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Athletic Trainers and Psychological Disorders Among Athletes

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Athletic Trainers and Psychological Disorders Among Athletes ATHLETIC TRAINERS AND PSYCHOLOGICAL DISORDERS AMONG ATHLETES: AN EXAMINATION OF THEIR ABILITIES TO RECOGNIZE, DIAGNOSE AND INTERVENE Courtney Brooks Albinson, B.A., M.A. Dissertation Prepared for the Degree of DOCTOR OF PHILOSOPHY UNIVERSITY OF NORTH TEXAS December 2006 APPROVED: Trent A. Petrie, Major Professor Karen D. Cogan, Committee Member Christy Greenleaf, Committee Member Bert Hayslip, Committee Member Linda Marshall, Chair of the Department of Psychology Sandra L. Terrell, Dean of the Robert B. Toulouse School of Graduate Studies Albinson, Courtney Brooks. Athletic trainers and psychological disorders among athletes: An examination of their abilities to recognize, diagnose and intervene. Doctor of Philosophy (Counseling Psychology), December 2006, 193 pp., 30 tables, references, 95 titles. Utilizing an analogue research design conducted via the Internet, this study assessed athletic trainers’ abilities to recognize, diagnose, and intervene with a hypothetical athlete experiencing depression, and examined the impact of their gender, athlete gender, and athlete’s presenting problem on their decisions. Athletic trainers’ perceived competency in using psychosocial interventions with athletes, history of referring athletes to psychology professionals, and training backgrounds in psychology also were examined. Participants (270 male and 370 female certified athletic trainers) were randomly assigned to one of six conditions (Athlete Gender X Presenting Problem). After reading the appropriate vignette, they completed questions related to the athlete’s psychological symptoms and diagnosis, referral recommendations, and use of psychosocial interventions if working with the athlete. The vignettes were identical except for the athlete’s gender and problem. Overall, athletic trainers accurately identified the athlete’s depressive symptoms/diagnosis and need for psychological referral. They rated the athlete significantly higher in Depressive Symptoms than in Anger/Agitation Symptoms and Compulsive Behavioral Symptoms, and as more likely to be experiencing a depressive disorder compared to an adjustment disorder, anxiety disorder, sleep disorder, or substance abuse disorder. Female athletic trainers provided significantly higher ratings of Depressive Symptoms than males and the injured athlete was rated significantly higher in Anger/Agitation than the performance problem athlete. Diagnosis ratings were not influenced by athlete gender, athletic trainer gender, or type of problem. Athletic trainers were most likely to refer the athlete to a psychology professional compared to an allied health professional, treating the athlete themselves, or doing nothing. Presenting problem significantly impacted referral recommendations. If treating the athlete themselves, athletic trainers were significantly more likely to use supportive interventions than cognitive-behavioral techniques; they felt significantly more competent in providing supportive interventions. Competency in both interventions was significantly enhanced if athletic trainers completed psychology coursework. Findings suggest that athletic trainers are able to accurately identify and intervene with athletes experiencing psychological problems. TABLE OF CONTENTS Page LIST OF TABLES ...................................................................................................vi Chapter 1. INTRODUCTION................................................................................ 1 Psychological Models of Response to Sport Injury ...................... 3 Cognitive Responses to Sport Injury................................ 5 Emotional Responses to Sport Injury............................... 5 Behavioral Responses to Sport Injury.............................. 7 Summary of Psychological Reactions to Injury ................. 9 The Influence of Athletic Trainers on Athletes’ Psychological Responses to Sport Injury.......................................................10 The Role of Athletic Trainers in Treating Psychological Aspects of Sport Injury ...........................................................................12 Reasons for Athletic Trainers to Intervene Psychologically ..................................................................................12 Recommended Psychological Interventions to be Employed by Athletic Trainers.......................................................16 Athletic Trainers’ Competency to Treat Athletes Psychologically .............................................................18 Purpose of Present Study........................................................23 2. METHOD .........................................................................................27 Participants............................................................................27 Measures...............................................................................29 Demographic Questionnaire ..........................................29 Symptom Ratings .........................................................31 Problem Ratings...........................................................32 Diagnosis Ratings .........................................................32 Recommendations for Referral.......................................33 Use of Psychosocial Interventions ..................................33 Procedure..............................................................................34 ii Athlete Vignettes..........................................................34 Pilot Testing.................................................................36 Experimental Procedure ................................................38 Factor Analyses............................................................39 Statistical Analyses .................................................................46 Demographic Information .............................................46 Primary Problem, Symptoms, Diagnosis, Referral, and Use of Psychosocial Interventions ............................................49 Exploratory Relationships between Psychosocial Intervention Competencies and Use of Psychosocial Interventions.......50 3. RESULTS .........................................................................................51 Demographic Information .......................................................51 Background Information ...............................................51 Education and Training in Sport and General Psychology ..................................................................................52 Referral Practices .........................................................58 Perceived Roles of Certified Athletic Trainers ..................62 Perceived Competency in Using Psychosocial Interventions ..................................................................................65 Problem Ratings.....................................................................75 Symptom Ratings...................................................................78 Diagnosis Ratings...................................................................83 Referral Ratings .....................................................................87 Use of Psychosocial Strategies/Techniques ...............................96 4. DISCUSSION .................................................................................112 Athletic Trainers’ Abilities to Identify the Symptoms and Diagnosis of Depression.......................................................................113 The Effects of the Independent Variables on Athletic Trainers’ Assessments of Depression Symptoms and Diagnosis...................................................................117 Athletic Trainers’ Referral Recommendations and Past Referral Practices..............................................................................120 iii Referral Recommendations for the Hypothetical Athlete ................................................................................120 Athletic Trainers’ Past Referral Practices .......................122 The Effects of the Independent Variables on Athletic Trainers’ Decisions Regarding Referral .........................124 Athletic Trainers’ Use of Psychosocial Strategies/Techniques....129 Athletic Trainers’ Perceptions of Their Roles in Facilitating Psychological Well-Being .............................................129 Athletic Trainers’ Use of Psychosocial Interventions with the Hypothetical Athlete ...................................................131 The Effects of the Independent Variables on Athletic Trainers’ Use of Psychosocial Interventions...................133 Influence of Psychology Coursework Taken on Athletic Trainers’ Perceptions of Competency in Providing Psychosocial Interventions ..........................................135 Summary of Study Results ....................................................137 Study Limitations and Future Directions .................................141 Limitations of the Analogue Research Design................141 Response Rate ...........................................................144 Future Directions........................................................147 Appendices A. DEMOGRAPHIC QUESTIONNAIRE....................................................149 B. SYMPTOM RATINGS .......................................................................159 C. PROBLEM RATINGS........................................................................162 D. DIAGNOSIS RATINGS.....................................................................164 E.
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