Anxiety Treatment Plan

Anxiety Treatment Plan

Meet My Client

By Lindsay Davis

Profile:

This is 15 year-old Alex Whitman. Alex is an elite level gymnast with hopes to make the Junior Olympic team in July of 2018.

Alex suffers from intense anxiety during her gymnastic meets. She does well in most categories but has crippling fear and anxiety in performing specifically on the balance beam. No matter what tactic or strategy Alex uses to overcome these fears, she feels overwhelming self-doubt when she competes her beam event. Alex becomes overly aroused, feels nauseous and has a rapid heart rate as a result of her anxiety on beam. She has also expressed to her coach that she cannot stop the continuous, negative cycle of thoughts of failure and self-doubt that preoccupy her mind before taking her starting position.

Step 6: Relaxation Techniques to Help with Somatic Symptoms

Step 1: Identifying Problem and Type of Anxiety

Step 7: Coping, Perception and Interpretation of Pressure

• The next step in Alex's treatment plan would be devising tailored anxiety reduction techniques that she can do before competition. Alex's anxiety stems from her "overdoing it" or "trying too hard" resulting in mistakes on beam.

• Each athlete is different in their preference of arousal needed for optimal performance to occur. Some feel the need for high arousal and some need lower arousal. For Alex, lowering her amount of arousal on beam with help with her balance and thought process.

• I would use mental relaxation techniques that are multimodal in nature to focus not only her cognitive anxiety but also address her somatic anxiety. Such approach would be Cognitive-affective stress management training (SMT). Using the skill acquisition approach, muscle relaxation techniques can be used weekly and daily to help control her somatic anxiety of rapid heart beat and nausea.

• About an hour before her beam event, I would ask Alex to find a quiet space, sit or lay down, close her eyes and tense each muscle group for 10-15 seconds and then release. I would ask her to try and pace her breathing at the same increments to match. At the same time, thinking positive self-commands such as "take things one step at a time, just like you've done in practice" (Weingburg & Gould, 2015, p. 282).

In a sport setting, anxiety refers to "an unpleasant psychological state in reaction to perceived stress concerning the performance of a task under pressure" (Weinburg & Gould, 2015, p. 76).

The process of changing anxiety levels is not an overnight development. These strategies take time and constant use to be beneficial.

• Problem-focused coping would be most useful in helping Alex to change her behavior and thought processes in competition. Coping techniques are particularly useful for athletes in Alex's type of situation because they can help improve self-efficacy in competitive situations.

• At the same time, Alex's negative anxiety can also be decreased by altering her perception of self-generated pressure. Re-evaluating her perception of why she feels extensive pressure helps pinpoint if it is logical/real or self-generated.

For example, Alex may associate her beam performance with an exaggerated amplification of her coach's expectations. We must change this perception by replacing the notion with the reality that it is not her coach's expectations, but her own, that are having negative consequences on her actual beam performance. This type of rational thinking is thought to be a favorable coping mechanism.

• When Alex gets ready to perform in the beam event, she experiences negative thoughts such as "I can't do this. I never land my dismount right"...etc. Because of these negative thoughts, Alex typically makes unusual mistakes in her beam routine.

• This flip from one mindset to another leads me, as her sport psychologist, to determine Alex is affected mostly by Cognitive State Anxiety in competition with some symptoms of Somatic State Anxiety apparent during her performance on beam.

Step 4: Continuously Recognizing and Stopping The Negative Mindset

Step 2: Measuring Alex's Anxiety

Why I chose this treatment plan

I chose this treatment plan because I believe it shows an all encompassing effort to help turn negative anxiety into facilitative anxiety. All too often, athletes and coaches alike believe anxiety to be a negative concept. In reality, anxiety is often used to help prop up an athlete's mental and physical awareness to a desirable setting in order to accomplish their task.

Elite athletes are more likely to view anxiety as facilitative and this is often what leads to their success and accomplishments. I also believe that some of the world's greatest athletes never make it to their highest potential because negative anxiety destroys their mental approach in competition. Consistently working with athletes to identify their sources of anxiety and reinforcing improvement through small successes is of the up-most importance in turning negative anxiety into positive anxiety.

• Viewing Anxiety as facilitative and shaping Alex's thought process:

• As Alex's sport psychologist, I would ask her to pinpoint when the negative thoughts first occur. Secondly, we would devise a self-talk plan to deter these thoughts whenever they popped into her head.

• For instance, when Alex has negative thoughts of "I can't do this" or "Chill out", we would try to incorporate a positive spin on these particular thoughts. So Alex will mentally stop herself, physically slap her hands together and specifically think thoughts like, "I can do this dismount. I've done it in practice many times" or "I've landed this dismount successfully by putting more weight on my back foot". (Specificity can be helpful in thought-stopping)

• It is important for Alex to continuously practice this thought-stopping technique in her normal day-to-day practices as well as competition. It is also important for Alex's coach to recognize how her negative thoughts lead to destructive behavior and his role should be to provide tailored instructions and personalization to her self-talk methods. "Thoughts and self-talk should be instructional and motivational rather than judgemental" (Weinburg & Gould, 2015 p. 345.)

• This self-talk method should be implemented in a way that keeps Alex focused solely in the present and not focused on her past mistakes on beam.

• Typical problem: Some athletes think too much instead of relying on practiced muscle memory. If self-talk is not an effective method for helping certain athletes with anxiety, using images or visualization can be productive. For Alex, if she finds that self-talk is not effective, we could try her picturing herself successfully landing her dismount on beam instead.

• My second step in helping Alex alleviate her anxiety would be to utilize a self-report measure to better understand how Alex feels in an overall competitive state. This type of multidimensional measure allows for a sport psychologist to gain valuable insight into an athlete's anxiety levels and competitive state of mind.

• The scale of particular use to measure Alex's anxiety would be the Cognitive State Anxiety Inventory-2 (CSAI-2) (Martens, Vealey, & Burton, 1990). The CSAI-2 is one of the most frequently used instruments when assessing competitive state anxiety in sport psychology research.

• The three subscales of the CSAI-2 will help describe Alex's level of Cognitive Anxiety, Somatic Anxiety, and Self-confidence.

Step 3: Connecting Anxiety, Arousal and Performance

Step 5: Developing Confidence

• Sources of anxiety for athletes are often personalized and differ from athlete to athlete. (Gillham & Gillham, 2014). Citing previous research, anxiety can positively influence performance given that the athlete's mindset is also positive. (Jones & Swain, 1995). Because Alex's anxiety has attached negative physiological symptoms, her arousal levels are often too high when it comes time for her compete in the beam event, resulting in a temporary halt in balance and coordination. This narrowing of attentional field causes Alex's mistakes.

• Identifying that Alex needs work on her self-confidence levels is a significant starting point for turning her negative anxiety into positive anxiety. Continued work on Alex's optimal frame of mind regarding beam, recognizing and decreasing her level of arousal on beam, and developing confidence in this performance task is an ideal treatment plan for her specific situation.

Works Cited

The most important aspect of self-confidence is that it can be developed.

For Alex, building her self-confidence on beam is crucial in improving her anxiety and arousal levels. Therefore, simulating the competition experience of Alex's beam routine in practice could potentially help alleviate her stress and anxiety of performing the task in competition.

Spectators, competition leotards, and a judges panel. All of these can be imitated in a practice setting to induce anxiety. With enough of these simulations, Alex's level of anxiety on beam could decrease. Over time, by focusing on small successful accomplishments in simulated practices will hopefully help to further achieve larger successes in competitive atmospheres.

"Building confidence in the absence of successful competition means enlarging the definition of success to include those controllable components underlying performance." (USOC Coaches' Guide of Sport Psychology)

Dr. Kristen Mauldin

PSY-360-A

• Gillham, E., & Gillham, A.D. (2014). Identifying athletes' sources of competitive state anxiety. Journal of Sport Behavior, 37(1), 37-55.

• Jones, G., & Swain, A. (1995). Predispositions to experience debilitative and facilitative anxiety in elite and nonelite performers. Sport Psychologist, 9(2), 201-211.

• Weinberg, R. S., & Gould, D. (2015). Foundations of sport and exercise psychology (6th ed.). Champaign, IL: Human Kinetics.

• Coaches Guide: Sport psychology mental training manual. Produced by the sport psychology staff of the United States Olympic Committee.