Create a case study (give me the basic details of the case, ie. 16 year old, female gymnast, elite level, struggling with performance anxiety on balance beam) and then use the MAC approach to help her with this problem. Use the five pillars they describe in the paper and illustrate how you would use each pillar to help guide the athlete through their sports psychological issue.
PII: S0005-7894(04)80016-9 BEHAVIOR THERAPY 35,707--723, 2004 A Mindfulness-Acceptance-Commitment-Based Approach to Athletic Performance Enhancement: Theoretical Considerations F~aNI~ L. GARDNER ZELLA E. MOORE La Salle University While traditional cognitive-behavioral skills-training-based approaches to athletic performance enhancement posit that negative thoughts and emotions must be con- trolled, eliminated, or replaced for athlete-clients to perform optimally, recent evi- dence suggests that efforts to control, eliminate, or suppress these internal states may actually have the opposite effect. Interventions based on mindfulness and ac- ceptance suggest that internal cognitive and emotional states need not be eliminated, changed, or controlled in order to facilitate positive behavioral outcomes. Rather, it is suggested that an alternative or supplemental approach to the enhancement of ath- letic performance may be achieved through strategies and techniques that target the development of mindful (nonjudgmental) present-moment acceptance of internal experiences such as thoughts, feelings, and physical sensations, along with a clarifi- cation of valued goals and enhanced attention to external cues, responses, and con- tingencies that are required for optimal athletic performance. Applied sport psychology, in its efforts to enhance the competitive perfor- mance of athletes, has traditionally utilized cognitive behavioral methods and techniques with an emphasis on developing self-control of internal states, commonly referred to as psychological skills training (Whelan, Mahoney, & Meyers, 1991). In contrast, behavioral theorists in professional psychology have recently begun to advocate and demonstrate empirical support for inter- ventions that emphasize acceptance, rather than direct change, suppression, or control, of cognitive and affective experiences (Hayes, Strosahl, & Wilson, 1999; Roemer & Orsillo, 2002; Segal, Williams, & Teasdale, 2002). With modern meta-cognitive and acceptance-based theory, research, and practice as a foundation, and theoretical aspects of self-regulatory processes in athletic performance carefully considered, the purpose of this article is to present a new approach to performance enhancement that, adapted and developed Address correspondence to Frank L. Gardner, Department of Psychology, La Salle Univer- sity, 1900 W. Olney Avenue, Box 842, Philadelphia, PA 19141; e-maih
[email protected]. 707 005-7894/04/0707~3723 $1.00/0 Copyright 2004 by Association for Advancement of Behavior Therapy All rights for reproduction in any form reserved. 708 GARDNER & MOORE specifically for use with an athletic population, may elaborate on and increase the effectiveness of traditional performance enhancement approaches. This approach is referred to as Mindfulness-Acceptance-Commitment (MAC) based performance enhancement, and is adapted from clinical models of Accep- tance and Commitment Therapy (Hayes et al., 1999) and Mindfulness-Based Cognitive Therapy (Segal et al., 2002). This innovative approach to athletic performance enhancement efforts is markedly different in both theoretical assumptions and intervention strategies and techniques from the traditional psychological skills training approaches that have to date dominated applied sport psychology. Historical Development of Psychological Skills Training Historically, efforts to enhance athletic performance have been most clearly related to the development of social cognitive theory (Bandura, 1977) and early skills training models of cognitive-behavioral interventions (Meichen- baum, 1977). From this perspective, athletes develop and utilize psychologi- cal (mental) skills such as goal setting, imagery/mental rehearsal, arousal control, self-talk, and precompetitive routines as vehicles to aid in the devel- opment of self-control of internal processes such as thoughts, emotions, and bodily sensations, in an attempt to create the ideal performance state (Hardy, Jones, & Gould, 1996). Within the domain of interventions for athletic performance enhancement, a number of authors frequently describe and support the use of psychological skills training (PST) procedures, while concurrently commenting on the inconsistent and inconclusive empirical support for such approaches (Burton, Naylor, & Holliday, 2001; Gould, Damarjian, & Greenleaf, 2002; Gould & Udry, 1994; Meyers, Whelan, & Murphy, 1996; Weinberg, 1994, 2002; Wil- liams & Leffingwell, 2002; Zaichkowsy & B altzell, 2001). In addition, questions may be raised regarding the theoretical assumptions that are at the foundation of these procedures. Fundamental to PST is the long- held assumption that reduction of negative emotions and bodily states, and associated increases in positive cognitions and confidence levels, are directly related to an "ideal performance state," which in turn is directly related to optimal athletic performance (Hardy et al., 1996). Based primarily on corre- lational studies, practitioners of sport psychology have long accepted the notion that more successful performers are less anxious, more confident, and experience fewer negative thoughts (Gould, Eklund, & Jackson, 1992; Gould, Weiss, & Weinberg, 1981; Orlick & Partington, 1988). What follows from this theoretical position is the related assumption that interventions target- ing the enhancement of athletic performance focus on supplanting negative thoughts with positive ones and reducing or controlling negative affective states (Hardy et al., 1996). In those few studies that have carefully studied the mechanisms of change mediating traditional PST procedures and competitive performance, results MAC P E R F O R M A N C E E N H A N C E M E N T 709 have generally not been supportive of the assumptions made in the use of tra- ditional psychological skills training procedures. These studies, utilizing a variety of different sports, suggest that reduction in "negative" affective states such as anxiety, and/or increases in self-confidence, do not consistently result in significant increases in athletic performance (Burton, 1989; Daw & Burton, 1994; Holm, Beckwith, Ehde, & Tinius, 1996; Maynard, Smith, & Warwick- Evans, 1995; Murphy & Woolfolk, 1987; Weinberg, Seabourne, & Jackson, 1981). This conclusion receives additional support from a recent study by Cohen and colleagues (Cohen, Pargman, & Tannenbaum, 2003) in which physiolog- ical arousal was experimentally manipulated during a dart-throwing competi- tion. The results of this study found no relationship between arousal levels and actual performance. In addition, a recent meta-analysis examined the effects of competitive anxiety and self-confidence on athletic performance (Craft, Magyar, Becker, & Feltz, 2003). In this review, using multivariate meta-analytic techniques, characteristics such as design features, subjects, and type of sport were separately coded. From this analysis, the authors con- cluded that a weak relationship appears to exist between competitive anxiety, self-confidence, and athletic performance. It should be noted that these studies are limited by their assumption that all athletes are at nonclinical levels of anxiety or other affective states and thus would all benefit from a single intervention protocol based upon a common goal of enhancing athletic performance. It may very well be that those ath- letes for whom anxiety (or other affective states) is at subsyndromal or actual clinical levels might benefit from different interventions than those whose anxiety/affective levels are at nonclinical levels. That being said, these studies do suggest that for a number of athletes, reduction of anxiety (with corre- sponding reduction of "negative" thinking and increases in self-confidence) may have little significant impact on actual competitive performance enhance- ment. This in turn suggests the possibility that for many competitive performers, particularly for those not experiencing unusually high levels of pre-competitive anxiety, an alternative to traditional interventions targeting reduction of anxiety, increased confidence, and reduced "negative" thinking, may be appropriately considered for use in athletic performance-enhancement efforts. An Alternative Approach to Athletic Performance Enhancement In recent years, there has been an increasing body of literature that calls into question the position that "negative" internal experiences invariably lead to negative behavioral outcomes (Hayes et al., 1999). In essence, this literature suggests that attempting to suppress unwanted thoughts and emotions can actually have a paradoxical effect, triggering a meta-cognitive scanning pro- cess that actively searches for signs of "negative" or unwanted cognitive activity and brings it to awareness when detected (Purdon, 1999; Wegner, 1994). As such, excessive cognitive activity and task-irrelevant focus replaces meta-cognitive task-relevant attention and functional goal-directed behavior. Sarah Gairdner 710 GARDNER & MOORE The literature further suggests that efforts at thought suppression or control might actually result in an increase in frequency of unwanted thoughts and emotions (Clark, Ball, & Pape, 1991). Further, the reactivation of previously suppressed thoughts has been found to result in corresponding increases in affective states and increased autonomic activity (Wegner, Shortt, Blake, & Page, 1990), which is most often contrary to the desired outcome when work- ing with competitive athletes. These processes and consequences of thought suppression have often been referred to as "ironic process of mental control" (Wegner, 1994). Recent empirical data describing self-regulatory processes across a wide range of human performance domains (Barlow, 2002; Rapee & Lim, 1992; Sbrocco & Barlow, 1996; Stopa & Clark, 1993) and athletic performance in particular (Moore & Gardner, 2001) suggest that consistent functional human performance involves meta-cognitive attention to external cues, options, and contingencies involved in both immediate performance tasks and valued distal goals. At the same time, optimal self-regulation requires minimal self-judgment, minimal vigilance to external or internal threat, and mini- mal worry (i.e., scanning for threat) about possible performance conse- quences and ramifications. Conversely, Crocker and colleagues (Crocker, Alderman, & Smith, 1988) utilized a stress-management intervention including meditation and in-practice integration of coping skills to develop the capacity to focus on performance, attend in the moment, and cope with experienced emotion for elite volleyball players. In this study, while no reductions in competitive anxiety and minimal changes in actual negative cognitions were noted, there were significant com- petitive performance improvements, and these improvements were main- tained at 6-month follow-up. In a more recent study utilizing qualitative ana- lytic methods, D'Urso and colleagues (D'Urso, Petrosso, & Robazza, 2002) found that when assessing the contribution of psychological skill utilization and physical skill utilization differences between best and worst athletic perfor- mances, only the physical skill-based constructs were reliably related to per- formance differentiation. Consistent with contemporary contextual-acceptance theory, the authors also noted that "both positive and negative emotions may exert beneficial or detrimental effects depending on their idiosyncratic mean- ing and intensity" (D'Urso et al., 2002, p. 172). The empirical evidence appears to