Psychological Aspects of Sport-Related Concussions

Gordon Bloom, Jeffrey Caron, Gordon A. Bloom, Jeffrey G. Caron

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351200493
• Edition: 1
• Topic: Medicine
• Subtopic: Sports Medicine

Recognition of concussion as a serious injury, informed by neurological and physiological research, is now commonplace in sport. However, research on the psychology of concussive injury—its psychological implications and outcomes, and psychological interventions for prevention and recovery—has largely been overlooked. This is the first book to explicitly and authoritatively set out the psychological aspects of sport-related concussion from a multidisciplinary and global perspective

The book attempts to offer a global understanding of the injury by presenting an historical overview; exploring the psychological implications of sport-related concussion and the influence of gender and sociocultural context on concussive injury and recovery; setting out practical guidance on working with special populations suffering from concussive injuries; and discussing the theoretical and methodological considerations for research on concussion and future directions for this research.

Written by a group of leading international experts and offering a hitherto underdeveloped perspective on this crucial area of sports injury research, this book is crucial reading for any upper-level student, researcher, sport scientist, coach, or allied health professional working on sport-related concussion. It is also valuable reading for students and researchers interested in the psychosocial processes that impact injury and recovery or general professional practice in sport psychology.

1 Introduction

Gordon A. Bloom and Jeffrey G. Caron

If you hit your head hard enough, things can get really confusing. Things can come unraveled and you have no control … People don’t understand going from, in their eyes, a hockey celebrity to the point where you can’t walk out of your house. You can’t shave. You have no desire to do anything. You’re depressed.

(Excerpt from an interview with a retired professional athlete; see Caron et al., 2013, p. 173)

Broadly speaking, researchers in psychology study the relationship between the brain and behavior. Since the 1980s, there has been a great deal of psychological research on sport-related performance, well-being, and injuries. In particular, athletic injuries have become an area of specialization within psychology, evidenced by an ever-increasing number of peer-reviewed articles (e.g., Forsdyke et al., 2016) and textbooks (e.g., Arvinen-Barrow & Walker, 2013), which have provided key information about the antecedents, determinants, and outcomes associated with psychological aspects of athletic injuries. Concussions are a specific type of athletic injury that have become recognized as a serious injury in a variety of sports (Johnson, Partridge, & Gilbert, 2015). Recent documentaries and films such as Concussion, which depicted Dr. Bennett Omalu’s discovery of chronic traumatic encephalopathy among deceased former professional football athletes, along with increased media coverage of high-profile athletes with severe concussions (e.g., Canadian professional ice hockey player Sidney Crosby), have also increased the public’s awareness of this injury (Hainline & Ellenbogen, 2017; McGannon, Cunningham, & Schinke, 2013). Despite the increased attention, researchers and clinicians are still learning about the short- and long-term health implications of sport-related concussions.

A concussion is defined as a traumatic brain injury (TBI) that results from biomechanical forces transmitted via a direct or indirect blow to the face, head, or elsewhere on the body (McCrory et al., 2017). On the spectrum of TBI, concussions are considered “mild” because they are closed head injuries that are typically not life-threatening. However, the term “mild” is a rather paradoxical way to describe an injury that has been linked to serious adverse health consequences (Manley et al., 2017; Moore, Kay, & Ellemberg, 2018). The majority of sport-related concussions occur as a result of participating in contact or collision sports like American football, rugby, and ice hockey. Concussed athletes experience one or more of the following after injury: physical signs, behavioral changes, balance and cognitive impairment, and sleep disturbance, as well as somatic, cognitive, and emotional symptoms (McCrory et al., 2017). Most concussed adult athletes recover within 10–14 days, whereas symptomatology for children and adolescent athletes typically resolves within 30 days (McCrory et al., 2017). A smaller percentage of athletes are slow to recover and can experience concussion symptoms for longer periods of time that can last from months to years (Martini & Broglio, 2018), an issue that continues to be at the forefront of research on concussions.

Scientists have been interested in concussions dating back as far as 1700 bce, when a case involving a patient who had symptoms of coma, stupor, and confusion was described in the Edwin Smith medical document (see Chapter 2 for a more detailed historical overview). The term “concussion” first appeared in the medical literature when Nichols and Smith (1906) wrote about “concussions of the brain” in an editorial commentary for the Boston Medical and Surgical Journal (p. 3). The authors reported on their experiences providing care for Harvard University football players during the 1905 season (Nichols & Smith, 1906). Although there was research on sport-related concussions in the 20th century, much of the exponential growth in research that we are currently experiencing can likely be attributed to the Concussion in Sport Group (CISG), who first met in the early 2000s. The CISG is an assembly of leading clinical and research experts from various backgrounds including (but not limited to) sports medicine, neurology, neuropsychology, and sports science. The CISG has held five meetings to date: Vienna in 2001, Prague in 2004, Zurich in 2008 and 2012, and Berlin in 2016 (cf. McCrory et al., 2017). These meetings have largely shaped “best practice” for the evaluation and management of concussion worldwide.

The vast majority of research has centred on the pathophyisiological diagnosis, evaluation, and management of sport-related concussions. However, researchers have also become interested in the psychological aspects of sport-related concussions. In fact, there is now a large body of evidence demonstrating that concussed athletes may concurrently suffer from psychological sequelae such as depression, isolation, irritability, and anxiety, which can exacerbate the overall effect of a concussion (e.g., Henry, Tremblay, & De Beaumont, 2017; Ptito, Chen, & Johnston, 2008). Contemporary thinking and research on the psychological aspects of concussion owes much to the pioneering work of neuropsychologist Dr. Jeffrey Barth and colleagues, who studied individuals involved in motor vehicle accidents in the 1980s (e.g., Barth et al., 1983; Rimel et al., 1981). The authors found that 34% of these individuals who sustained a mild head injury had not returned to work three months after injury. Moreover, these individuals with mild head injuries were found to be experiencing emotional stress and deficits associated with their attention, concentration, memory, and judgment. Almost a decade later, Barth et al. (1989) were among the first to issue warnings about the long-term effects of sport-related head injuries after studying more than 2,000 college and professional football athletes.

There is now an ever-growing body of evidence suggesting that individuals who sustain sport-related concussions can experience psychological symptoms that can last for days, weeks, or in some severe cases, persist from months to years (e.g., Caron et al., 2013). Unlike most musculoskeletal injuries, however, a concussion is an “invisible injury,” meaning there are typically no visible signs of trauma (Bloom et al., 2004). Consequently, it is difficult for casual observers to identify the athlete as being injured. Additionally, athletes with musculoskeletal injuries are often provided with a timeline for recovery and regimented rehabilitation protocol, whereas athletes diagnosed with a concussion have no definitive timeline for recovery, and they often leave the doctor with a minimally structured return to activity schedule. Currently, there is work underway to enhance clinicians’ ability to predict timelines for recovery through the use of neuroimaging, fluid biomarkers, and genetic testing (see McCrea et al., 2017 for a review).

Although research on psychological aspects of sport-related concussions has continued to grow since Barth and colleagues’ work in the 1980s, many questions remain unanswered. In a recent special issue on sport-related concussions in the journal Sport, Exercise, and Performance Psychology, editor Anthony Kontos (2017) noted: “the role of psychological factors in predicting outcomes following a concussion is not well understood. We also know little about the psychological sequelae that often accompany concussion” (p. 215). Given that sport-related concussions have reached an epidemic level and are widely regarded as a serious public health issue, the time is right to highlight the current understanding of psychological implications of the injury and recovery process.

About the editors

I [GB] have been working as a sport psychology researcher and consultant for over 20 years. As a consultant, I work with athletes and teams at a variety of competitive levels. A significant amount of this work has involved consulting with injured athletes, including helping them cope with isolation, pain, anxiety, and disruption of daily life as a result of their injuries. When I first started working in the Department of Kinesiology and Physical Education at McGill University in 2000, I was asked to give a talk to a group of medical doctors at a local hospital about the psychology of athletic injuries. One of the attendees that day was Dr. Karen Johnston, a neurosurgeon who specialized in sport-related concussions. After the talk, Dr. Johnston and I agreed that the role of psychology had largely been absent from the literature on the management of sport-related concussions. Additionally, we felt that psychological skills training, which I had been using in my professional practice with injured athletes, had great potential in solving some of the practical issues facing clinicians (i.e., diminishing persistent concussion symptoms). Soon after that initial meeting, we started working on a series of projects. Interestingly, the same year that Dr. Johnston, myself, and our co-authors published our first papers on the psychological aspects of sport-related concussions (Bloom et al., 2004; Johnston et al., 2004), so too did colleagues in Canada (Mainwaring et al., 2004) and the United States (Kontos, Collins, & Russo, 2004).¹ Since then, my work has continued to encourage researchers to account for psychological factors related to athletic, academic, and social factors associated with concussive injury and recovery.

After my undergraduate degree, I [JC] was interested in pursuing graduate work in the area of sport-related concussions because I had experienced a number of head injuries during my career as a high-performance ice hockey player. As I began learning about the expanse of research on the topic, I realized there was a relative dearth of empirical literature on psychosocial aspects of sport-related concussions—especially using qualitative methodologies. My first publication explored the effects of multiple concussions on retired professional ice hockey players using interpretative phenomenological analysis, a type of qualitative methodology that allowed me to explore the mens’ injury experiences alongside my own (Caron et al., 2013). The results of this research highlighted the depths of symptomatology experienced by these men (e.g., depression, suicidal ideation), as well as the profound impact that the injury and recovery process had on participants’ personal and professional lives. Reflecting on these findings, it became clear that there was (and remains) a need for concussion education programming and outreach. As a result, my doctoral work developed, implemented, and assessed a concussion education intervention for adolescent athletes (Caron et al., 2018). In my current role as a faculty member at Université de Montréal, my research program on sport-related concussions continues to examine the dissemination of education information and also how psychosocial strategies could help us to better understand and improve recovery and return to activity experiences.

About this book

We were fortunate to have such a renowned group of authors agree to contribute to this book. We believe that the various chapters facilitate a more comprehensive understanding of the psychological aspects of concussions and recovery processes. A wide range of topics are covered in this book, which are briefly summarized below.

The book begins with a contribution from Podlog and colleagues in Chapter 2. The information in their chapter effectively provides a contextual backdrop for the rest of this book by discussing historical aspects of concussions. Chapter 3 was co-authored by Ellemberg and colleagues, who provide an overview of the role of neuropsychology in concussive injury and management, which includes a discussion of the neurophysiological cascade in concussion and contemporary neuroimaging techniques. Following this, in Chapter 4, Kontos examines common psychological issues that occur following a sport-related concussion, such as anxiety, depression, and malingering. The chapter also discusses a novel approach that clinicians can use to inform targeted management and treatment strategies for concussed athletes.

In Chapter 5, Caron summarizes contemporary concussion education efforts. He also discusses the ways in which this knowledge has been disseminated to members of the sport community, including some suggestions for future research and practice. Chapter 6 from Michalovic and colleagues is a natural extension of Chapter 5, as it examines how theory can (and should) be used to better understand and improve concussion-related behaviors. The authors also detail how theory has been used in other health-related domains and how it could inform concussion research. In Chapter 7, Seguin and Durand-Bush describe a novel approach to assisting concussed athletes during their recovery. Specifically, the authors outline a psychologi...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Copyright
• Dedication
• Contents
• List of figures
• List of tables
• List of contributors
• 1 Introduction
• 2 Historical perspectives of athletic injuries and concussions
• 3 The role of neuropsychology in understanding, assessing, and managing sport-related concussions
• 4 Psychological outcomes associated with concussion
• 5 Concussion education
• 6 Theoretical implications and applications for understanding and changing concussion-related behaviors
• 7 A psychological skills training program for concussed athletes
• 8 Concussion in athletes with disabilities
• 9 Sex differences of sport-related concussion
• 10 Child and adolescent athletes
• 11 Psychological aspects of concussion in university athletes
• 12 Concussions in professional sports
• 13 Sociocultural aspects of concussion
• 14 Quantitative approaches in sport-related concussion research
• 15 Qualitative methods in concussion research
• Index