By: Christine Mosher, LICSW
I am a psychotherapist and my full-time job is working for Walden Behavioral Care, which is an eating disorder clinic based in Massachusetts, with additional facilities in Connecticut and Georgia. I also have my own private practice part-time, currently using Telehealth, where I treat clients of all ages, including children, adolescents, adults, and seniors. I have several clients who are athletes, ranging from the youth to high school and college level. Some of the sports they participate in are gymnastics, golf, cross-country running, basketball and soccer. I also work with several former athletes who have participated in football, tennis, wrestling, and hockey.
In today’s climate with the onset of the Coronavirus pandemic and the rise of social justice issues in our country, athletes are struggling with an increase in mental health issues such as Anxiety, Depression, Adjustment Disorder, Insomnia, Body Image Issues and Eating Disorders.
Some of the types of Eating Disorders my clients have been struggling with are Anorexia, Bulimia, Binge-Purge ED, and Orthorexia, which is a fixation with eating so called “healthy” foods.
I have also noticed a difference in how athletes of different ages have been reacting to not being able to play their sport at this time. With the youth athletes, their primary struggle is not having physical activity to do to keep them moving, not being able to see their friends, and not keeping busy with sport practices and games that used to fill their afternoons and weekends. This has been very challenging for kids, and their parents, as well. Parents may see an uptick in irritability, increased need for attention, angry outbursts, and other behavioral issues within this age group.
With high school athletes, they’ve not only lost their ability to play their sport for their school, but they’ve also lost their sense of identity, which is very important during their adolescent years. Being a student athlete in high school is something that gives teens a sense of self-esteem, self-worth, and acceptance amongst their peers, which feels critical to adolescents during this time in their lives. Many of my clients are having difficulty coping with this lack of interaction with their friends and teammates, and have had an increase in depression and anxiety, an increased use of social media to replace in-person socialization, insomnia, leading to sleeping later in the day, which can lead to not eating on a regular schedule and skipping meals, which can lead to lack of adequate nutrition and weight loss. Eating disorders commonly develop as a coping mechanism to deal with emotional distress.
The college athletes I’ve dealt with who have also lost their ability to play their sport are also dealing with Anxiety, Depression, Adjustment D/O and Eating Disorders. Having to move home with their parents after living at school with their roommates, friends, and possibly teammates has been very stressful for these young adults. It’s as if the rug has just been pulled out from underneath them. Full seasons have been lost…games, practices, road trips and tournaments are suddenly gone. College student athletes are usually on a very tight schedule, trying to fit in classes, study time, practice time, game time, meal time, etc…They are now having difficulty figuring out how to make a new schedule and how to make use of all their open time that they normally would have been dedicating to their sport. Some athletes missed their whole spring season, and may have graduated without any ceremony or sense of closure, leaving behind teammates and coaches that they may have grown close to, which creates a sense of grief and loss. Some have gone back to college this fall, not knowing if they were going to be able to play their sport or not, and if so, what will that look like? “Will we be able to practice together as a team, will we even have games, are we going to have to wear masks while we play?” It’s very difficult for them to cope with this level of uncertainty and so many unanswered questions.
College student athletes are also very aware and disheartened by the current world climate in regards to racism and other social justice issues that have been highlighted in the media over the last 6 months. One of my college athletes who is struggling with Anxiety, Depression and an Eating Disorder said to me, “Why should I try to be the best person I can be if we have to live in such a terrible world like this?” So feeling a sense of loss of hope for the future is also a serious problem, which makes it harder for athletes to keep motivated.
Clinical Interventions:
Some of the interventions I have used include trying to help athletes to modify their thoughts and behaviors to help improve their moods. I have tried to encourage clients identify other areas of interest to explore during this time of pandemic that they wouldn’t ordinarily have time to do, such as pursuing art or music, cooking or baking, or doing crafts or puzzles or other creative activities. Many clients have a difficult time identifying another activity they would like to try, as so much of their identity, time and effort has been focused on being an athlete, but some clients have been able to explore these ideas and find some level of joy and relaxation with new activities and skills.
I have also found good success using Cognitive Behavioral Therapy, which can help athlete clients to try to look at things from a different perspective. By challenging cognitive distortions and reframing their thoughts, clients can help adjust their behavioral response to problems and improve their mood. For example, an athlete might say “It really stinks that I had to leave college and move home with my family last semester. It’s not fair that I had to leave my sport and my friends. I just feel like staying in bed all day.” This negative thought creates an angry mood and poor behavioral response. If athletes can change that thought to, “Yeah, it stinks that I had to leave college and my sport, but maybe I can use this time at home with my family to slow down the pace of my life, focus on my self-care, and really think about what I want for my future.” Changing negative thoughts to more positive ones can lead to a more hopeful mood and more effective behaviors.
Also, Dialectical Behavioral Therapy has been helpful for some of my athletes. With DBT, clients learn mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation skills to help them better respond to stressful situations. One example of a skill clients can use when they are feeling stressed or anxious is the STOP skill. S is for stop what you’re doing; T is for take a step back or take a deep breath; O is for observe what is going on inside of you, your thoughts and feelings, and what is going on around you; and P is for proceed mindfully. This can help clients respond to a challenging situation in a more productive way.
I have found that introducing clients to mindfulness and meditation has also been helpful. Teaching them to focus on one thing at a time, without judgement, utilizing all their senses to really experience and appreciate the moment while they’re in the moment. I encourage clients to take slow, deep breaths, listen to guided meditations, or visualize a favorite place to calm the mind and relax the body. I suggest to clients that it is important to let go of things that are outside of their control, and just focus on what is within their control. For example, clients can make a daily or weekly schedule, try to go to bed and wake up at roughly the same time every day, create a meal plan and make it a goal to eat 3 meals and 3 snacks a day so they can stay fueled for their sport, drink plenty of water, schedule a regular time to work out, and take time for self-care…take a mindfulness walk in nature, in the woods or along the beach. Notice all the sights, sounds, and smells around you. Spend time with family and friends, people you love and who care about you. These are all things that are within an athlete’s control that can contribute to creating a more positive mood and developing more effective responses to help them cope during this difficult time.
Two Tips:
1. If you are an athlete of any age experiencing mental health issues, including Eating Disorders, reach out for help. You are not alone, there is treatment available, and you can recover.
2. Even though the world around us seems out of control, we can choose to be in control of ourselves and how we react to situations. Focus on yourself and what you can do, not what you can’t do.
Two Resources:
1. Walden Behavioral Care: www.waldenbehavioralcare.com; www.waldeneatingdisorders.com; GOALS program.
2. NEDA (National Eating Disorders Association) https://www.nationaleatingdisorders.org/