Q&A: Athletes' Mental Health — Clinical Sports Psychologist Donald R. Marks, Psy.D.

Donald R. Marks, Psy.D. is the director of clinical training for Kean University's doctoral Combined School and Clinical Psychology program, and a clinical health psychologist specializing in clinical sports psychology and the treatment of chronic pain related to injury or medical illness. He is editor emeritus of the Journal of Clinical Sport Psychology, for which he served as editor-in-chief from 2012 to 2018, and co-editor of the forthcoming The Routledge Handbook of Clinical Sport Psychology. 

Q. Can you tell us about your work in clinical sports psychology?

My work primarily addresses the assessment and treatment of psychological distress and behavioral problems, particularly interpersonal problems, among athletes, coaches, support personnel, and family members. 

Clinical sport psychology is the intersection of clinical psychology and sport psychology. Clinical sport psychologists address depression, anxiety, eating disorders, trauma, interpersonal problems, and a range of other mental health concerns. It is an emerging area and has grown substantially in the past decade with considerable new research that focuses on athlete behavior and psychological well-being. 

 Although psychological distress can affect athletic performance, the clinical sport psychologist generally doesn’t focus on that. Instead, clinical sport psychology addresses what causes psychological distress, and works to foster increased psychological flexibility. As distress subsides, athletic performance is often enhanced - an effect rather than a primary treatment target.

 Q. What is the rate of psychological distress among athletes compared to the general population? 

Although we still have more data to gather, studies suggest the rate among athletes is about the same as in the general population or even slightly higher. For years, many people believed athletes and elite performers experienced less psychological distress, the assumption being exercise is beneficial. It was also taken for granted that elite performers would likely be psychologically, as well as physically fit. As it turns out, athletes are just as prone to distress as other people. In some instances, such as college athletes, they may find themselves subject to pressures and demands exceeding those of non-athletes. 

What’s different may be the rules concerning the display of distress among the sport population. Athletes may be encouraged to maintain either a stoic or "positive attitude" despite aversive situations or experiences. 

 Q. Is there variation by sport?  

 Participation in team sports may serve as a mild buffer against emotional and behavioral difficulties, yielding lower rates of psychological distress than participation in individual sports. "The loneliness of the long-distance runner," to borrow the phrase made famous by Alan Sillitoe, is not without its long-term consequences.

Q. How does bullying and hazing, as well as domestic violence, impact athletes?

Hazing and bullying are quite widespread in sport, particularly in youth sport environments. Rates of victimization through bullying and cyber-bullying in collegiate sports approach 50 percent in recent studies. These problems remain a serious cause for concern, although rates of victimization and perpetration vary widely from study to study. Additional research is needed to understand the prevalence. 

 Domestic violence and sexual violence among athlete populations are enormous concerns. A recent study found NCAA Division I universities reported a significantly higher incidence of sexual violence, domestic violence, and dating violence than universities with Division II or Division III athletics, or those without athletic programs.   

Q. What happens psychologically when an athlete is on a losing streak or suffers an injury that affects performance? 

Sometimes we lose. Sometimes we lose multiple games in a row. Coaches and athletes often make a mistake by insisting on "staying positive," as though success depends upon feeling a certain way or thinking a particular thought. Instead, it’s more likely athletes make positive self-evaluations when they win or perform well, so it appears that positive thinking contributes to success. Making room for the disappointment and hurt experienced when an athlete loses lets that athlete relinquish internal struggle. It also provides an opportunity to identify what’s most important -- what is the athlete playing and winning for? Identifying those values contributes to persistence, and enthusiasm for practice. 

 Persistence with flexibility is the key. It’s disappointing to lose playing time, and painful to suffer performance limitations. An athlete may grieve the loss of an important game or even a whole season. If we allow those emotional experiences and thoughts to arise, we can then shift our focus to rehabilitation, and return to play without keeping up a battle against unwanted feelings.