Anxiety and Generalized Anxiety Disorder in Elite Athletes
DOI:
https://doi.org/10.20344/amp.21600Keywords:
Anxiety, Anxiety Disorders, Athletes, SportsAbstract
Physical activity is recommended as a strategy for promoting mental health, and it can even be integrated into treatment plans for psychiatric disorders affecting the general population. However, elite athletes are a subpopulation with protective and risk factors inherent to high-level competition and are not shielded from psychiatric symptoms and conditions. The mental health of elite athletes has been the subject of increasing attention, driven in part by the initiatives of the International Olympic Committee and the growing importance of sports psychiatry. This article is a narrative review that provides an overview regarding anxiety, in particular generalized anxiety disorder in elite athletes. Our assessment concluded that competitive anxiety may affect an elite athlete’s performance in both harmful and beneficial ways. Assessing the duration, frequency, and functional impact of anxiety symptoms is crucial
for ruling out generalized anxiety disorder. Elite athletes do not show a significantly different prevalence of generalized anxiety disorder compared to the general population. Identifying specific protective and risk factors can contribute to adopting more effective preventive and intervention strategies. As in the general population, psychotherapy is recommended for elite athletes as the initial treatment for this condition, combined, if necessary, with pharmacotherapy, according to the World Anti-Doping Agency Code.
Downloads
References
Lazarus RS. How emotions influence performance in competitive sports. Sport Psychol. 2000;14:229-52.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: APA; 2022.
Martens R, Vealey RS, Burton D. Competitive anxiety in sport. 1st ed. Champaign: Human Kinetics; 1990.
Javaid SF, Hashim IJ, Hashim MJ, Stip E, Samad MA, Ahbabi AA. Epidemiology of anxiety disorders: global burden and sociodemographic associations. Middle East Curr Psychiatry. 2023;30:1-11.
Gordon BR, McDowell CP, Lyons M, Herring MP. Resistance exercise training among young adults with analogue generalized anxiety disorder. J Affect Disord. 2021;281:153-9.
Plag J, Schmidt-Hellinger P, Klippstein T, Mumm JL, Wolfarth B, Petzold MB, et al. Working out the worries: a randomized controlled trial of high intensity interval training in generalized anxiety disorder. J Anxiety Disord. 2020;76:102311.
Anderson E, Shivakumar G. Effects of exercise and physical activity on anxiety. Front Psychiatry. 2013;4:27.
Reardon CL. The mental health of athletes: recreational to elite. Curr Sports Med Rep. 2021;20:631-7.
International Olympic Committee. Mental Health Action Plan. 2023. [consultado 2023 dez 28]. Disponível em: https://stillmed.olympics.com/media/ Documents/News/2023/07/Mental-Health-Action-Plan-2023.pdf?_ga=2.35011553.173243837.1693809757-2074473781.1691568222.
Abstracts of the International Society for Sports Psychiatry Autumn Scientific Meeting, November 20/November 21, 2021. Sports Psychiatry. 2022;1:73-7.
Swann C, Moran A, Piggott D. Defining elite athletes: issues in the study of expert performance in sport psychology. Psychol Sport Exerc. 2015;16:P3-14.
Harrison PJ, Cowen P, Burns T, Fazel M. Shorter Oxford textbook of psychiatry. 7th ed. Oxford: Oxford University Press; 2018.
Spielberger CD. Notes and comments trait-state anxiety and motor behavior. J Mot Behav. 1971;3:265-79.
Ford J, Ildefonso K, Jones M, Arvinen-Barrow M. Sport-related anxiety: current insights. Open Access J Sports Med. 2017;8:205-12.
Weinberg RS, Gould D. Foundations of sport and exercise psychology. 6th ed. Champaign: Human Kinetics; 2015.
Cox RH. Sport psychology: concepts and applications. 7th ed. New York: McGraw-Hill; 2012.
Reardon CL, Gorczynski P, Hainline B, Hitchcock M, Purcell R, Rice S, et al. Anxiety disorders in athletes. Adv Psychiatry Behav Health. 2021;1:149-60.
Knowles KA, Olatunji BO. Specificity of trait anxiety in anxiety and depression: meta-analysis of the state-trait anxiety inventory. Clin Psychol Rev. 2020;82:101928.
Sylvers P, Lilienfeld SO, LaPrairie JL. Differences between trait fear and trait anxiety: implications for psychopathology. Clin Psychol Rev. 2011;31:122-37.
Madsen EE, Hansen T, Thomsen SD, Panduro J, Ermidis G, Krustrup P, et al. Can psychological characteristics, football experience, and player status predict state anxiety before important matches in Danish elite-level female football players? Scand J Med Sci Sports. 2022;32:150-60.
Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit formation. J Comp Neurol Psychol. 1908;18:459-82.
Arent SM, Landers DM. Arousal, anxiety, and performance: a reexamination of the inverted-u hypothesis. Res Q Exerc Sport. 2003;74:436-44.
Easterbrook JA. The effect of emotion on cue utilization and the organization of behavior. Psychol Rev. 1959;66:183-201.
Powell DH. Treating individuals with debilitating performance anxiety: an introduction. J Clin Psychol. 2004;60:801-8.
Rowland DL, Moyle G, Cooper SE. Remediation strategies for performance anxiety across sex, sport and stage: Identifying common approaches and a unified cognitive model. Int J Environ Res Public Health. 2021;18:10160.
Wilson MR. Anxiety: attention, the brain, the body, and performance. In: The Oxford Handbook of Sport and Performance Psychology. Oxford: Oxford University Press; 2012. p.173-90.
Guillén F, Sánchez R. Competitive anxiety in expert female athletes: sources and intensity of anxiety in national team and first division Spanish basketball players. Percept Mot Skills. 2009;109:407-19.
Cagle JA, Overcash KB, Rowe DP, Needle AR. Trait anxiety as a risk factor for musculoskeletal injury in athletes: a critically appraised topic. Int J Athl Ther Train. 2017;22:26-31.
Johnson U, Ivarsson A. Psychological predictors of sport injuries among junior soccer players. Scand J Med Sci Sports. 2011;21:129-36.
Ivarsson A, Johnson U, Andersen MB, Tranaeus U, Stenling A, Lindwall M. Psychosocial factors and sport injuries: meta-analyses for prediction and prevention. Sports Med. 2017;47:353-65.
Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med. 2016;50:537-44.
Utley JJ. Psychology of sport injury: a holistic approach to rehabilitating the injured athlete. Chin J Sports Med. 2010;29:343-7.
Podlog L, Dimmock J, Miller J. A review of return to sport concerns following injury rehabilitation: practitioner strategies for enhancing recovery outcomes. Phys Ther Sport. 2011;12:36-42.
Podlog L, Eklund RC. A longitudinal investigation of competitive athletes’ return to sport following serious injury. J Appl Sport Psychol. 2006;18:44-68.
Claussen MC, Schneeberger AR, Gerber M. Sports psychiatry – journal of sports and exercise psychiatry. Sports Psychiatry. 2022;1:1-2.
Rice SM, Gwyther K, Santesteban-Echarri O, Baron D, Gorczynski P, Gouttebarge V, et al. Determinants of anxiety in elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53:722-30.
Poucher ZA, Tamminen KA, Kerr G, Cairney J. A commentary on mental health research in elite sport. J Appl Sport Psychol. 2021;33:60-82.
Burns L, Weissensteiner JR, Cohen M. Lifestyles and mindsets of olympic, paralympic and world champions: is an integrated approach the key to elite performance? Br J Sports Med. 2019;53:818-24.
Pineda-Espejel HA, Alarcón E, Morquecho-Sánchez R, Morales-Sánchez V, Gadea-Cavazos E. Adaptive social factors and precompetitive anxiety in elite sport. Front Psychol. 2021;12:651169.
Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, Alcotte M, et al. Psychological balance in high level athletes: gender-based differences and sportspecific patterns. PLoS One. 2011;6:e19007.
Kamis D. Sex differences in psychiatric diagnosis and management of athletes. Adv Psychiatry Behav Health. 2021;1:145-8.
Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53:667-99.
Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports Med. 2016;46:1333-53.
Åkesdotter C, Kenttä G, Eloranta S, Håkansson A, Franck J. Prevalence and comorbidity of psychiatric disorders among treatment-seeking elite athletes and high-performance coaches. BMJ Open Sport Exerc Med. 2022;8:e001264.
Junge A, Wellmann K, Zech A. Prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of German first and lower leagues. Scand J Med Sci Sports. 2023;33:1866-73.
Åkesdotter C, Kenttä G, Eloranta S, Franck J. The prevalence of mental health problems in elite athletes. J Sci Med Sport. 2020;23:329-35.
Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53:700-6.
Oevreboe TH, Ivarsson A, Sundgot-Borgen J, Knudsen AK, Reneflot A, Pensgaard AM. Mental health problems in elite sport: the difference in the distribution of mental distress and mental disorders among a sample of Norwegian elite athletes. BMJ Open Sport Exerc Med. 2023;9:e001538.
Daley MM, Shoop J, Christino MA. Mental health in the specialized athlete. Curr Rev Musculoskelet Med. 2023;16:410-8.
Zhang S, Woodman T, Roberts R. Anxiety and fear in sport and performance. In: Oxford Research Encyclopedia of Psychology. Oxford: Oxford University Press; 2018.
Gorczynski PF, Coyle M, Gibson K. Depressive symptoms in high-performance athletes and non-athletes: a comparative meta-analysis. Br J Sports Med. 2017;51:1348-54.
Pluhar E, McCracken C, Griffith KL, Christino MA, Sugimoto D, Meehan III WP. Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. J Sports Sci Med. 2019;18:490-6.
Vu V, Conant-Norville D. Anxiety: recognition and treatment options. Psychiatr Clin North Am. 2021;44:373-80.
Junge A, Feddermann-Demont N. Prevalence of depression and anxiety in top-level male and female football players. 2016;2:87.
Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry. 2012;12:157.
Junge A, Prinz B. Depression and anxiety symptoms in 17 teams of female football players including 10 German first league teams. Br J Sports Med. 2019;53:471-7.
Biggin IJ, Burns JH, Uphill M. An investigation of athletes’ and coaches’ perceptions of mental ill-health in elite athletes. J Clin Sport Psychol. 2017;11:126- 47.
Wood S, Harrison LK, Kucharska J. Male professional footballers’ experiences of mental health difficulties and help-seeking. Physician Sportsmed. 2017;45:120-8.
Kaier E, Cromer LD, Johnson MD, Strunk K, Davis JL. Perceptions of mental illness stigma: comparisons of athletes to nonathlete peers. J Coll Stud Dev. 2015;56:735-9.
Wahto RS, Swift JK, Whipple JL. The role of stigma and referral source in predicting college student-athletes’ attitudes toward psychological help-seeking. J Clin Sport Psychol. 2016;10:85-98.
Stillman MA, Glick ID, McDuff D, Reardon CL, Hitchcock ME, Fitch VM, et al. Psychotherapy for mental health symptoms and disorders in elite athletes: a narrative review. Br J Sports Med. 2019;53:767-71.
National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. London: NICE; 2020.
Walton CC, Rice S, Hutter RI, Currie A, Reardon CL, Purcell R. Mental health in youth athletes. Adv Psychiatry Behav. Health. 2021;1:119-33.
Reardon CL, Creado S. Psychiatric medication preferences of sports psychiatrists. Phys Sportsmed. 2016;44:397-402.
World Anti-Doping Agency. World Anti-Doping Code 2021. 2021. [consultado 2023 dez 12]. Disponível em: https://www.wada-ama.org/sites/default/files/ resources/files/2021_wada_code.pdf
Meeusen R, Piacentini MF, Van Den Eynde S, Magnus L, De Meirleir K. Exercise performance is not influenced by a 5-HT reuptake inhibitor. Int J Sports Med. 2001;22:329-36.
Parise G, Bosman MJ, Boecker DR, Barry MJ, Tarnopolsky MA. Selective serotonin reuptake inhibitors: their effect on high-intensity exercise performance. Arch Phys Med Rehabil. 2001;82:867-71.
Marvin G, Sharmat A, Aston W, Field C, Kendallt MJ, Jones DA. The effects of buspirone on perceived exertion and time to fatigue in man. Exp Physiol. 1997;82:1057-60.
World Anti-Doping Agency. Prohibited list 2024: world anti-doping code international standard. 2023. [consultado 2023 dez 12]. Disponível em: https:// www.wada-ama.org/sites/default/files/2023-09/2024list_en_final_22_september_2023.pdf.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.