1 / 33

Psychological considerations in ACL injuries

Psychological considerations in ACL injuries. Drew Brannon, Ph.D. Licensed Psychologist. The Plan. Brief background Case of Madi Diagnosis and management Return to play considerations Prevention and protocol Discussion. Role of Sport Psychology .

malise
Download Presentation

Psychological considerations in ACL injuries

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Psychological considerations in ACL injuries Drew Brannon, Ph.D. Licensed Psychologist

  2. The Plan • Brief background • Case of Madi • Diagnosis and management • Return to play considerations • Prevention and protocol • Discussion

  3. Role of Sport Psychology • Public’s understanding vs. actual service delivery • Variability in training has created confusion

  4. The “bystander” sport psychologist

  5. Clinical/Sport Psychology Framework

  6. Clinical issues • Depression • Anxiety • Grief/loss • Sexual trauma • Eating disorders • Anger

  7. Sport specific issues • Performance Anxiety • Burnout • Focus • Injury • Confidence • Role changes • Career transition • Goal setting • Motivation

  8. Case of Madi • Collegiate student-athlete • High level soccer player • Key team contributor

  9. Family history/dynamic • Sister: diagnosed with ADHD • Mother: notable symptoms of anxiety • Madi: first collegiate student-athlete in family • Both parents busy/successful working professionals

  10. Medical history • One previous ACL tear during high school (11th grade) • Extensive physical therapy • Complicated rehab process • Slow recovery

  11. Psychological history • Diagnosed with ADHD @ 7 y/o • Prescribed Focalin XR (20mg) • History of disruptive/risk taking behaviors • History of depressive episodes since age 14

  12. The injury • Fall preseason camp prior to Sophomore year • Three-a-day practices • Day 9

  13. Diagnosis/management • MRI confirms tear • Surgery scheduled • Procedure performed

  14. Stages of grief (Kubler-Ross, 1969) • 1. Denial • 2. Anger • 3. Bargaining • 4. Depression • 5. Acceptance

  15. Response during early stages • (Tracey, 2003; Leddy et. al.,. 1994; Udry, 1997; Heil, 1993) • Greatest mood disturbance during initial phase following injury • Early recovery process greatest period of emotionality • Critical point of psychological intervention occurs in first three weeks post-injury

  16. Initial responses • Disengagement from team • Perceived lack of interest from coaching staff • Overly involved parents • Need for attention • Sense of helplessness

  17. Continued • Absence of sport removes her only known coping mechanism • Now has more time on her hands • Peer group heavily involved in alcohol use/abuse

  18. Complicating factors (apparent) • Disagreement regarding rehab • Poor compliance with rehab • Impatience from all parties

  19. Introduction of psychologist • Initial consult mandated by team physician • Gathering of information difficult due to lack of cooperation • Was willing to discuss other things, which slowly built rapport

  20. Follow up sessions • Madi becomes more willing to attend • Disclosure of family dynamics clarifies nature of several problem areas • Trusted information eventually shared

  21. Complicating factors (additional) • Onset of depressive symptoms • Poor self-care practices • Lack of regard for behavior • Effects of social choices

  22. Psychological factors of rehab (Heil, 1994; Pargman, 2007) • Inconsistent motivation • Unhappy with role on team • Lack of trust toward coaches • Identity confusion

  23. Diagnosis/treatment • Extensive clinical interviewing • Beck Depression Inventory • Collateral information • Psychiatric consult

  24. Ongoing treatment • Weekly counseling sessions • Medication management • Consults with sports medicine staff

  25. Madi’s tipping point

  26. New approach/perspective • Willing and motivated toward rehab • Improved sleep and dietary habits • Increased independence from parents • More engagement with support systems

  27. Return to play • Clearance from sports medicine staff • Psychological symptoms to benefit from return • Significant anxiety necessitated controlled return • Hesitation about return due to fear of regression

  28. Mental skills for return to play • Cognitive-behavioral therapy • Self-talk affirmations • Guided imagery/visualization

  29. Restoring confidence • Watched game tape • Read old press releases • Talked to high school and club coaches

  30. Prevention/Protocol • Role of psychological services in long-term rehab • Sport psychology consult protocol (pre-op, post-op, monthly follow-up, PRN) • Comprehensive treatment team approach

  31. Further prevention • Qualified team leaders • Life skills programming • Caring coaches

  32. Injured athlete groups • Power of the shared experience • Knowing you’re not alone • Receiving ideas for getting through adversity • Better use of time that other activities?

  33. Discussion • What could I have done differently in this case to improve the situation and/or outcome? • What are critical psychological factors for sports medicine professionals to consider in athletes during long-term rehab?

More Related