Confronting Fear When Injured Part 2: Working with Fear?
A person jumping over gap between rocks.
In the previous post, we explore some basics about fear in the context of athletic injury. Today the focus is on how we engage with fear. The below are some suggestions for how to engage with fear.
Facing the Fear Directly
While this section could go on for a very long time, that is not going to happen. We will briefly explored some techniques and ideas that have helped athletes address fear during injury recovery. This is meant to be information only, not a form of treatment or a recommendation for a treatment approach. It is essential that these approaches are done with the support of a professional, like a sport and performance consultant.
Technique 1: Facing Fear Directly
Facing fear directly means gradually approaching a fear-evoking situation in a safe and reassuring atmosphere instead of addressing the fear more directly and in demanding conditions (Petrie, 2007). This approach needs to be done in a safe and reassuring environment with a trained professional who can be of support, help guide the process, and encourage resilience.
Technique 2: Accepting the Injury and Recovery Process
Taking a more accepting approach means helping a person to feel more comfortable feeling the fear while evoking a strong reaction to it (Petrie, 2007). When thinking about injury,, what comes to mind is the introduction of mindfulness and acceptance and commitment therapy. Research has demonstrated that injured athletes can benefit from mindfulness as part of rehabilitation to increase pain tolerance and bring awareness (Mohammed et al., 2018). Awareness is vital when addressing fear, especially when considering the "two systems" view of the behavioral responses and physiological changes and conscious feeling states. Sometimes it takes a lot to tease the effects apart and then accept and honor why they arose, which is where acceptance and commitment therapy becomes beneficial (ACT). ACT-based interventions can help with educating people about how to meet recovery challenges, commit to their rehabilitations, exhibit behaviors potentially beneficial to successful return to play, and enhance injury rehabilitation in general (Mahoney & Hanrahan, 2011; Shortway et al., 2018). When one accepts the fear instead of fighting it or worrying about it, less energy is spent on that process, and more can be spent on rehabilitation.
Technique 3: Flooding of the Injury
Flooding means that someone is exposed to a fearful situation for a protracted time period with the specific purpose of provoking intense fearful feelings (Petrie, 2007). Drawn from behavioral psychology, flooding strives to diminish the unwanted response to the root of the fear. An important piece to this approach is that one must have the resources and ego strength to go through this experience, as it asks a person to be that fear and hold it. If this approach is used inappropriately, harm may be caused.
Technique 4: Systematic Desensitization of the Injury
Systematic desensitization is a more gradual approach to interacting with the source of the fear while still attempting to hold the fear-provoking experience. Taking this more step-by-step approach allows for a more titrated experience.. The process also allows for tolerance building and confidence building. As a person progresses through the process, a collection of successful experiences accumulates, which can then be used to address how far someone has come, boosting confidence. If setbacks occur during the process, that can still be used to show how far someone has come and their ability to overcome adversity. In other words, this technique can also become the micro experience for the macro rehabilitation experience.
Technique 5: Modeling
Modeling occurs when an injured person is exposed to individuals or entities that become examples of a rehabilitation journey. Ideally, the chosen person would be someone that the injured person could interact with directly, which is the hardest to accomplish, so turning to the web to find someone virtually or using recorded footage may be the next best option. For an athlete, vicarious experiences, verbal persuasions, and emotional exhortation are hopefully experienced in the modeling process to increase effectiveness (Flint, 2007). Finding other athletes who have successfully returned and faced their fears allows a person to model themselves in various degrees and find hope.
These are just some of the approaches and techniques that exist to help address fear in athletic injury. Injuries can be scary, and there is help out there. Do not be afraid to reach out for help and support.
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If any of these approaches interest you, take the time to learn more about them for trusted sources. And if you need support, remember to find a qualified professional to support you.
Learn More About EXPLICIT AND IMPLICIT TRAINING:
Fear of Reinjury in Athletes: Implications for Rehabilitation
References
Flint, F. A. (2007). Modeling in injury rehabilitation: Seeing helps believing. In D. Pargman (Ed.), Psychological bases of sport injuries (3rd ed.) (pp. 95-107). Fitness Information Technology.
LeDoux, J. E., & Pine, D. S. (2016). Using neuroscience to help understand fear and anxiety: A two-system framework. American Journal of Psychiatry, 173(11), 1083-1093. https://doi.org/10.1176/appi.ajp.2016.16030353
Mahoney, J., & Hanrahan, S. J. (2011). A brief educational intervention using acceptance and commitment therapy: Four injured athletes’ experiences. Journal of Clinical Sport Psychology, 5(3), 252-273.
Mohammed, W. A., Pappous, A., & Sharma, D. (2018). Effect of mindfulness based stress reduction (MBSR) in increasing pain tolerance and improving the mental health of injured athletes. Frontiers in Psychology, 15(9), 722. doi: 10.3389/fpsyg.2018.00722
Petrie, T. A. (2007). Using counseling groups in the rehabilitation of athletic injury. In D. Pargman (Ed.), Psychological bases of sport injuries (3rd ed.) (pp. 193-192). Fitness Information Technology.
Shortway, K. M., Wolanin, A., Block-Lerner, J., & Marks, D. (2018). Acceptance and commitment therapy for injured athletes: Development and preliminary feasibility of the return to ACTion protocol. Journal of Clinical Sport Psychology, 12(1), 4–26. https://doi.org/10.1123/jcsp.2017-0033
Tovote, P., Fadok, J. P., & Lüthi, A. (2015). Neuronal circuits for fear and anxiety. Nature Reviews Neuroscience, 16(6), 317-331.
Vealey, R. S., Garner-Holman, M., Hayashi, S. W., & Giacobbi, P. (1998). Sources of sport-confidence: Conceptualization and instrument development. Journal of Sport and Exercise Psychology, 20(1), 54-80.