined as requiring medical attention and causing the athlete to miss at least one practice or game. The independent variables included injury status with the following four levels: (a) injured (injured at postinjury and follow-up testing, n = 77); (b) recovered (injured at postinjury but recovered at follow-up, n = 68); (c) noninjured (n = 110); and (d) late injured (not injured at postinjury, but injured at follow-up testing, n = 58). Initial testing occurred at the preseason physical examination with subsequent testing occurring postinjury, and 2 months following the postinjury assessment, which was the follow-up test. Each time an injured athlete was tested, a randomly selected noninjured athlete was also tested. Of the initial pool in the sample, 145 athletes sustained injures during the season, and were assessed postinjury. Leddy et al. found following injury, the injured and recovered groups displayed significantly higher levels of depression than the noninjured, and late injured. They also reported that the injured and late injured athletes had significantly higher levels of depression, than the noninjured and recovered athletes. Additionally, 51% of the injured athletes, which included athletes from both the injured and recovered levels of injury status, had mild 103 symptoms of depression at postinjury, with others having greater levels of depression warranting treatment (Leddy et al., 1994). Gyurcsik (1995) conducted a qualitative investigation regarding the retrospectives of 15 seriously injured highly competitive athletes. The interview process consisted of a 15 question structured interview, and a 2 hr open-ended interview. Gyurcsik identified 10 themes which emerged from the participants experience of injury: (a) importance of diagnosis; (b) fear of injury and reinjury; (c) important role of health care professionals; (d) affective and cognitive responses; (e) sharing their experience with other injured athletes; (f) value of empathetic support; (g) experience of altered self-concept; (h) feelings that their bodies had let them down; (I) threat to their goals in sport; and (j) changes in personal control during the injury process. The researcher explained that soon after injury, the participants reported more external attributions with rehabilitation, which ultimately became more internalized as they accepted the injury. Acceptance of the injury, which usually came when the extent of the injury was finally determined, appeared to have a dramatic impact in changing negative emotions into positive emotions. Gyurcsik (1995) concluded that cognitive adaptation, and comparisons to previously injured athletes who returned to competition, 104 appeared to facilitate the emotional readjustment process following injury. In essence, the sooner an injured athlete is able to emotionally adapt to injury, the greater will be their rehabilitation adherence. In summary, the models of injury, and emotional responses to athletic injury, explain an array of reactions associated with the process of athletic injury. Regardless of how an athlete expresses himself/herself following injury, members of the sports medicine team must be knowledgeable of these theories and responses. For members of the sports medicine team to provide the optimal physical rehabilitation program for their athletes, they must also prescribe the appropriate psychological rehabilitation. Profile of Mood States The Profile of Mood States (POMS) (McNair, Lorr, & Droppleman, 1971) is a popular and useful psychometric instrument when assessing mood states in sport psychology research (Henderson, Bourgeois, LeUnes, & Meyers, 1995; Snow & LeUnes, 1994). Leddy et al. (1994) added, that for the most part, quantitative measurement regarding the emotional response to athletic injury has been assessed by the POMS (McNair et al., 1971). The section will consist of test development, validity and reliability, and the POMS and emotional response to athletic injury. 105 Test Development Peterson and Headen (1984) defined the POMS as an adjective rating form which assesses present mood states. A present mood state is a short-lived emotional state, whereas the more stable long-termed mood states may be reflective of personality traits. Peterson and Headen explained that POMS development began in the 1960's, when the authors did a series of factor analysis studies from a total of 100 different adjective checklists, to determine the components of mood state. Through repeated factor analyses, items were discarded until the final adjective list of 65 items remained (Peterson & Headen, 1984) . The POMS is a 65-item measure which assesses the six mood characteristics of 'Tension-Anxiety', 'Depression- Dejection', 'Anger-Hostility', 'Vigor-Activity', 'Fatigue- Inertia', and 'Confusion-Bewilderment' (McNair, Lorr, & Droppleman, 1992). The POMS items are rated on a 5 point rating scale with response choices ranging from 0 "not at all" to 4 "extremely". McNair et al. (1992) acknowledged that the instrument is easily administered, with most participants completing the inventory in a relatively short period of time. The adjectives on the POMS should be easily understood by anyone with at least a 7th grade reading level. The instructions on the usual form of the POMS, asks for the feelings of the respondents during the past week. 106 The 1-week period was thought to emphasize a period long enough to represent the individuals typical mood pattern, and a period short enough to assess acute changes. To adapt to specifics for each particular study, other time sets can be used, although available normative data deals primarily with the one week time set (McNair et.al., 1992). Scoring for each mood factor is the sum of the scores representing the adjectives for each factor. With the exception of one item in the 'Tension-Anxiety' factor, and one item in the 'Confusion-Bewilderment' factor, all items are weighted positively (McNair et al., 1992). Besides the six subscale scores, a Total Mood Disturbance (TMD) score can be derived by adding the negative factors of 'Tension- Anxiety', 'Depression-Dejection', 'Anger-Hostility', 'Fatigue-Inertia', and 'Confusion-Bewilderment', and subtracting the score of the positive mood factor of vigor from the sum (Raglin, Eksten, & Garl, 1995) . Validity and Reliability of the POMS Pertaining to validity, Peterson and Headen (1984) noted that "from six different factor analysis replications, the factor loadings of the individual items for each factor are relatively consistent and are related to the factor with significant strength to suggest that they are an important contributor to that factor" (p. 526). The six factor analysis studies previously mentioned were conducted on 1223 107 male psychiatric outpatients, 650 female psychiatric outpatients, and 235 male undergraduate and graduate students (McNair et al., 1992). The preceding statement lends credence to the factorial validity of the six mood factors with the populations examined. McNair et al. (1992) reported that "an examination of the individual items defining each mood scale supports the face or content validity of the factor scores" (p. 8). The researchers also stated that the following seven areas of research have provided evidence of the predictive and construct validity of the POMS: (a) brief psychotherapy studies; (b) controlled outpatient drug trials; (c) cancer research; (d) drug abuse and addiction research; (e) studies of response to emotion-inducing conditions; (f) research on sports and athletes; and (g) studies of concurrent validity coefficients and other POMS correlates. In reference to concurrent validity, McNair et al. implied that the POMS has been correlated with similar measures. The six POMS subscales have correlated significantly with the Hopkins Symptom Distress Scale (Parloff, Kelman, & Frank, 1954) subscales of somatization (r = -.35 to .61), anxiety (r = -.49 to .77), and depression (r = -.42 to .86). In addition, the POMS subscale of 'Tension-Anxiety' correlated significantly with the Taylor Manifest Anxiety Scale (r = .80) (Taylor, 1953). Moreover, the POMS subscale of 108 'Depression-Dejection' correlated significantly with the Beck Depression Scale (r = .61) (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The POMS subscale of 'depression- dejection' also correlated significantly with the Inpatient Multidimensional Psychiatric Scale (r = .30) (Lorr, Klett, McNair, & Lasky, 1963). Finally, the POMS subscales of 'Anger-Hostility' and 'Vigor-Activity' correlated significantly with the Interpersonal Behavior Inventory (r = .32; r = .21) (Lorr & McNair, 1963). With regard to the use of the POMS in sports and exercise, the POMS was cited in 56 publications between 1975 and 1988, adding to the face validity (LeUnes, Hayword, & Daiss, 1988). With sport and athletes, Morgan (1980) first noted the "iceberg profile" which has become the characteristic athletic profile. The "iceberg profile" has athletes scoring below the 50th percentile on 'Tension', 'Depression', 'Fatigue', and 'Confusion', and above the 50th percentile on 'Vigor'. The "iceberg profile" has been replicated on many occasions in sport, adding to the validity of the instrument with the athletic population. The tendency for athletes to score in the previously described fashion, has typically separated them from nonathlete populations (McNair et al., 1992). Regarding reliability, McNair et al. (1992) suggested the data are highly satisfactory. Internal consistency of the six factors for 350 male psychiatric outpatients ranged 109 from .87 to .95, and for 650 female outpatients ranged from .84 to .95. For test-retest reliability, 100 subjects from the previous study who entered for treatment were assessed. The stability coefficients of the six factors for 100 psychiatric outpatients ranged from .65 for 'Vigor' to .74 for 'Depression', when taken between intake and pretherapy. For the same sample, the stability coefficients ranged from .43 to .53 for scores between intake and 6 weeks posttreatment. Adding to the reliability data, Norcross, Guadagnoli, and Prochaska (1984) reported from an investigation of psychiatric outpatients and smokers, alpha reliability coefficients of .92 for the outpatients and .91 for the smokers. McNair et al. (1992) implied that the stability data appear to be adequate when considering the fluctuating nature of mood states. Test-retest reliability is difficult to assess here, since mood states are expected to be inconsistent over two test administrations, in comparison to trait behaviors (McNair et al., 1992; Vinciguerra, 1992). Weckowicz (1978) added that "a high reliability of the test may indicate its relative lack of sensitivity to the changes of state and thus may indicate that the test does not measure what it is supposed to measure - changes in state" (p. 1019). Peterson and Headen (1984) concluded that overall, the POMS is a solid measure of mood state. As commented upon by 110 Norcross et al. (1984), "the Profile of Mood States appears to be an internally consistent, multidimensional instrument with a relatively stable factor structure that accounts for a high percentage of the total variance" (p. 1277) . POMS and Athletic Injury Albert et al. (1988) examined the affective changes as a result of injury in women's intercollegiate gymnastics. The participants consisted of five injured female gymnasts from a highly ranked program, and five female nonathletes. The control group was matched on the basis of age, major, and years of study at the university. Injury was delimited to sport related orthopedic damage which forced the gymnast to miss one week of practice or one competitive meet. The POMS (McNair et al., 1971) was administered to the participants every 2 weeks for 4 months. Albert et al. reported from visual inspection of POMS profiles between the five injured athletes and their matched pairs, that the profiles of the injured group changed, which was likely due to the effects of injury. 'Vigor', 'Fatigue', and 'Tension' demonstrated the greatest change on the profiles (Albert et al., 1988). Chan and Grossman (1988) examined the psychological and emotional effects of running loss due to injury. Participants for the study were 32 female and 28 male runners who had run consistently and put in some 20 miles Ill per week. They compared two groups of 30 (16 female, 14 male) ; a prevented runners group and a continuing runners group. The prevented runners were unable to run for 4 weeks due to a running related injury, but were functional in all other aspects of their daily lives. The POMS (McNair et al., 1971) and measures of depression, and self-esteem were completed by the participants. Chan and Grossman found that the prevented runners reported significantly greater overall psychological distress, Total Mood Disturbance, tension, anxiety, depression, confusion, anger, and less vigor than the continuing runners group. No difference was found between the two groups regarding fatigue. The inability to run due to injury may lead to a significant change in the overall emotional state of the individual (Chan & Grossman, 1988) . Smith et al. (1990) in a pilot-study, interviewed 57 injured athletes to establish whether sufficient adverse emotional responses existed to warrant the investigation. Boredom, helplessness, anger, shock, and fear were emotions ranked sufficiently high by the injured athletes to necessitate further investigation. Following the pilot- study, 72 injured athletes (49 male and 23 female) ranging in age from 12 to 54 were invited to participate in the study. Participants completed the Emotional Responses of Athletes to Injury Questionnaire (Smith et al., 1990), and 112 the Profile of Mood States (POMS) (McNair et al., 1971). Athletes with more serious injuries exhibited significantly more tension, depression, and anger and less vigor than college norms for athletes with less serious injuries. The observed mood disturbance for the seriously injured group lasted approximately 1 month following onset of injury (Smith et al., 1990). McDonald and Hardy (1990) were interested in adding to the available literature regarding the emotional reactions which follow athletic injury. The participants consisted of three female and two male athletes from a highly competitive intercollegiate athletic program, who had recently suffered a severe injury. Severe injury was defined as an injury precluding participation for greater than 3 weeks. Affect was measured by the POMS (McNair et al., 1971) which was administered on eight occasions throughout the initial 4 weeks of injury. Additional measures of social desirability and perceived rehabilitation, plus a follow-up interview were conducted. McDonald and Hardy found that "the affective profile of this sample demonstrates a transition from an extremely negative state immediately following injury to an extremely positive state during weeks 2 through 4 of the rehabilitation period" (p. 264). Negative affect decreased and positive affect increased as did perception of rehabilitation. The findings add significantly to the 113 literature, although the small sample size seems extremely limiting (McDonald & Hardy, 1990). Uemukai (1993) was interested in identifying psychological recovery stages which would facilitate the counseling process. The researcher intended "to construct and apply an affect recovery process scale in order to identify and assess the affective responses of athletes to injury" (p. 2). The participants consisted of 149 male and 63 female athletes who had an injury lasting at least 1 week in length. The participants completed the POMS (McNair et al., 1971), and the Affect Recovery Scale which Uemukai (1993) developed based upon the stages of the Ktibler-Ross (1969) model. The researcher found: (a) few athletes expressed denial; (b) anger was expressed with serious injuries within 2 weeks following onset of injury; (c) bargaining was consistently expressed during recovery; (d) depression was expressed with severe injury 2 to 4 weeks from the onset of injury; (e) acceptance was not expressed until 2 weeks after a serious injury; and (f) a greater sense of rehabilitation commitment occurred when emotions changed from negative to positive. No link was made apparent on how the findings were associated with the POMS in the present investigation (Uemukai, 1993). Smith et al. (1993) investigated the preinjury and postinjury emotional responses of injured competitive 114 athletes. The researchers implied that a limitation with previous studies was that they lacked preinjury data. In such retrospective designs, postinjury data can not be as strongly associated with injury. Smith et al. intended to examine the difference between preinjury and postinjury mood states. In addition, the researchers examined whether injury severity influenced mood state, whether mood state differed at various levels of participation within the same sport, and whether postinjury mood states differed between sports, or by gender. Injury in the present investigation was delimited to a sports related injury which required medical attention and restricted activity for at least one day (Smith et al., 1993). Smith et al. (1993) described the preinjury participants as 238 male and 38 female competitive athletes from the sports of hockey, basketball, volleyball, and baseball. Emotional response to injury was measured by the ERAIQ (Smith et al., 1990), and the POMS (McNair et al., 1971). The forms were completed initially during the preseason, and subsequently for those who sustained injury, each week their activity was restricted. The postinjury group consisted of 31 males and 5 females. They found that anger and depression increased significantly, and vigor decreased significantly postinjury. The only significant finding concerning the level or significance of injury, was 115 that those who sustained injury restricting activity greater than 3 weeks, experienced significantly more depression. No differences were found for different levels of participation within the same sport, nor between athletes in different sports. Regarding gender, the only significant finding reported was that male athletes had greater levels of anger preinjury. Due to the research design, postinjury increases in depression and anger, and decreases in vigor, are most likely attributable to the injury sustained. Severity of injury was the only significant predictor of emotional response (Smith et al., 1993). Brewer et al. (1995) investigated the relationship between a variety of situational factors and emotional adjustment to athletic injury. The participants for the study consisted of 81 male and 40 female patients at a sports medicine clinic. The POMS (McNair et al., 1971), the Beck Depression Inventory (Beck, 1967), the Athletic Identity Measurement Scale (Brewer, Van Raalte, & Linder, 1993) and a postinjury questionnaire were completed by the participants. Contrary to other findings, Brewer et al. (1995) found that despite the injuries, the participants reported a positive adjustment to injury. The POMS profiles resembled the "iceberg profile" which has been typically seen in healthy athletes. In general, situational factors were only weakly correlated to emotional response. The 116 situational variables of age, physician-rated current injury sta'tus, impairment of sport performance, and social support for rehabilitation were the only to reach significance. The participants for the study had been injured for a mean of 27 days, and were expected to be injured for an average of another 37 days when they completed the questionnaires. A possibility in the present study is that when filling out the measures 27 days postinjury, any prevailing negative emotions had become positive. As noted by the investigators, "perhaps injury duration and expected duration of restriction from sport participation are less important determinants of emotional adjustment among more severely injured patients" (p. 244). The researchers added that "it can be'tentatively concluded that young, acutely injured athletes who perceive a lack of support for and control over their rehabilitation may be most vulnerable to emotional distress following injury" (Brewer et al., 1995, p. 244). Daly, Brewer, Van Raalte, Petitpas, and Sklar (1995) examined cognitive appraisal, emotional adjustment, and rehabilitation adherence following knee surgery. Emotional responses and rehabilitation adherence have not been previously examined together. Daly et al. (1995) theorized that a rationale exists for doing so: "In cognitive appraisal models of response to sport injury, it is proposed that cognitions affect emotions, which in turn influence 117 behavior" (p. 24). Negative cognitive appraisal by injured athletes would lead to more emotional responses, positive cognitive appraisals would lead to less emotional responses, and emotional distress would inversely relate to rehabilitation adherence. Participants included 19 male and 12 female athletes who had sustained a knee injury requiring some type of surgical intervention. The POMS (McNair et al., 1971) and measures of cognitive appraisal, and rehabilitation adherence, were administered to the participants. Daly et al. (1995) found that low levels of cognitive appraisal were significantly related to total mood disturbance. Mood disturbance correlated negatively with attendance at rehabilitation, and contrary to the hypothesis, mood disturbance was not related to rehabilitation adherence. Daly et el. added that "although emotional disturbance was not associated with adherence during rehabilitation sessions, cognitive appraisal was correlated with emotional disturbance, and emotional disturbance, in turn, was correlated with attendance at rehabilitation sessions" (p. 27). Since psychological distress has been associated with poor rehabilitation attendance, sports medicine practitioners should be able to recognize the symptoms and employ appropriate intervention strategies (Daly et al., 1995). As the preceding review indicates, the POMS has been 118 used extensively in researching the emotional response of injury to athletes. The Hardiness Construct The contents of the following section include the following subsections: definition and theory of hardiness, hardiness and executives, hardiness with various groups, hardiness in sport and exercise, the Personal Views Survey, and validity and reliability of the PVS. Definition and Theory of Hardiness The origins of the hardiness construct has its roots in existential psychology (Jennings & Staggers, 1994; Kobasa, 1982; Orr & Westman, 1990; Pollock & Duffy, 1990). According to Kobasa and Maddi (1977), "existential psychology views the person as a biological, social, and psychological being whose primary task is the search for and establishment of meaning" (p. 243) . The prevailing notion is that each individual can control and shape their own life by being actively involved in decision making. Previous views considered the individual a more passive participant rather than one who would actively seek change (Kobasa & Maddi, 1977) . Maddi and Kobasa (1991) reported that interview data from Illinois Bell executives, clinical experience, and research findings from other psychological studies led to the development of the hardiness construct. Kobasa (1982) 119 reported that the initial interest in hardiness from studies with Illinois Bell executives, dealt with the stress-illness relationship, and the proposed moderating effects of hardiness. Kobasa (1982) theorized that personality was central to the issue reflecting "a persons general orientations towards life or characteristic interests and motivations which would influence how any stressful situation was perceived by a person, and then its ultimate physiological and psychological impact on a person" (p. 6). In addition, she postulated that "the personality emphasis has sought to determine the conscious psychological processes by which persons efficiently recognize and act on their situations" (p. 6). People should be able to adapt to the environment and grow from the experience. Hardiness was introduced as a combination of the three subconcepts of commitment, control and challenge (Allred & Smith, 1989; Kobasa, 1979; Maddi, 1990; Maddi & Khoshaba, 1994; Westman, 1990). Kobasa, Maddi, Puccetti, and Zola (1985) defined hardiness "as a personality style consisting of interrelated orientations of commitment versus alienation, control versus powerlessness, and challenge versus threat" (p. 525). Kobasa (1979; 1982) claimed that the hardiness construct is based on three general characteristics: (a) ability to feel deeply involved in or committed to activities of their lives, giving a person a 120 sense of purpose in life; (b) control and influence of events experienced, with people assuming some responsibility for the occurrence of events around them; and (c) change, rather than stability, is viewed as an exciting and normal challenge to further development in life. Maddi (1990) defined commitment as "people high in commitment think of themselves and their environments as interesting and worthwhile and thus can find something in whatever they are doing that piques their curiosity and seems meaningful" (p. 134). He defined control as "people high in control believe they can through effort have an influence on what goes on around them" (p. 134). Adding to control, Kobasa, Maddi, and Kahn (1982) stated that control may best be explained as when one feels influential rather than helpless. Furthermore, "people high in challenge believe that what improves their lives is growth through learning rather than easy comfort and security" (Maddi, 1990, p. 135). Kobasa, Maddi, and Courington (1981) theorized that hardy people are curious, find experience interesting and meaningful, feel they can be influential, and expect change as a normal process versus a threat. The tendencies previously mentioned are thought to help people cope with stress as a resistance resource (Kobasa et al., 1981; Kobasa et al., 1985; Kobasa, Maddi, & Puccetti, 1982; Prapavessis & Grove, 1994), and as a buffer in the 121 relationship between stress and illness (Funk & Houston, 1987; Nowack, 1989). Commitment, control, and challenge, react with one another in hardiness theory (Kobasa et al., 1982; Maddi & Hess, 1992; Orr &'Westman, 1990). The interaction effect is seen as being quite different from the separate effect of the three components. In opposition to the previous definitions, those individuals who are alienated versus committed may perceive things as threatening. Individuals considered powerless versus in control will lead to passivity or avoidance; and those who may see change as a disruption of status quo and as a threat versus a challenge (Allred & Smith, 1989; Orr & Westman, 1990). Kobasa et al. (1981) suggested that nonhardy people find themselves and their environment boring, meaningless, and threatening. Nonhardy feel powerless when change occurs and they have little basis for a positive outlook under stress. Several researchers have reported that hardiness activates transformational coping (Funk & Houston, 1987; Maddi, 1990; Maddi & Hess, 1992; Morrissey & Hannah, 1987; Orr & Westman, 1990). Transformational coping deals with how a person adapts to a stressor, whereby a hardy person will cope with stress more effectively (Maddi, 1987; 1990; Prapavessis & Grove, 1994). The hardy person may actually thrive on stress and purposefully seek out change, not 122 simply react to it (Orr & Westman, 1990). The presence of hardiness may help transform stressful circumstances into developmental versus debilitating experiences (Maddi & Khoshaba, 1994). Goss (1994) proposed that hardiness may affect stress in two ways. First, hardy people may transform something stressful into something less stressful by altering how they appraise a situation. Secondly, hardy people may have greater coping strategies to reduce the stressfulness of a situation. Attributable to transformational coping, an individual with a hardy personality would incur less illnesses under stress when compared to nonhardy (Allred & Smith, 1989; Funk & Houston, 1987; Nowack, 1989; Roth, Wiebe, Fillingim, & Shay, 1989) . Hardiness acts as a buffer between stress and illness in this role (Maddi & Hess, 1992; Westman, 1990), by decreasing the strain associated with stress (Goss, 1994; Maddi, 1990). Individuals high in hardiness have been found high in transformational coping versus regressive coping (Maddi, 1990). Hull, Van Treuren, and Virnelli (1987) and Rhodewalt and Zone (1989) proposed that perception or interpretation of events is quite different between hardy and nonhardy. Hardy individuals tend to interpret situations in less stressful ways. By transforming stress into something less stressful, then less strain is placed on a person, with the result of decreased illness (Allred & 123 Smith, 1989; Hull et al., 1987; Kelley, 1994; Maddi, 1987; 1990). Regarding the role of hardiness in stress and illness, Maddi (1987) made the following comment: In a nutshell, personality hardiness provides the motivational force for coping transformationally with the stressful circumstances that occur. This diminishes the stressfulness of the circumstances, so that they decrease in ability to produce strain. In turn, this decreases the likelihood of wellness breakdowns such as illness, (p. 104) Along similar lines, Gentry and Kobasa (1984) discussed the role of personality as a mediator to the health producing effects of stress. The fact that some people under high stress do not get sick, led them to believe that some personality variable must help decrease the negative impact of stress. Rhodewalt and Zone (1989) claimed that hardy possess a set of attitudes that render them stress resistant. The combination of commitment, control, and challenge combine to buffer individuals from the negative aspects or change (stressor). Specifically, Rhodewalt and Zone (1989) suggested that "retrospective and prospective research indicates that hardy persons can endure large amounts of life change without manifesting the elevated illness scores of their high stress, nonhardy counterparts" (p. 81) . 124 Hardiness and Executives The first empirical investigation of the hardiness construct was reported by Kobasa (1979), who considered the importance of hardiness as a conditioner of the illness provoking effects of stress. Kobasa (1979) suggested the literature demonstrated a low but consistent correlation between stress and illness of below .30. In part/ the impetus for hardiness research regarding the stress-illness relationship is attributable to the comment by Kobasa (1979) that "during the last decade, evidence that recent life histories of hospitalized persons contained more frequent and serious stress than control groups" (p. 1). Instead of studying stress among ill people, it was the aim of Kobasa (1979) to study stress in healthy individuals. The primary research question posed by Kobasa (1979) was how do highly stressed people stay healthy? She postulated that highly stressed but healthy people are thought to have: (a) decisional control over choosing various courses of action to deal with stress; (b) cognitive control, or the ability to interpret, appraise situations and interpret them as less debilitating; and (c) coping skill, or a greater repertoire of suitable responses to stress (Kobasa, 1979). Kobasa (1979) proposed three hypotheses in the present investigation. The first hypothesis presented was that for individuals under stress, those with greater control versus 125 powerlessness, would remain healthier. The second hypothesis insinuated that those who were committed under stress, would remain healthier than those who were alienated. As Kobasa theorized, "committed persons have a belief system that minimizes the perceived threat of stressful events" (p. 3). Committed persons feel an involvement with others which serves as a resistance resource. The third hypothesis presented was that under stress, those who view change as challenge would remain healthier than those who view it as threatening. Individuals defined in this manner look forward to new experiences, and know where to turn for resources to help them cope with stress. Individuals who feel positive about change are more flexible, which allows them to effectively appraise the threat of new situations (Kobasa, 1979) . Kobasa (1979) described the sample as two groups of middle and upper level executives from a public utility company. High stress-low illness and high stress-high illness groups were identified from a stress-illness questionnaire. One group of 86 male participants, suffered high stress without falling ill, whereas a second group of 75 male participants, reported becoming sick after exposure to stressful work conditions. Hardiness of the participants was measured with the original first generation Hardiness Test (Kobasa, 1979). The investigator reported a correlation 126 of .24 between stress and illness, which was weak but statistically significant. The high stress-low illness and high stress-high illness groups were found to differ from one another thru discriminant function analysis. The high stress to low illness executives were found to be, at least in some ways, more in control, more committed, and more oriented to challenge. The variables which made the most significant contribution for the high stress-low illness group included: (a) sense of commitment to self, as opposed to alienation; (b) vigorousness about life, versus vegetativeness; (c) meaningfulness as opposed to nihilism; and (d) internal rather than external locus of control (Kobasa, 1979). Kobasa et al. (1981) addressed the mediating role of personality hardiness and constitutional predispositions. Constitutional predispositions were thought to increase the likelihood that stressful life events would result in illness, whereas hardiness was postulated to decrease the likelihood of illness under stressful circumstances. Kobasa et al. (1981) described the initial pool of participants (time 1) as 837 male executives from a public utility company. The executives at time one were sent a packet containing questionnaires regarding stressful life events and illness symptoms for the previous 2 years. Of the initial respondents, 400 were randomly selected and sent 127 another composite questionnaire, including demographics and the 6-subscale second generation measure of hardiness. Constitutional predisposition was assessed by using medical history records kept with the company. The questionnaires were also mailed one year after time 1 (time 2), and one year after time 2 (time 3). The follow up questionnaires were used to measure stress and illness symptoms since the preceding questionnaire. The final sample consisted of 259 male participants who completed all phases of the investigation (Kobasa et al., 1981). Kobasa et al. (1981) reported a significant stress- illness correlation of .24, which was consistent with the literature. The correlation demonstrates the large variance with individual differences in the degree with which stress may lead to illness. From analysis of variance (ANOVA), the investigators reported stressful life events and constitutional predisposition increased illness symptoms, whereas hardiness decreased illness symptoms, confirming their hypothesis. Since the previous findings were more retrospective in nature, the researchers also conducted analysis of covariance (ANCOVA) with the covariate of illness at time 1. From this more prospective approach, the researchers still found a significant relationship between hardiness and constitutional predisposition. From the significant hardiness main effect, the researchers concluded 128 that hardiness was a prospective resistance resource against illness (Kobasa et al., 1981). Kobasa, Maddi, and Kahn (1982) acknowledged that previous studies were retrospective in design, whereas the researchers noted the need for more prospective designs. For example, the personality data collected in retrospective designs could simply be the result of illness. The initial pool of participants for the present investigation consisted of 670 male executives for a large utility company. At time 1, a composite questionnaire assessing stress and illness was completed. Shortly thereafter another composite questionnaire was sent to 400 randomly selected participants. The second composite questionnaire consisted of the second generation measure of hardiness. At time 3, the participants were sent the same material as time 2. The three test administrations were all separated by one year, with the final sample totaling 259 male participants. The researchers found that with the exception of the 'Cognitive Structure' subscale, substantial intercorrelations in the predicted direction occurred. Furthermore, stressful life \ events were associated with increased symptomology; but hardiness decreased the likelihood of the onset of symptoms. The researchers concluded that "the significant main effect due to hardiness in ANCOVA suggests that this tendency toward commitment, control, and challenge functions 129 prospectively as a resistance resource." (pp. 174-175). Hardiness had its greatest benefit as stress mounted (Kobasa, Maddi, & Kahn, 1982). Kobasa, Maddi, and Puccetti (1982) investigated the interaction of hardiness and exercise as mediators in the stress-illness relationship. They proposed that mediators such as personality characteristics, exercise, social support, constitutional predisposition, health practices, and coping techniques, would diminish the potential negative impact of stress upon health. The researchers hypothesized that hardiness would transform stress into something less stressful creating less strain, and optimally less illness. In addition, they hypothesized that exercise would operate less to alter the stressful events, but would help decrease the strain associated with stress. And finally, Kobasa, Maddi, and Puccetti hypothesized that the combination of the two variables would have a greater buffering effect than their independent actions. The participants consisted of 137 male executives from a large utility company who completed measures for stressful life events, illness, exercise, and hardiness. Hardiness was measured by the second generation instrument. They found that stress increased illness, whereas both hardiness and exercise decreased illness. In addition, the two-way interactions involving stressful life events with hardiness and exercise, were both found to be 130 significant. The stress-illness correlations between high and low hardiness groups with those who_ either did or did not exercise were not statistically significant for all cases. Kobasa, Maddi, and Puccetti did note that "although, not statistically significant, the pattern is clear that the combination of personality hardiness and exercise is even more effective in preserving health than is either alone" (p. 401) . The researchers summarized that hardiness and exercise both emerged as distinct variables that mediate the stress-illness relationship, and may have an even greater effect when combined (Kobasa, Maddi, & Puccetti, 1982). Kobasa et al. (1985) elaborated on a study involving the examination of hardiness, exercise and social support as resistance resources against illness. The researchers looked at the three independent variables isolated and in combination, and at retrospective and prospective levels. Kobasa et al. noted that previous research had established the fact that "executives high in hardiness are freer of illness under stress" (p. 526) , and this had been demonstrated in both retrospective and prospective designs. The participants for the study consisted of 70 male executives. The independent variables of stressful life events, exercise, social support, and hardiness, plus the dependent variable of illness history were assessed. Hardiness was measured utilizing the second generation 131 hardiness instrument. The researchers indicated that hardiness and exercise were unrelated. So an individual does not feel hardy from exercise, or exercise out of a sense of hardiness. The researchers found that a combination of the three resistance resources appears to decrease illness likelihood under stress. As the number of resources increases, the likelihood for illness decreases and visa versa. Hardiness emerged as the most important buffer, accounting for the majority of all the variance. Exercise and social support were also found to be significant, with exercise prevailing as the second most important buffer in the present investigation. The researchers summarized that hardiness provides substantial protection against concurrent and future illness. Exercise and social support provide to a lesser extent (Kobasa et al., 1985). Hardiness in Snort and Exercise Roth et al. (1989) studied the stress resistance enhancing effects of fitness and hardiness. The participants for the investigation consisted of 163 male and 210 female undergraduate students. The variables of physical health, life stress, fitness, exercise participation, and hardiness were measured. The investigators found that hardiness correlated significantly with illness and stress. Also, Roth et al. reported significant correlations between illness and commitment, illness and control, but not with illness and 132 challenge. Commitment and control were also significantly correlated with negative life experience. Both hardiness and fitness were associated with health in general. The predictive effect of hardiness on health was not significant. Commitment emerged as the most important, and challenge as the least important of the three dimensions of hardiness. Consistent with what was reported by Hull et al. (1987), the dimension of challenge appears to have little health benefit. To examine for possible moderating or interaction effects of hardiness, multiple regression analysis failed to support the hypothesis that either fitness or hardiness promote health by moderating the negative effects of stressful life events; none of the relevant interaction effects even approached statistical significance. To examine the possible mediating effects of hardiness, the researchers noted from structural equation analysis that "the health effects of hardiness may actually be mediated by the occurrence or interpretation of stressful life experiences" (p. 141). Hardy persons may simply experience fewer negative life events, or hardy persons may possess a cognitive style such that troubling life events are interpreted as less negative and thus less harmful (Roth et al., 1989). Maddi and Hess (1992) examined the role of hardiness and success in basketball, and remarked that "the present 133 study proposes the relevance of personality hardiness to individual athletic performance" (p. 360). The researchers hypothesized that hardiness would demonstrate a moderate relationship to basketball performance. Maddi and Hess added that "the general outlook of commitment, control, and challenge will help in maintaining a motivational edge through which the demands of the game will appear manageable and the necessary decisive actions will be taken" (p. 362). In comparison, "players low in hardiness should be more likely to feel alienated, powerless and threatened as the demands of the game mount" (Maddi & Hess, 1992, p. 362). Maddi and Hess (1992) selected 37 male basketball players from three high school varsity teams in Southern California as participants for the study. Hardiness was measured by the Personal Views Survey (Maddi, 1987) which was administered during the preseason. To make the hardiness measure specific to the sample studied, Maddi and Hess modified 6 items on the test. The word "spouse" was changed to "best friend", and the word "work" was changed to "school/work". Performance statistics for eight quantifiable aspects of basketball were obtained on the players at the end of the season, and then standardized. Maddi and Hess interpreted a clear pattern of positive intercorrelations between estimates of hardiness and of basketball performance from the data. Only two of the eight performance variables 134 did not relate to hardiness, and they were free throw percentage and shooting percentage. The total hardiness and composite basketball performance measures had a significantly positive correlation of .45, thus supporting the hypothesis that hardiness is positively related to overall basketball performance. The researchers concluded that hardiness was shown to generally contribute to basketball performance. The researchers insinuated that the reader should not overgeneralize the results and consider hardiness as a primary factor for basketball performance. Hardiness was simply reported to offer some contribution to performance (Maddi & Hess, 1992). Grove (1993) investigated hardiness and mood state of 21 athletes who had surgery to repair anterior cruciate ligament damage. The researcher reported that athletes with high levels of total hardiness, reported significantly less overall mood disturbance than those with low hardiness. Little information was provided regarding the study, but the finding may benefit sports medicine personnel with injury management and rehabilitation (Grove, 1993). Goss (1994) investigated hardiness and mood disturbances in overtraining swimmers. Physical training has risen over the past few decades, with researchers such as Goss interested in the role that such a stressor may have on an athlete. The goal of overtraining is to improve 135 performance, but at some arbitrary point, overtraining will decrease performance. Mood disturbances have been reported to increase as training increases. Goss stated that "these mood disturbances have been determined to increase in a dose-response manner with increased training" (p. 136). The mood disturbances decrease back towards normal as training decreases. Hardiness is a personality proposed in the present investigation to "explain the differences in mood states among groups of individuals who are subjected to stress" (p. 137). Goss suspected that some athletes may be able to train harder with no significant change in mood due to hardiness. Goss examined the relationship between hardiness and mood disturbance of swimmers during overtraining, and explored the general relationship between hardiness, mood disturbances, and coping behaviors. Although buffering effects of hardiness have been found outside of sport, it is not known if hardiness would be specific to the sporting environment (Goss, 1994). Goss (1994) described the participants as 131 male and 122 female swimmers from junior high, high school, and college levels. Collegiate swimmers (n = 178) dominated the sample. A modified version of the Cognitive Hardiness Inventory (CHI) developed by Nowack (1990) was used to assess hardiness, and the POMS (McNair et al., 1971) was used to assess mood disturbances. In addition, measures of 136 social desirability and coping were administered. The swimmers completed the four scales during the first 2 weeks of the collegiate and competitive seasons. The POMS and coping measure were again administered at two 7-week intervals following the beginning of training. The coaches provided a training volume summary which was important since a three-fold progression was needed over the season for overtraining. Goss reported a significant correlation for age and hardiness, but the amount of variance in the hardiness score accounted for by age was minimal. No differences were reported regarding gender and hardiness, and gender and mood disturbances. A significant relationship existed between hardiness and the six subscales of the POMS at each of the 3 data collection periods. As hardiness increased, mood disturbances were found to decrease. From repeated measures MANOVA for the three time periods, Goss found significant differences across time for global mood state, fatigue, and vigor. A post hoc scheffe test indicated that the three variables differed significantly between time 1 and time 2, and between time 1 and time 3. The researcher also found from repeated measures MANOVA, that the' high hardiness group had significantly lower global mood scores than the low hardiness group. The high hardiness group had been delimited to those swimmers scoring approximately one standard deviation above the mean of the entire sample, and 137 the low hardiness group to those scoring one standard deviation below the groups mean (Goss, 1994) . In summary regarding the negative relationship between hardiness and mood disturbances, Goss (1994) noted that "although hardiness and mood disturbances have not been specifically addressed in the literature, this relationship follows the theoretical concept of hardiness, which suggests that individuals high in hardiness are less apt to suffer detrimental effects of stress" (pp. 145-146). Hardy swimmers experienced fewer mood disturbances while overtraining than did nonhardy swimmers. In fact, hardy swimmers were less disturbed at the beginning of the season, and over the entire season. Goss added that "hardiness in athletes has not been addressed by any other investigations, making it difficult to refute or rebut any other findings" (p. 146). Goss concluded that the personality characteristic of hardiness may warrant further exploration with the athletic population (Goss, 1994). Personal Views Survey Since the initial empirical exploration of the hardiness construct by Kobasa (1977), several sources of measurement have been reported, with a great deal of confusion prevailing (Dale, 1992) . The Personal Views Survey (PVS) (Maddi, 1987) or third generation hardiness measure, was preceded by second generation and first generation 138 measures of hardiness. Per Orr and Westman (1990), the first generation Hardiness Test (Kobasa, 1979) was composed of several standardized and newly constructed instruments. The selection of instruments was designed to assess commitment, control, and challenge, of which Kobasa (1979) postulated formed the hardiness construct. Hull et al. (1987) reported that the initial hardiness measure emerged from a large sample of executives and was composed of some 19 preexisting personality scales. Hull et al. (1987) reported that by 1981 a 6 subscale second generation Hardiness Test (Kobasa, Maddi, & Kahn, 1982) was used to measure hardiness. Maddi (1990) added that "most of the studies employed the so-called second generation Hardiness Test, which combined six scales from the existing literature" (p. 135). Kobasa, Maddi and Kahn (1982) and Orr and Westman (1990) reported that the hardiness dimensions of commitment, control, and challenge were each measured by two subscales. Commitment was measured by the 'alienation from work' and 'alienation from self' subscales from the Alienation Test (Maddi, Kobasa, & Hoover, 1979). The Alienation Test (Maddi et al., 1979) measures commitment negatively, so in essence by being low in alienation, one is considered high in commitment. Control was reported to be measured by the Internal-External Locus of Control scale (Rotter, Seeman, & Liverant, 1962), and the 139 'powerless' subscale of the Alienation Test (Maddi et al., 1979). Challenge was measured negatively by the 'cognitive structure' subscale of the Personality Research Form (Jackson, 1974), and the 'security' subscale of the California Life Goals Evaluation Schedules (Hahn, 1966). Kobasa, Maddi, and Kahn added that "the security scale measures the degree to which safety, stability, and predictability are deemed important" (p. 172). Those who score high on this scale most likely do not perceive change as a positive experience. Kobasa, Maddi, and Kahn remarked that "the cognitive structure scale appears to emphasize inflexibility of cognitive categories, which may, render change as a threat" (p. 172) . From a principal components factor analysis, they reported that the 'cognitive structure' subscale did not share variance with the other five subscales. Due to the poor loading, Kobasa, Maddi, and Kahn eliminated the 'cognitive structure' subscale from the analysis. The second generation measure was initially composed of 6 subscales, but ultimately reduced to 5 subscales (Kobasa, Maddi, & Kahn, 1995). Several negative aspects have emerged from the literature regarding the second generation Hardiness Test (Kobasa, Maddi, & Kahn, 1982). One critical concern is the negative measurement of the components (Gentry & Kobasa, 1984; Funk & Houston, 1987). A central question is whether 140 it is nonalienated people who are less prone to the stress- illness relationship, or hardy people (Gentry & Kobasa, 1984). The Hardiness Test (Kobasa, Maddi, & Kahn, 1982) reflects an absence of alienation versus the presence of hardiness. Funk and Houston (1987) reported that the instrument directly measures alienation from self and work, need for security, feelings of powerlessness, and external locus of control. An additional criticism brought up by Hull et al. (1987) addresses the issue that in the 3 years from 1979 to 1982, measurement of hardiness went from being composed of 19 subscales to 5 subscales. The criticism emerges from the fact that very little explanation has been provided concerning this process. Maddi (1987; 1990) reported that the third generation hardiness measure, or PVS (Maddi, 1987) , emerged while attempting to quell some of the criticisms regarding previous measures of the hardiness construct. The PVS contains 50 rating scale items of which 17 measure the subscale of 'Challenge', 16 measure the subscale of 'Commitment', and 17 measure the subscale of 'Control' (Kelley, 1994). A total hardiness score is obtained by summing the scores from each of the three subscales. The format of the PVS is that of a Likert scale ranging from 0 (not at all) to 3 (completely true). Each dimension of 141 hardiness has positive and negative indicators in the PVS (Maddi, 1987; 1990). Orr and Westman (1990) reported that the third generation measure helped correct for previous problems concerning negatively worded items. The new items "were phrased with a broader social context in mind, the direction of the items were balanced, and hardiness was indicated positively by the total score" (Orr & Westman, 1990, p. 67). The third generation measure was the first to measure the presence of hardiness through a greater number of positive indicators, rather than measuring the construct via its absence (Jennings & Staggers, 1994). Validity and Reliability of the PVS As remarked by Ouellette (1993), the PVS (Maddi, 1987), "represents a better balance of positive and negative elements and produces a total score as well as three component scores with internal consistency and stability" (p. 87). In addition, factor analysis revealed the proposed three factors of hardiness (Bartone, 1989; Kelley, 1994; Ouellette, 1993) . Moreover, the instrument also correlates well with previous measures, and provides replications of the results from earlier studies which utilized different measures (Ouellette, 1993). Campbell, Amerikaner, Swank, and Vincent (1989) 142 reported that the third generation measure contains items deemed most significant through factor analysis. Commitment explained 23% of the variance, control 64% of the variance, and challenge 13% of the variance. Only factors loading higher than .30 were included, which yielded 16 items for commitment, and 17 each for control and challenge. Campbell et al. (1989) provided evidence for construct validity by comparing the PVS to the Personal Orientation Inventory (POI) (Knapp, 1976). Campbell et al. (1989) reported a significant correlation of .35 between the PVS and the 'time competence' subscale of the POI, suggesting that the PVS and POI are measuring some similar aspects of personality. The composite score demonstrated a reliability coefficient alpha of .88 and a correlation with the second generation measure of .89 (Campbell et al., 1989). Maddi and Khoshaba (1994) indicated that the PVS (Maddi, 1987) has a better integration of positively and negatively worded items, than previous measures. Maddi and Khoshaba (1994) explained that "these are the items from a larger initial pool that have survived considerable psychometric analysis" (p. 267). In addition, Maddi and Khoshaba (1994) stated that the PVS has correlated at .93 with the second generation hardiness measure, and at .71 when only nonredundant items were used. Maddi (1987) reported from factor analysis, that the third generation 143 measure yielded the three proposed factors of hardiness, and added that estimates of reliability have repeatedly been greater than .70 for the three subscales, and above .90 for the composite score. In regards to validity of the third generation test, major findings were reported to replicate those of the second generation measure (Maddi, 1987). In a study of 158 undergraduate college students, Maddi and Khoshaba (1994) reported adequate coefficient alpha reliability estimates of .75, .84, .71, and .88 for 'Commitment', 'Control', 'Challenge', and the composite hardiness score. Orr and Westman (1990) reported coefficient alpha of .90 on the third generation test, and also noted that the scale correlated at .78 with the 71 item second generation test. From a study of stress and burnout in 249 college coaches, Kelley (1994) reported alpha coefficients ranging from .63 for 'Challenge' to .87 for the composite score, and added that test-retest reliability has been reported in the .60's with a 6 week time interval. Okun, Zautra, and Robinson (1988) in a study of 33 women with arthritis reported strong alpha scores for the composite hardiness score and the three dimensions ranging from .70 to .84 . In an investigation by Maddi and Hess (1992), the researchers modified the wording of six items on the PVS (Maddi, 1987) to make the instrument more specific for the 144 sample of high school basketball players. As explained by the researchers, "generally, the wording was changed from 'spouse' to 'best friend' and from 'work' to 'school'" (p. 363). Internal consistency estimates of the slightly modified version were .77, .83, .81, and .81 for commitment, control, challenge, and the composite score (Maddi & Hess, 1992) . Maddi and Khoshaba (1994) stated that construct validational evidence has accumulated, suggesting that hardiness may constitute a reasonable measure of mental health. Also, Maddi and Khoshaba mentioned that with working adults, the three subscales have generally shown expected intercorrelations, but with college undergraduate students, challenge has appeared unrelated to the dimensions of commitment and control. Maddi and Khoshaba stated that "evidence is accumulating that the third generation test is psychometrically adequate in internal consistency and in yielding commitment, control, and challenge scales with the expected interrelationships that justify a total hardiness score" (Maddi & Khoshaba, 1994, p. 267) . Although far from perfect, Ouellette (1993) suggested that the PVS (Maddi, 1987) is presently the most psychometrically sound hardiness instrument available. The wording of the scale may not be suitable for all groups under study, and that although there is a better mix of 145 positively and negatively worded items, an abundance of negatively worded items still exists. The PVS (Maddi, 1987) contains 39 negatively worded items, and 11 positively worded items (Ouellette, 1993). 146 Appendix C CONSENT TO PARTICIPATE VOLUNTARILY IN A RESEARCH INVESTIGATION DEPARTMENT OF PHYSICAL EDUCATION SPRINGFIELD COLLEGE SPRINGFIELD, MA 01109 Mimi Murray. Ph.D. William N. Miller Responsible Faculty Member Investigator's Name Participant's Name Date PROJECT TITLE: PSYCHOLOGICAL ASPECTS OF PARTICIPATION IN INTERCOLLEGIATE ATHLETICS You are being asked to participate in a research investigation as described in this form below. All such investigational projects carried out within this department are governed by the regulations of both the Federal Government and Springfield College. These regulations require that the investigator obtain from you a signed agreement (consent) to participate in this project. The investigator will explain to you in detail the purpose of the project, the procedures to be used, and the potential benefits and possible risks of participation. You may, ask the investigator any questions you may have to help you understand the project and you may expect to receive satisfactory answers to questions. A basic explanation of the project is written below. If, after this discussion, you decide to agree to participate in the project, please sign this form on the line indicated below in the presence of the investigator, or a member of your athletic training staff. I. The purpose of this research project is to gain a more thorough understanding of the psychological aspects of participation in intercollegiate athletics at various periods throughout the season. The approximate number of subjects involved in this project is 400. Your participation in this project will entail approximately 30 minutes. 147 The procedures to be used include: 1. The investigator or a member of your school's athletic training staff will administer the questionnaires to you. 2. Completion of a background questionnaire. 3. Completion of a questionnaire before the season begins, and at an additional point during the season. 4. Completion of the Personal Views Survey before the season begins. II. The information obtained about you will be kept in complete confidence. The information may be used for statistical or scientific purposes without identifying you as an individual. Any significant new findings will be provided to you during the course of study. Participation in the study is voluntary, and you are free to withdraw from this project at any time. Further information can be obtained from the Graduate School of Springfield College concerning pertinent questions about the research and an explanation of your rights as a research participant. I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE PROJECT. I WILLINGLY CONSENT TO PARTICIPATE. Signature of Participant Date I CERTIFY THAT I HAVE EXPLAINED FULLY TO THE ABOVE PARTICIPANT THE NATURE AND PURPOSE, THE POTENTIAL BENEFIT AND POSSIBLE RISK OF THE INDICATED PROCEDURE. Signature of Investigator 148 Appendix D PROFILE OF MOOD STATES (POMS) Name Date Sex: Male Female ID # Below is a list of words that describe feelings people have. Please read each one carefully. Then fill in ONE circle under the answer to the right which best describes HOW YOU HAVE BEEN FEELING DURING THE PAST WEEK INCLUDING TODAY. The numbers refer to these phrases. 0 = Not at all 1 = A little 2 = Moderately 3 = Quite a bit 4 = Extremely 0 12 3 4 1. Friendly OOOOO 2. Tense 00000 3. Angry 00000 4. Worn out 00000 5. Unhappy 00000 6. Clear-headed OOOOO 7. Lively OOOOO 8. Confused OOOOO 9. Sorry for things done OOOOO 10. Shaky OOOOO 11. Listless OOOOO 12. Peeved OOOOO 13. Considerate OOOOO 149 0 12 3 4 14. Sad OOOOO 15. Active 00000 16. On edge OOOOO 17. Grouchy OOOOO 18. Blue OOOOO 19. Energetic OOOOO 20. Panicky OOOOO 21. Hopeless ...OOOOO 22. Relaxed OOOOO 23. Unworthy OOOOO 24. Spiteful OOOOO 25. Sympathetic OOOOO 26. Uneasy OOOOO 27. Restless OOOOO 28. Unable to concentrate OOOOO 29. Fatigued OOOOO 30. Helpful OOOOO 31. Annoyed OOOOO 32. Discouraged OOOOO 33. Resentful OOOOO 34. Nervous OOOOO 35. Lonely OOOOO' 36. Miserable OOOOO 37. Muddled OOOOO 150 0 12 3 4 38. Cheerful OOOOO 39. Bitter 00000 40. Exhausted 00000 41. Anxious OOOOO 42. Ready to fight OOOOO 43. Good natured OOOOO 44. Gloomy OOOOO 45. Desperate OOOOO 46. Sluggish OOOOO 47. Rebellious OOOOO 48. Helpless OOOOO 49. Weary OOOOO 50. Bewildered OOOOO 51. Alert OOOOO 52. Deceived OOOOO 53. Furious OOOOO 54. Efficient OOOOO 55. Trusting OOOOO 56. Full of pep OOOOO 57. Bad-tempered OOOOO 58. Worthless .00000 59. Forgetful OOOOO 60. Carefree OOOOO 61. Terrified OOOOO 151 0 12 3 4 62. Guilty OOOOO 63. Vigorous 00000 64. Uncertain about things 00000 65. Bushed 00000 4-1 Scorincr Instructions o for the Profile Mood States : 'TENSION-ANXIETY' Items 2, 10, 16, 20, 22, 26, 27, 34, 41 • 'DEPRESSION-DEJECTION' Items 5, 9, 14, 18, 21, 23, 32, 35, 36 , 44 , 45 , 48 , 58 , 61 62. 'ANGER-HOSTILITY' Items = 3, 12, 17, 24, 31, 33, 39, 42, 47 , 52 , 53 , 57 • 'VIGOR-ACTIVITY' Items - 7, 15, 19, 38, 51, 56, 60, 63. 'FATIGUE-INERTIA' Items = 4, 11, 29, 40, 46, 49, 65. 00 CM 'CONFUSION-BEWILDERMENTs. ' Items = 8, 37, 50, 54, 59, 64. To obtain a score for each mood factor, the sum of the responses is obtained for the adjectives defining the factor. All items defined in each factor are keyed in the same direction except for two items. Item # 22 (relaxed) in the 'Tension-Anxiety' scale, and item # 54 (efficient) in the 'Confusion-Bewilderment' scale, receive negative weights in calculating the factor scores. A Total Mood Disturbance score may be obtained by summing the scores (with 'Vigor- Activity' weighted negatively) on the six primary mood factors (McNair et al, 1992). Source: McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Profile of Mood States. San Diego, CA: Educational and Industrial Testing Services. 152 Appendix E PERSONAL VIEWS SURVEY Below are some items that you may agree or disagree with. Please indicate how you feel about each one by circling a number from 0 to 3 in the space provided. A zero indicates that you feel the item is not at all true; circling a three means that you feel the item is completely true. As you will see, many of the items are worded very strongly. This is to help you decide the extent to which you agree or disagree. Please read all the items carefully. Be sure to answer all on the basis of the way you feel now. Don't spend too much time on any one item. 0 = Not at all true 1 = A little true 2 = Quite a bit true 3 = Completely true 1. I often wake up eager to take up my life where it left off the day before 0 1 2 3 2. I like a lot of variety in my work 0 1 2 3 3. Most of the time, my bosses or superiors will listen to what I have to say 0 1 2 3 4. Planning ahead can help avoid most future problems 0 1 2 3 5. I usually feel that I can change what might happen tomorrow, by what I do today 0 1 2 3 6. I feel uncomfortable if I have to make any changes in my everyday schedule 0 1 2 3 7. No matter how hard I try, my efforts will accomplish nothing 0 1 2 3 8. I find it difficult to imagine getting excited about working 0 1 2 3 9. No matter what you do, the "tried and true" ways are always the best 0 1 2 3 10. I feel that it's almost impossible to change my teammate's mind about something ..0123 153 11. Most people who work for a living are just manipulated by their bosses 0 1 2 3 12. New laws shouldn't be made if they hurt a person's income 0 1 2 3 13. When you marry and have children you have lost your freedom of choice 0 1 2 3 14. No matter how hard you work, you never really seem to reach your goals 0 1 2 3 15. A person whose mind seldom changes can usually be depended on to have reliable judgement 0 1 2 3 16. I believe most of what happens in life is just meant to happen 0 1 2 3 17. It doesn't matter if you work hard at your job, since only the bosses profit by it anyway 0 1 2 3 18. I don't like conversations when others are confused about what they mean to say ..0123 19. Most of the time it just doesn't pay to try hard, since things never turn out right anyway 0 1 2 3 20. The most exciting thing for me is my own fantasies 0 1 2 3 21. I won't answer a person's questions until I am very clear as to what he/she is asking 0 1 2 3 22. When I make plans I'm certain I can make them work 0 1 2 3 23. I really look forward to my work 0 1 2 3 24. It doesn't bother me to step aside for a while from something I'm involved in, if I'm asked to do something else 0 1 2 3 25. When I am at school/work performing a difficult task I know when I need to ask for help 0 1 2 3 154 26. It's exciting for me to learn something about myself 0 1 2 3 27. I enjoy being with people who are predictable 0 1 2 3 28. I find it's usually very hard to change a friend's mind about something 0 1 2 3 29. Thinking of yourself as a free person just makes you feel frustrated and unhappy 0 1 2 3 30. It bothers me when something unexpected interrupts my daily routine 0 1 2 3 31. When I make a mistake, there's very little I can do to make things right again 0 1 2 3 32. I feel no need to try my best at school/work, since it makes no difference anyway 0 1 2 3 33. I respect rules because they guide me .... 0 1 2 3 34. One of the best ways to handle most problems is just not to think about them ..0123 35. I believe that most athletes are just born good at sports 0 1 2 3 36. I don't like things to be uncertain or unpredictable 0 1 2 3 37. People who do their best should get full financial support from society 0 1 2 3 38. Most of my life gets wasted doing things that don't mean anything 0 1 2 3 39. Lots of times I don't really know my own mind 0 1 2 3 40. I have no use for theories that are not closely tied to facts 0 1 2 3 41. Ordinary work is just too boring to be worth doing 0 1 2 3 155 42. When other people get angry at me, it's usually for no good reason 0 1 2 3 43. Changes in routine bother me 0 1 2 3 44. I find it hard to believe people who tell me that the work they do is of value to society 0 1 2 3 45. I feel that if someone tries to hurt me, there's usually not much I can do to try and stop him/her 0 1 2 3 46. Most days, life just isn't very exciting for me 0 1 2 3 47. I think people believe in individuality only to impress others 0 1 2 3 48. When I'm reprimanded at school/work, it usually seems to be unjustified 0 1 2 3 49. I want to be sure someone will take care of me when I get old 0 1 2 3 50. Politicians run our lives 0 1 2 3 156 Scoring Instructions for the Personal Views Survey: CHALLENGE Items = 2, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, 36, 37, 40, 43, 46, and 49. COMMITMENT Items = 1/ 8, 11 , 14 , 17 , 20 , 23 , 26, 29, 32, 38, 39, 41, 44, 47, and 50. CONTROL Items = 3, 4, 5, 7, 10, 13, 16, 19, 22, 25, 28, 31, 34, 35, 42, 45, and 48. Items to be reverse scored = 6-21 and 27-50. For CHALLENGE score, sum over the items on the subscale. If desired, a mean may be calculated. For COMMITMENT score, same as for CHALLENGE. For CONTROL score, same as for CHALLENGE and COMMITMENT. For COMPOSITE score, sum over the entire scale. Again, a mean may be used. Missing data may be replaced by an estimate of the score, or by the subscale mean. Source: Maddi, S. R. (1987). Hardiness training at Illinois Bell Telephone. In J. P. Opatz (Ed.), Health promotion evaluation (pp. 101-115). Stevens Point, WI: National Wellness Institute. Source for the slight mo'dification of six items made to accommodate the specific sample of intercollegiate athletes: Maddi, S. R., & Hess, M. J. (1992). Personality hardiness and success in basketball. International Journal of Sport Psychology. 23. 360-368. 157 Appendix F LETTER TO THE ATHLETICS DIRECTORS Dear : I am currently a doctoral student at Springfield College preparing to conduct research towards my dissertation in the area of sport psychology. I am writing to you to request your assistance in this investigation. The nature of my study is to compare the mood state of intercollegiate athletes before and after injury. Specifically, I would like to work with athletes from the men's and women's track and field teams, and the men's lacrosse team at . I would like to assess the mood states and hardiness levels of the athletes at an early pre-season team meeting. I will then follow-up with those who sustain injury as the season progresses. So not to bias the data, or to present a self-fulfilling prophecy type of situation, I will not be explaining to the athletes that the principle intent of the investigation deals with athletic injury. I will explain to them that the study will examine the psychological aspects of participation in intercollegiate athletics. I also found from a pilot-study that athletes, being somewhat superstitious, were not totally comfortable with the word "injury". As an athletic trainer for 11 years, I understand that one critical issue is the time commitment required of the teams. The only time I would need to meet with each team as a group, would be at a pre-season team meeting. To assess initial mood states and hardiness levels, two paper and pencil questionnaires would be utilized requiring 25 minutes. After this initial testing, I would have those sustaining time loss injuries throughout the season repeat the mood states questionnaire (5-8 minutes) in either the training room, or on the sidelines of the track/field when not practicing. I would also like to reaffirm that every aspect of the study will be held in complete confidentiality. The intent of my dissertation, will be to explore overlooked factors necessary in the rehabilitation of injured athletes. To the present, the majority of rehabilitation addresses the physiological aspects of injury, with very little regard towards the psychological issues. I am hoping that the 158 information which I will gather will not only benefit the investigation, but your coaches and athletic training staff as well. I would like to follow-up this letter with a personal phone call in the near future to see if you have any additional questions, and if you will give the necessary permission to conduct this investigation at . I understand that final approval to conduct my study is contingent upon your approval, but I have also mailed similar letters to Coach , Coach and Coach , so they may also have the opportunity to review my proposal. I look forward to speaking with you in the near future, and would like to thank you in advance for your consideration regarding this research project. Sincerely, William N. Miller 122 Chestnut St., # 310 Springfield, MA 01103 159 Appendix G LETTER TO THE COACHES Dear Coach : I am currently a doctoral student at Springfield College preparing-to conduct research towards my dissertation in the area of sport psychology. I am writing to you to request your assistance in this investigation. The nature of my study is to compare the mood state of intercollegiate athletes before and after injury. I would like to assess the mood states and hardiness levels of the athletes at an early pre-season team meeting. I will then follow-up with those who sustain injury as the season progresses. So not to bias the data, or to present a self-fulfilling prophecy type of situation, I will not be explaining to the athletes that the principle intent of the investigation deals with athletic injury. I will explain to them that the study will examine the psychological aspects of participation in intercollegiate athletics. I also found from a pilot-study that athletes, being somewhat superstitious, were not totally comfortable with the word "injury". As an athletic trainer for 11 years, I understand that one critical issue is the time commitment required of the team. The only time I would need to meet with the team as a group, would be at a pre-season team meeting. To assess initial mood states and hardiness levels, two paper and pencil questionnaires would be utilized requiring 25 minutes. After this initial testing, I would have those sustaining time loss injuries throughout the season repeat the mood states questionnaire (5-8 minutes) in either the training room, or on the sidelines of the track/field when not practicing. I would also like to reaffirm that every aspect of the study will be held in complete confidentiality. The intent of my dissertation, will be to explore overlooked factors necessary in the rehabilitation of injured athletes. To the present, the majority of rehabilitation addresses the physiological aspects of injury, with very little regard towards the psychological issues. I am hoping that the information which I will gather will not only benefit the investigation, but coaches and athletic trainers in general. 160 I would like to follow-up this letter with a personal phone call in the near future to see if you have any additional questions. I have also sent a letter to name of athletics director. I believe your support in this project would directly impact his/her decision on granting me permission to pursue my research at . I look forward to speaking with you in the near future, and would like to thank you in advance for your consideration regarding this research project. Sincerely, William N. Miller 122 Chestnut St., #310 Springfield, MA 01103 161 Appendix H LETTER TO THE ATHLETIC TRAINERS Dear : I am currently a doctoral student at Springfield College preparing to conduct research towards my dissertation in the area of sport psychology. I am writing to you to request your assistance in this investigation. The nature of my study is to compare the mood state of intercollegiate athletes before and after injury. Specifically, I would like to work with athletes from the men's and women's track and field teams, and men's lacrosse team at . I would like to assess the mood states and hardiness levels of the athletes at an early pre-season team meeting. I will then follow-up with those who sustain injury as the season progresses. So not to bias the data, or to present a self-fulfilling prophecy type of situation, I will not be explaining to the athletes that the principle intent of the investigation deals with athletic injury. I will explain to them that the study will examine the psychological aspects of participation in intercollegiate athletics. I also found from a pilot-study that athletes, being somewhat superstitious, were not totally comfortable with the word "injury". As an athletic trainer for 11 years, I understand that one critical issue is the time commitment required of the teams. The only time I would need to meet with each team as a group, would be at a pre-season team meeting. To assess initial mood states and hardiness levels, two paper and pencil questionnaires would be utilized requiring 25 minutes. After this initial testing, I would have those sustaining time loss injuries throughout the season repeat the mood states questionnaire (5-8 minutes) in either the training room, or on the sidelines of the track/field when not practicing. This is where I need some assistance from yourself or one of your student athletic trainers. I will need to keep in touch with a member of your athletic training staff so I can keep track of when athletes on the team get injured. In addition, I will need assistance collecting the post-injury data. This will consist of the athlete completing the mood states questionnaire again. It should require very little time and/or effort on your part since the form may be easily administered at some point 162 during an athlete's treatment. I would also like to reaffirm that every aspect of the study will be held in complete confidentiality. The intent of my dissertation, will be to explore overlooked factors necessary in the rehabilitation of injured athletes. To the present, the majority of rehabilitation addresses the physiological aspects of injury, with very little regard towards the psychological issues. I am hoping that the information which I will gather will not only benefit the investigation, but athletic trainers and coaches in general. I would like to follow-up this letter with a personal phone call in the near future to see if you have any additional questions, and if you will be able to provide me assistance during the course of the investigation. I have previously sent letters to the Athletics Director and Coaches, requesting permission to conduct the study. Thank you very much for your assistance. Sincerely, William Miller, M.S., LATC 122 Chestnut St., #310 Springfield, MA 01103 163 Appendix I DEMOGRAPHIC FORM •s’ Please fill in all of the items on this form and put a "/" or "X" in the □ provided. Name: Acre: Address: Gender: Male di Female CH2 Year in College: Freshman di Soph CH2 ' Junior IZta Senior CL How many years have you participated on an intercollegiate team? One di Two O2 Three d3 Four d4 Five ds Have you ever had an injury that prevented you from participating in any physical activity? Yes di No d2 If yes, number of times: Do you presently have an injury which is preventing you from participating with your team at full capacity? Yes di No da College/University Team(s) you compete on (fill in code): l=Baseball 2=Basketball 3=X-Country 4=Field Hockey 5=Football 6=Golf 7=Gymnastics 8=Ice Hockey 9=Lacrosse 10=Soccer ll=Softball 12=Swimming 13=Tennis 14=Track & Field 15=Volleyball 16=Wrestling (1) Team: Starter di Non-starter d2 (2) Team: Starter di Non-starter d2 164 Appendix J ATHLETIC INJURY QUESTIONNAIRE Name of Athlete Date of Injury Name of Athletic Trainer 1. Injury 2. Chronic or Acute? 3. Degree of Injury? 4. Surgery Required? 5. Extent of Injury (anticipated time away from the sport)? 6. Point of the season in which the injury occurred (preseason, early season, mid-season, late-season)? 7. Has the athlete had any previous injuries of this type, and, if so, please explain? 8. Number of previous injuries of this type? RAW DATA (Total Sample of 336) £ >1 CD •H •H rd p •H T3 P -p T3 OHQ<>t4CJH QWH£M,<0£ W^ld-OUHZQ J o U EMft d o n3 P u &P (0 o CD CL W d p fO w w O' d CD X! o CD d g Q CD • •H •H P X! <5! H -p -p ft O £ cn P CP >i d X CD O CD d CO o d CO d u m CD i d CD p o CO u (0 CD o to d CO CD o o p CD o d P CD CD CO CO 1 • •H •H •H rH p p P X! X) > ft P ft O £ cn p p ft > o p u d o (0 CD o CO CO CO u o p CD o d CD P CD CD CO 1 • - *H •H p I1 p x: X> H P ft o £ cn p p h InU ft p (0 tn d d CD d CD d u (0 o CO CO CO CD to o o p CD o d CD P CD CD CO i • •H •H rH T> p P xi d P dto p tod x! d PQ UP- P to ft ou O Hto £ _-H cn P(D P P o ft cn CD p B CD d d • to o d CD d P to X! 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Mean Min. Max. Pre Tension 47 33 72 49 38 65 Post Tension 47 34 59 47 37 60 Pre Depression 46 37 63 49 37 76 Post Depression 48 37 72 46 37 68 Pre Anger 48 37 73 56 40 85 Post Anger 53 37 73 53 37 94 Pre Vigor 55 33 70 55 33 70 Post Vigor 49 27 73 55 33 73 Pre Fatigue 49 34 64 49 35 70 Post Fatigue 48 35 63 49 37 67 Pre Confusion 44 32 70 48 32 61 Post Confusion 44 33 68 46 30 70 182 Table 7 Basic Assumptions for the Two-Way, Mixed Factorial MANOVA Variables Bartlett-Box E F ratio Tension Pretest 1.468 .226 Posttest .432 .511 Depression Pretest 2.609 .106 Posttest .027 .870 Anger Pretest .731 .393 Posttest .065 .798 Vigor Pretest .138 .711 Posttest .000 .986 Fatigue Pretest .222 .637 Posttest .938 .333 Confusion Pretest 1.426 .233 Posttest .453 .501 Box M F ratio = 1.497, E = .003 Bartlett Test of Sphericity = 205.187, sif = 15, E = .000 183 Table 8 (J) 'b x 2 MANQVA Comparing Scores on they 6 POMS Subscales for •y^f* OkdrAovMYv V>*\V^\ jWo'jns'S Iniurv Status and Time of Assessment for Intercollegiate Athletes (n = 48) Vc, Effect Wilks' F Hypo Error Effect E d>c_ vt-Ni Lambda df df ' cSize *3 ~/ Ll . Between / c Kf <* £> Within v .Vrf 9 (p ,63 Test Time (B) .73 2.49 6.00 41.00 .27 .038 , o Gb o vtoM 3 L fi>6b AB .74 2.38 6.00 41.00 ’. 26 .046 _P \ e t o —-K _s> -o\<^ i^.)r7 M 3 9 0l M . oil ‘ ^ 3 1 '1^? ib^v 184 Table 9 Posttest. Univariate F Ratios Comparing Injured and Noniniured Intercollegiate Athletes on the Six Subscales of the POMS Variable ss df ms F Tension Between 3.000 1 3.000 .125 .725 Within 1102.667 46 23.971 Depression Between 52.083 1 52.083 .548 .463 Within 4372.583 46 95.056 Anger Between 6.021 1 6.021 .075 .786 Within 3711.958 46 80.695 Vigor Between 234.083 1 234.083 6.158 .017 Within 1748.583 46 38.013 Fatigue Between 20.021 1 20.021 . 683 .413 Within 1347.458 46 29.293 Confusion Between 4.083 1 4.083 .153 . 698 Within 1229.167 46 26.721 185 Table 10 Iniured Group Univariate F Ratios ComDarincr Scores on the Pretest and Posttest Administrations of the Six POMS Subscales Variable £S df ms F E Tension Between .000 1 .000 . 000 1.000 Within 330.000 23 14.348 Depression Between 38.521 1 38.521 1.088 .308 Within 813.979 23 35.390 Anger Between 234.083 1 234.083 11.126 .003 Within 483.917 23 21.040 Vigor Between 165.021 1 165.021 5.561 . 027 Within 682.479 23 29.673 Fatigue Between 20.021 1 20.021 1.070 .312 Within 430.479 23 18.716 Confusion Between .188 1 .188 .013 .911 Within 340.313 23 14.796 186 Table 11 2 x 2 ANOVA with Repeated Measures on One Factor Comparing POMS Total Mood Disturbance Scores for Injured and Noniniured Athletes at Pretest and Posttest Source 5if ms F E l'?SO ,fJ \B Between Subjects 89717.96 1908.89 'T* B (Inj. Status) 301.04 1 301.04 ;i5; . 696 M N.'C d". Error between 89416.92 46 1943.85 Within Subjects ^46" > o 3. A (Test Time) 3.37 1 3.37 .01 .917 \£Ai. ^ ^ bT. ^ Vv\(, « ?o AB 1683.37 1 1683.37 5.43a .024 Va- Vr. Error Within 14252.25 309.83 3^ t3 Total 105656.-95 &5 a Table F (.05) (1, 4^) = 4rV5 Bartlett-Box Homogeneity of Variance: Pretest TMD F = .115; ]3 > .05 Posttest TMD F = .001; u > -05 Box M F = l-r551; £ > T-QS^ v A .// .?r <-iV k** S /o6 u i ■■ \Cl& 1 M/ ^ / 73 < <7 ^ 187 Table 12 Simple Effects Tests for Total Mood Disturbance across Time of Assessment (A Factor) and Iniurv Status (B Factor) Source ms F E Time of Assessment Differences for Injured 918.75 1 918.75 2.97 > .05 Time of Assessment Differences for Noninjured 768.00 1 768.00 2.48 > .05 Error Within 14252.25 46 309.83 Injury Status Differences for Pretest 1704.08 1 1704.08 1.51 > .05 Injury Status Differences for Posttest 280.33 1 280.33 .25 > .05 Error Within 103669.17 92 1126.84 "Table F (.05) (1, 46) 4.05 bTable F (.05) (1, 92) 3.95 188 Table 13 Basic Assumptions for the One-Way, Independent Groups MANOVA Variable Bartlett Box E F Ratio Challenge 1.282 .258 Commitment .531 .466 Control .1.180 .277 Box M F ratio = 1.917, E = -074 Bartlett Test of Sphericity = 37.113, df = 3, E = .000 189 Table 14 and Noniniured Intercollecriate Athletes (n = 48) Groups Means n Mean Diff. S ,E, Diff. t E Injured 112.04 24 5. 96 4.32 1.38 .174 Noninjured 106.08 24 aTable £ (.05) (46) = ± 2.021 190 BIBLIOGRAPHY Albert, N. J., McShane, D., Gordin, R., & Dobson, W. (1988) . The emotional effects of iniurv on female collegiate gymnasts. Paper presented at the Seoul Olympic Scientific Congress, Seoul, South Korea. Allred, K. D., & Smith, T. W. (1989). The hardy personality: Cognitive and physiological responses to evaluative threat. Journal of Personality and Social Psychology. 56(2). 257-266. Andersen, M. B., & Williams, J. M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10, 294-306. Astle, S. J. (1986). The experience of loss in athletes. Journal of Sports Medicine. 26. 279-284. Bartone, P. T. (1989). Predictors of stress-related illness in city bus drivers. Journal of Occupational Medicine. 31(8). 657-663. Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York, NY: Hoeber. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry. 4. 561-571. Booth, W. (1987, August 21). Arthritis Institute tackles sports. Science. 237, 846-847. 191 Bowman, J. (1995, September). Assisting the healing process: Mental skills for the rehabilitating athlete. Workshop presented at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed mood. Journal of Personality, 61(3), 343-364. Brewer, B. W. (1994). Review and critique of models of psychological adjustment to athletic injury. Journal of Applied Sport Psychology. 6. 87-100. Brewer, B. W., Linder, D. E., & Phelps, C. M. (1995). Situational correlates of emotional adjustment to athletic injury. Clinical Journal of Sport Medicine. 5. 241-245. Brewer, B. W., & Petrie, T. A. (1996). Psychopathology in sport and exercise. In J. L. Van Raalte & B. W. Brewer (Eds.), Exploring sport and exercise psychology (pp. 257- 274). Washington, DC: American Psychological Association. Brewer, B. W., Van Raalte, J. L., & Linder, D. E. (1993). Athletic identity: Hercules' muscles or Achilles heel? International Journal of Sport Psychology. 24. 237- 254. Brock, S. C., & Kleiber, D. A. (1994). Narrative in medicine: The stories of elite college athletes' career¬ ending injuries. Qualitative Health Research. 4(4). 411-430. 192 Campbell, J. M., Amerikaner, M., Swank, P., & Vincent, K. (1989). The relationship between the hardiness test and the personal orientation inventory. Journal of Research in Personality. 23. 373-380. Chan, C. S., & Grossman, H. Y. (1988). Psychological effects of running loss on consistent runners. Perceptual and Motor Skills. 66. 875-883. Coopersmith, S. (1990). SET: Self-esteem inventories. Palo Alto, CA: Consulting Psychologists Press, Inc. Dale, J. A. (1992). The relationship of hardiness and mood disturbances to performance in overtrained swimmers. Unpublished doctoral dissertation, University of Maryland, College Park. Daly, J. M., Brewer, B. W., Van Raalte, J. L., Petitpas, A. J., & Sklar, J. H. (1995). Cognitive appraisal, emotional adjustment, and adherence to rehabilitation following knee surgery. Journal of Sport Rehabilitation, 4(1), 23-30. Danish, S. J. (1986). Psychological aspects in the care and treatment of athletic injuries. In P. F. Vinger & E. F. Hoerner (Eds.), Sports injuries: The unthwarted epidemic (2nd ed.Mpp. 345-353). Littleton, MA: PSG. Deutsch, R. E. (1985). The psychological implications of sports related injuries. International Journal of Sport Psychology. 16. 232-237. 193 Ermler, K. L., & Thomas, C. E. (1990). Interventions for the alienating effect of injury. Athletic Training, 15(3), 269-271. Evans, L., & Hardy, L. (1995). Sport injury and grief responses: A review. Journal of Sport and Exercise Psychology. 17. 227-245. Falb, M. E. (1995). Psychological hardiness as a predictor of academic performance and its relationship to stress and health status of community college transfer students. Unpublished doctoral dissertation, Florida State University, Tallahassee, Florida. Ford, I., & Gordon, S. (1993). Social support and athletic injury: The perspective of sport physiotherapists. The Australian Journal of Science and Medicine in Sport, 25(1), 17-25. Ford, I., & Gordon, S. (1995). Perspectives of sport physiotherapists and sport/athletic trainers on the psychological content of professional practice and training; A cross-cultural survey. Manuscript submitted for publication. Ford, I., Gordon, S., & Horsley, C. (1993). Providing social support for injured athletes: The perspective of elite coaches. Snorts Coach, 16(4). 12-18. Funk, S. C., & Houston, B. K. (1987). A critical analysis of the hardiness scale's validity and utility. 194 Journal of Personality and Social Psychology, 53(3), 572- 578. Gentry, W. D., & Kobasa, S. C. (1984). Social and psychological resources mediating stress-illness relationships in humans. In W. D. Gentry (Ed.), Handbook of behavioral medicine, (pp. 87-116). New York, NY: The Guilford Press. Gieck, J. (1990). Psychological considerations of rehabilitation. In W. E. Prentice (Ed.), Rehabilitation techniques in sports medicine (pp. 107-122). St. Louis, MO: Times Mirror/Mosby. Gordon, S., & Lindgren, S. (1990). Psycho-physical rehabilitation from a serious sport injury: A case study of an elite fast bowler. The Australian Journal of Science and Medicine in Sport. 22(3). 71-76. Gordon, S., Milios, D., & Grove, J. R. (1991). Psychological aspects of the recovery process from sport injury: The perspective of sport physiotherapists. The Australian Journal of Science and Medicine in Sport. 23(2) , 53-60. Goss, J. D. (1994). Hardiness and mood disturbances in swimmers while overtraining. Journal of Sport and Exercise Psychology. 16. 135-149. Green, L. B. (1992). The use of imagery in the rehabilitation of injured athletes. The Sport Psychologist. 195 6, 416-428. Grove, J. R. (1993). Personality and injury rehabilitation among sport performers. In D. Pargman (Ed.), Psychological bases of snort injuries (pp. 99-120). Morgantown, WV: Fitness Information Technology. Gyurcsik, N. (1995). Athletes' retrospectives on serious sports injuries. Presentation at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Hahn, M. E. (1966). California life goals evaluation schedules. Palo Alto, CA: Western Psychological Services. Heil, J., Zemper, E., & Carter, C. (1993). Behavioral factors in fencing injuries. In S. Serpa, J. Alves, V. Ferreira, & A. Paula-Brito (Eds.), Proceedings of the 8th World Congress of Sport Psychology (pp. 574-576). Lisbon, Portugal: International Society of Sport Psychology. Henderson, J., Bourgeois, A. E., LeUnes, A., & Meyers, M. C. (1995). Group cohesiveness, mood disturbance, and stress in female basketball players. Manuscript submitted for publication. Henderson, J. & Carroll, W. (1993) . The athletic trainer's role in preventing sport injury and rehabilitating injured athletes: A psychological perspective. In D. Pargman (Ed.), Psychological bases of sport injuries (pp. 15-31). Morgantown, WV: Fitness Information Technology. 196 Henschen, K. P., & Shelley, G. A. (1993). Counseling athletes with permanent disabilities. In S. Serpa, J. Alves, V. Ferreira, & A. Paula-Brito (Eds.), Proceedings of the 8th World Congress of Sport Psychology (pp. 577-581). Lisbon, Portugal: International Society of Sport Psychology. Hull, J. G., Van Treuren, R. R., & Virnelli, S. (1987). Hardiness and health: A critique and alternative approach. Journal of Personality and Social Psychology. 53(3). 518- 530. Jackson, D. N. (1974). Personality research form manual. Goshen, NY: Research Psychologists Press. Jackson, D. W., Jarrett, H., Barley, D., Kausch, J., Swanson, J. J., & Powell, J. W. (1978). Injury prediction in the young athlete. American Journal of Sports Medicine, 6. 6-14 . Jennings, B. M., & Staggers, N. (1994). A critical analysis of hardiness. Nursing Research. 43(51. 274-281. Kelley, B. C. (1994). A model of stress and burnout in collegiate coaches: Effects of gender and time of season. Research Quarterly for Exercise and Sport. 65(1). 48-58. Kenow, L. J. (1995, September). Development of an undergraduate psychology of injury course. Presentation at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Kirkby, R. (1995). Psychological factors in sport 197 injuries. In T. Morris & J. Summers (Eds.), Sport psychology: Theory, applications and issues (pp. 456-473). New York, NY: John Wiley & Sons. Knapp, R. R. (1976). Handbook for the personal orientation inventory. San Diego, CA: Education and Industrial Testing Service. Kobasa, S. C. (1977). Stress personality and health: A study of an overlooked possibility. Unpublished doctoral dissertation, University of Chicago, Illinois. Kobasa, S. C. (1979). Stressful life events, personality, and health: An inquiry into hardiness. Personality and Social Psychology, 37(1), 1-11. Kobasa, S. C. (1982). The hardy personality: Toward a social psychology of stress and health. In G. S. Sanders & J. Suls (Eds.), Social psychology of health and illness (pp. 3-32). Hillsdale, NJ: Lawrence Erlbaum Associates. Kobasa, S. C., & Maddi, S. R. (1977). Existential personality theory. In R. J. Corsini (Ed.), Current Personality Theories (pp. 243-276). Itasca, IL: F. E. Peacock. Kobasa, S. C., Maddi, S. R., & Courington, S. (1981). Personality and constitution as mediators in the stress- illness relationship. Journal of Health and Social Behavior. 22, 368-378. Kobasa, S. C., Maddi, S. R., & Kahn, S. (1982). 198 Hardiness and health: A prospective study. Journal of Personality and Social Psychology, 42(1), 168-177. Kobasa, S. C., Maddi, S. R., & Puccetti, M. C. (1982). Personality and exercise as buffers in the stress-illness relationship. Journal of Behavioral Medicine. 5(4), 391-404. Kobasa, S. C., Maddi, S. R., Puccetti, M. C., & Zola, M. A. (1985). Effectiveness of hardiness, exercise and social support as resources against illness. Journal of Psychosomatic Research. 29(5). 525-533. Kubler-Ross, E. (1969) . On death and dying. New York, NY: Macmillan. LaMott, E. E. (1994). The anterior cruciate ligament injured athlete: The psychological process. Unpublished doctoral dissertation, University of Minnesota, Minneapolis, MN. Larson, G. A., Starkey, C., & Zaichkowsky, L. D. (1996). Psychological aspects of athletic injuries as perceived by athletic trainers. The Sport Psychologist, 10(1), 37-47. Laubach, W. J., Brewer, B. W., Van Raalte, J. L., & Petitpas, A. J. (1996). Attributions for recovery and adherence to sport injury rehabilitation. The Australian Journal of Science and Medicine in Sport. 28(1). 30-34. Leddy, M. H., Lambert, M. J., & Ogles, B. M. (1994). Psychological consequences of athletic injury among high- 199 level competitors. Research Quarterly for Exercise and ■Snort. 65(4) . 347-354. ^ LeUnes, A. S. A., & Daiss, S. (1988) Annotated bibliography on the Profile of Mood States in sports, 1975-1988. Journal of Sport Behavior. 11, 213-240. V^yLorr, M ., Klett, J., McNair, D. M., & Lasky, J. J (1963). Manual: Inpatient Multidimensional Psychiatric Scale. Palo Alto, CA: Consulting Psychologists Press. Lorr, M., & McNair, D. M. (1963). An interpersonal behavior circle. Journal of Abnormal and Social Psychology, 62, 68-75. Lorr, M., & McNair, D. M. (1984). Manual for the Profile of Mood States, Bipolar Form. San Diego, CA: Educational and Industrial Testing Service. Lynch, G. P. (1988). Athletic injuries and the practicing sport psychologist: Practical guidelines for assisting athletes. The Sport Psychologist, 2, 161-167. Maddi, S. R. (1987). Hardiness training at Illinois Bell Telephone. In J. P. Opatz (Ed.), Health promotion evaluation (pp. 101-115). Stevens Point, WI: National Wellness Institute. Maddi, S. R. (1990). Issues and interventions in stress mastery. In H. S. Friedman (Ed.), Personality and disease (pp. 121-154). New York, NY: John Wiley & Sons. Maddi, S. R., & Hess, M. J. (1992). Personality 200 hardiness and success in basketball. International Journal of Sport Psychology. 23. 360-368. Maddi, S. R., & Khoshaba, D. M. (1994). Hardiness and mental health. Journal of Personality Assessment. 63(2), 265-274. Maddi, S. R., & Kobasa, S. C. (1991). The development of hardiness. In A. Monat & R. S. Lazarus (Eds.), Stress and coping: An anthology (3rd ed.)(pp. 245-257). New York, NY: Columbia University Press. Maddi, S. R., Kobasa, S. C., & Hoover, M. (1979). An alienation test. Journal of Humanistic Psychology, 19. 73- 76. Mainwaring, L. M. (1992). The psychological response of athletes to sport-related knee injury rehabilitation. Unpublished doctoral dissertation, York University, North York, Ontario, Canada. McDonald, S. A., & Hardy, C. J. (1990). Affective response patterns of the injured athlete: An exploratory analysis. The Sport Psychologist. 4. 261-274. McGowan, R. W., Pierce, E. F., Williams, M. & Eastman, N. W. (1994) . Athletic injury and self diminution. The Journal of Sports Medicine and Physical Fitness. 34(3). 299- 304 . McNair, D. M., Lorr, M., & Droppleman, L. F. (1971). Profile of Mood States. San Diego, CA: Educational and 201 Industrial Testing Services. McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). Manual for the Profile of Mood States (Revised Ed.). San Diego, CA: Educational and Industrial Testing Service. Moos, R. H., & Tsu, V. D. (1977). The crisis of physical illness: An overview. In R. H. Moos (Ed.), Coping with physical illness (pp. 3-21) . New York, NY: Plenum. Morgan, W. P. (1980, July). Test of champions: The iceberg profile. Psychology Today, 14(2), 92-93, 97-99, 102, 108 . Morrissey, C., & Hannah, T. E. (1987). Measurement of psychological hardiness in adolescents. Journal of Genetic Psychology. 148(3). 393-397. Nixon, H. L., II. (1996). Explaining pain and injury attitudes and experiences in sport in terms of gender, race, and sports status factors. Journal of Sport and Social Issues. 20(1). 33-44. Norcross, J. C., Guadagnoli, E., & Prochaska, J. 0. (1984) . Factor structure of the profile of mood states (POMS): Two partial replications. Journal of Clinical Psychology. 40(5). 1270-1277. Nowack, K. M. (1989) . Coping style, cognitive hardiness, and health status. Journal of Behavioral Medicine. 12(2). 145-158. Nowack, K. M. (1990). Initial development of an 202 inventory to assess stress and health risk. American Journal of Health Promotion. 4(3). 173-180. Okun, M. A., Zautra, A. J., & Robinson, S. E. (1988). Hardiness and health among women with rheumatoid arthritis. Personality and Individual Differences. 9. 101-107. Orr, E., & Westman, M. (1990). Does hardiness moderate stress, and how?: A review. In M. Rosenbaum (Ed.), Learned resourcefulness: On coping skills, self-control, and adaptive behavior (pp. 64-94). New York, NY: Springer. Ouellette, S. C. (1993). Inquiries into hardiness. In L. Goldberger & S. Breznitz (Eds.), Handbook of stress: Theoretical and clinical aspects (2nd Ed.)(pp. 77-100). New York, NY: The Free Press. ^ Parloff, M. B., Kelman, H. C., & Frank, J. D. (1954). Comfort, effectiveness and self-awareness as criteria of improvement in psychotherapy. American Journal of Psychiatry. 111. 343-351. Passer, M. W. (1982). Psychological stress in youth sport. In R. A. Magill, M. J. Ash, & F. L. Smoll (Eds.), Children in sport (pp. 153-177). Champaign, IL: Human Kinetics. Pearson, L., & Jones, G. (1992). Emotional effects of sports injuries: Implications for physiotherapists. Physiotherapy. 78(10). 762-770. Pedersen, P. (1986). The grief response and injury: A 203 special challenge for athletes and athletic trainers. Athletic Training. 21(4). 312-314. Pero, S. F. (1995a, September). Development. implementation, and evaluation of an educational program in sport psychology for athletic trainers. Presentation at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Pero, S. F. (1995b, January). Sport psychology and athletic training. Workshop presented at the 47th annual meeting of the Eastern Athletic Trainers Association, Philadelphia, PA. Peterson, R. A., & Headen, S. W. (1984). Profile of mood states. In D. J. Keyser & R. C. Sweetland (Eds.), Test critiques: Volume I (pp. 522-529). Kansas City, MO: Test Corporation of America. Petitpas, A., & Danish, S. J. (1995). Caring for injured athletes. In S. M. Murphy (Ed.), Sport psychology interventions (pp. 255-281). Champaign, IL: Human Kinetics. Petrie, G. (1993). Injury from the athlete's point of view. In J. Heil (Ed.), Psychology of sport injury (pp. 17- 23). Champaign, IL: Human Kinetics. Pollock, S. E., & Duffy, M. E. (1990). The health- related hardiness scale: Development and psychometric analysis. Nursing Research. 39(4). 218-222. Prapavessis, H., & Grove, J. R. (1994) . Personality 204 variables as antecedents of precompetitive mood state temporal patterning. International Journal of Sport Psychology. 22. 347-365. Quackenbush, N., & Crossman, J. (1994). Injured athletes: A study of emotional responses. Journal of Sport Behavior. 17 (3). 178-187. Raglin, J. S., Eksten, F., & Garl, T. (1995). Mood state response to a pre-season conditioning program in male collegiate basketball players. International Journal of Soort Psychology. 26. 214-225. Rhodewalt, F., & Zone, J. B. (1989). Appraisal of life I change, depression, and illness in hardy and nonhardy women. Journal of Personality and Social Psychology. 56(1). 81-88. Rose, J., & Jevne, R. F. J. (1993). Psychosocial processes associated with athletic injuries. The Sport Psychologist. 7. 309-328. Rotella, R. J. (1985). The psychological care of the injured athlete. In L. K. Bunker, R. J. Rotella, & A. S. Reilly (Eds.), Psychological considerations in maximizing sport performance (pp. 273-287). Ann Arbor, MI: McNaughton and Gunn. Rotella, R. J. (1988). Psychological care of the injured athlete. In D. N. Kulund (Ed.), The injured athlete (2nd ed.)(pp. 151-164). Philadelphia, PA: J. B. Lippincott. Rotella, R. J., & Heyman, S. R. (1986). Stress, injury, 205 and the psychological rehabilitation of athletes. In J. Williams (Ed.), Applied sport psychology (pp. 343-364). Palo Alto, CA: Mayfield. Roth, D. L., Wiebe, D. J., Fillingim, R. B., & Shay, K. A. (1989). Life events, fitness, hardiness, and health: A simultaneous analysis of proposed stress-resistance effects. Journal of Personality and Social Psychology. 57(1), 136- 142 . Rotter, J. B., Seeman, M., & Liverant, S. (1962). Internal vs. external locus of control of reinforcement: A major variable in behavior theory. In N. F. Washburne (Ed.), Decisions, values, and groups (pp. 473-516). London: Pergamon. Smith, A. M., & Milliner, E. K. (1994). Injured athletes and the risk of suicide. Journal of Athletic Training. 29(4). 337-341. Smith, A. M., Scott, S. G., O'Fallon, W. M., & Young, M. L. (1990). Emotional responses of athletes to injury. Mayo Clinic Proceedings. 65. 38-50. Smith, A. M., Scott, S. G., & Wiese, D. M. (1990). The psychological effects of sports injuries: Coping. Sports Medicine. 9(6). 352-369. Smith, A. M., Stuart, M. J., Wiese-Bjornstal, D. M., Milliner, E. K., O'Fallon, W. M., & Crowson, C. S. (1993). Competitive athletes: Preinjury and postinjury mood state 206 and self-esteem. Mayo Clinic Proceedings. 68. 939-947. Snow, A., & LeUnes, A. (1994). Characteristics of sports research using the profile of mood states. Journal of Sport Behavior. 17(4). 207-211. Steadman, J. R. (1993). A physician's approach to the psychology of injury. In J. Heil (Ed.), Psychology of sport injury (pp. 25-31). Champaign, IL: Human Kinetics. Steele, M. K., Ill (1996). Sideline help. Champaign, IL: Human Kinetics. Taylor, J. A. (1953). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology. 40. 285- 290. Thomas, C. E., & Rintala, J. A. (1989). Injury as alienation in sport. Journal of the Philosophy of Sport. XVI. 44-58. Udry, E. M. (1995, September). How to get in and stay in a sports medicine setting without even being injured. Presentation at the 10th annual conference of the Association for the Advancement of Applied Sport Psychology, New Orleans, LA. Uemukai, K. (1993) . Affective responses and the changes in athletes due to injury. In S. Serpa, J. Alves, V. Ferreira, & A. Paula-Brito (Eds.), Proceedings of the 8th World Congress of Sport Psychology (pp. 500-503). Lisbon, Portugal: International Society of Sport Psychology. 207 Vinciguerra, B. A. (1992). Hood states and injury occurrence in intercollegiate field hockey. Unpublished master's thesis, Springfield College, Springfield, Massachusetts. Wagman, D., & Khelifa, M. (1996). Psychological issues in sport injury rehabilitation: Current knowledge and practice. Journal of Athletic Training, 31(3), 257-261. Weckowicz, T. E. (1978). Profile of mood states. In 0. K. Burros (Ed.), The eighth mental measurements yearbook (Vol. 1) (pp. 1018-1019). Highland Park, NJ: Gryphon. Weiss, M. R., & Troxel, R. K. (1986). Psychology of the injured athlete. Athletic Training, 21(2), 104-109, 154. Westman, M. (1990). The relationship between stress and performance: The moderating effect of hardiness. Human Performance. 3(3). 141-155. Wiese-Bjornstal, D. M., & Smith, A. M. (1993). Counseling strategies for enhanced recovery of injured athletes within a team approach. In D. Pargman (Ed.), Psychological bases of sport injuries (pp. 149-182). Morgantown, WV: Fitness Information Technology. Wiese-Bjornstal, D. M., Smith, A. M., & LaMott, E. E. (1995). A model of psychologic response to athletic injury and rehabilitation. Athletic Training: Sports Health Care Perspectives, 1(1). 17-30. Wiese, D. M., & Weiss, M. R. (1987). Psychological 208 rehabilitation and physical injury: Implications for the sportsmedicine team. The Sport Psychologist. 1. 318-330. Wiese, D. M., Weiss, M. R., & Yukelson, D. P. (1991). Sport psychology in the training room: A survey of athletic trainers. The Sport Psychologist. 5. 15-24.