The Effects from Mindfulness Training on Norwegian Junior elite Athletes in Sport

Stress

One contemporary stress theory that integrates both physical and psychological stress as a theoretical proponent for both training and straining of the athletes is the Cognitive Activation Theory of Stress (CATS; (Ursin & Eriksen, 2004). CATS defines the stress load neutrally, in that the stress load (or stressor) in itself is neither good or bad. The way the stress load might become harmful is when it is prolonged and excessive (Ursin, 2009). Research shows that animals that are kept in stressful situations without a possibility to control the situation develop illnesses (Ursin, 2009; Ursin & Eriksen, 2004). Ursin (2009, page 642) wrote that when animals “are left in situations beyond their control [they] may develop gastric ulcerations, hypertension, cardiac failure, immunological deficits, or changes in the brain biochemistry similar to those occurring during depression and psychoses”.

Thus, if the total load of being a student, an elite athlete, and taking care of other important facets of ones’ life adds up to be too much, an athlete might feel the situation is beyond his or her control. The consequence might be overreaching or burnout if the physical and psychological loads are too grave, either alone or combined, and the recuperation and rest are not satisfactory. This theory has been successfully used in sport previously (e.g., Abrahamsen, Roberts & Pensgaard, 2012; Abrahamsen, Roberts, Pensgaard, & Ronglan, 2008; Eriksen, Murison, Pensgaard, & Ursin, 2005; Kristiansen, Abrahamsen, & Stensrud, 2012).

First of all, CATS (Ursin & Eriksen, 2004) is different from most stress theories because the stress load is regarded as potentially helpful in developing the ability to cope with stress if the stress is not excessively severe or sustained. As Ursin and Eriksen explain (page 572): “The stress response is a general, unspecific alarm response occurring whenever there is a discrepancy between what is expected or the ‘normal’ situation (set value) and what is happening in reality (actual value).” The alarm will occur in different situations that are considered novel, when there is a homeostatic imbalance, or when the athlete perceives a threat. The alarm is uncomfortable but helpful in order to “drive” the athlete to proper solutions and therefore the alarm will continue until the discrepancy is eliminated. This can be accomplished in two ways, either by changing the set value (e.g. train an athlete to perceive the situation as normal by mental training or simulation training) or by change the here and now situation (actual value is changed to set value).Thus, compared with other theories coping is different than in CATS.

In CATS, coping is regarded as positive response outcome expectancies (PROE), meaning that if the athlete feels that he/she has the capacity to solve the situation and meet the demand, the alarm will drop. This is different from the ways of coping that traditionally has been used in sport research (e.g., (Kristiansen, Roberts, & Abrahamsen, 2008; Lafferty & Dorrell, 2006). Some sport examples could clarify the concept. An athlete might consider the resources (ways of coping) to be adequate to attain the desired outcome (PROE), which will then reduce the athlete’s stress response. However, an athlete can also feel PROE when uncertain about the ways of coping; “I’m not sure about the strategy to use, but I know I can win!” The latter example will also reduce the athlete’s stress level. As Ursin and Eriksen highlight, the ways of coping (or strategy chosen) does not predict the internal state and as a consequence “it does not predict health effects” (2004, page 579). PROE on the other hand does, as an athlete that has succeeded previously may have positive outcome expectancies that reduce stress. Therefore, this athlete will exhibit less likelihood to experience any negative consequences of stress in the long run (such as burnout).

Thus, stress management should be an important tool in athlete burnout prevention (Nigg, Borelli, Maddock & Dishman, 2008). One acknowledged technique that can help athletes to cope with the stressors of elite sport participation is mindfulness (e.g., (Gardner & Moore, 2004; Kee & Wang, 2007). This can work in several ways. As Kee and Wang points out, being mindful will help athletes perceive the present moment non-judgmentally as they desist assigning personal values to the process. Doing so will make stress activation less likely as there is no perceivable threat. Furthermore, being mindful could still maintain intentional, but accepting, focus on ones emotions, thoughts and sensations in the present moment. Thus, an athlete that perceives to be “stressed”, or activated as outlined by CATS, will recognize this and may have the ability to lower stress by either accepting it or by changing their focus and thoughts. In addition to theoretical predictions (e.g., (Ursin & Eriksen, 2004), research supports that stress is related to the athlete burnout syndrome (Black & Smith, 2007; Gustafsson & Skoog, 2012; Raedeke & Smith, 2001; 2004).

Athlete Burnout

Athlete burnout is considered to be a multidimensional syndrome or construct (Raedeke & Smith, 2009; Coakley, 2009; Gustafsson et al., 2011), which consists of three central dimensions: 1) Emotional and physical exhaustion, 2) Reduced sense of accomplishment, and 3) Sport devaluation (Raedeke, 1997). Emotional and physical exhaustion seem to be the most obvious manifestation of burnout and are characterized by feelings of emotional and physical fatigue associated with training and competitions (Raedeke & Smith, 2009). Reduced sense of accomplishment is explained by perceived inefficacy and a tendency to negative evaluations of oneself, in terms of sports performance and own accomplishments. Athletes, who experience this phenomenon, perform below expectations and are unable to achieve personal goals (Raedeke & Smith, 2009). Sport devaluation is defined as a detached attitude towards the sport, reflected by negativity and a lack of concern regarding the sport itself and the performance quality (Raedeke & Smith, 2009). The most common consequence of high levels of burnout is lack of motivation (Goodger et al., 2007), which may lead to the unwanted outcome of dropout from sports (Moen, 2013).

Athlete burnout is a difficult and chronic state that has a long recovery phase (Shirom, 2005). Although the occurrence of athlete burnout is not fully understood (Judge, Bell, Theodore, Simon & Bellar, 2012), it is suggested that the number of athletes who are suffering from burnout, seems to be rising (Gould & Dieffenbach, 2002). Chronic stress from various sources seems to be the most important antecedent for athlete burnout (Raedeke & Smith, 2001; Schaufeli & Buunk, 2003), which is in line with the predictions of the CATS (Ursin & Eriksen, 2004). Psychosocial factors (Cresswell & Eklund, 2006), excessive training stress and lack of recovery (Gould, Tuffey, Udry & Loehr, 1997; Gustafsson, Hassmén, Kenttä & Johansson, 2008; Lemyre, Treasure & Roberts, 2006), sport hassles (Cresswell, 2009), or perceived performance pressure from coaches (Price & Weiss, 2000) are only some of a wide range of stressors (or loads), which can contribute to the development of athlete burnout.

Mindfulness

Mindfulness has been described as paying attention on purpose in the present moment and without judgment (Kabat-Zinn, 1994). Thus, mindfulness has three principal components; non-evaluation (non-judgment), open receptivity and present-centeredness (Brown & Ryan, 2003). According to Weinstein and Ryan (2011) these three components together characterize the mindful-awareness state and are believed to work together in producing beneficial outcomes. A tendency towards open-mindedness and curious introspection has also been shown to be integral in this beneficial process (Martin, 1997; Teasdale, Segal, Williams, & Mark, 1995).

Several mindfulness programs have been developed (Gardner & Moore, 2004); Kabat-Zinn, 1982, 1990; Segal, Williams, and Teasdale, 2002). Mindfulness-based Stress Reduction (MBSR, Kabat-Zinn, 1982, 1990) is probably the most well-known of numerous mindfulness based interventions (Thompson, Kaufman, De Petrillo, Glass & Arnkoff, 2011). This program is a group-based mindfulness intervention originally designed as an adjunct treatment for patients with chronic pain (Keng, Smoski & Robins, 2011). The program consists of an eight-to-ten weeks course, in which groups of up to thirty participants meet twice a week for two and a half hours for mindfulness meditation training and instruction (Kabat-Zinn, 1990). In addition to mindfulness exercises in class, participants are asked to engage in home mindfulness practices and attend an all-day intensive mindfulness meditation retreat. The assumption of MBSR is that individuals learn to be less reactive and judgmental toward their experiences, and more able to recognize and break free from habitual and maladaptive patterns of thinking and behavior (Keng et al., 2011). Again, this will help avoid excessive stress activation as outlined in CATS (Ursin & Eriksen, 2004). Marks (2008) suggested mindfulness practice to be relevant for athletes in cases of performance development, performance dysfunction, performance impairment, and performance termination. The suggestion that mindfulness may improve athletic performance is supported by the theoretical overlap between mindfulness and “flow” (Thompson et al., 2011; Gardner & Moore, 2004; Kaufman, Glass & Arnkoff, 2009; Kee & Wang, 2008). “Flow” is described as a state of mind or consciousness, in which a person is completely absorbed in his or her actions and experiences a unity of body and mind (Csikszentmihalyi, 1990) that facilitates peak performance (De Petrillo, Kaufman, Glass & Arnkoff, 2009; Jackson & Csikszentmihalyi, 1999; Jackson & Eklund, 2002; Segal et al., 2002).

According to Marks (2008) an explanation for all presented positive effects of the mindfulness programs could be that mindfulness practice provides an opportunity to enhance concentration and non-reactivity. The emotional experience of stressful events is not denied during the practice, but acknowledged and accepted, while maintaining task-focus. Enhancement of continues attention reduces rumination and facilitates shift of attention focus to desired targets and impede thereby elaboration of unpleasant thoughts and feelings (Marks, 2008). This explanation fits well with the suggestions of Weinstein, Brown & Ryan (2009) about two primary ways through which mindfulness training may produce beneficial effects. Firstly, mindfulness practice may promote a less defensive, more willing exposure to challenging and threatening events and experiences. This may reduce negative cognitive appraisals of those situations, thus leading to lower levels of perceived stress. Secondly, mindfulness training may foster an enhanced capacity to cope adaptively with situations, which are perceived as challenging, threatening, or harmful (Weinstein et al., 2009). They hypothesized that higher levels of mindfulness would be related to both, a lower tendency to appraise or interpret events as stressful and to more adaptive coping in stressful situations (Weinstein et al., 2009).

Mindfulness-based interventions are found to reduce stress symptoms (Baer, 2003; Grossman et al., 2004) and it is found that mindfulness is negatively associated with athlete burnout (Mc Cracken & Yang, 2008). It has also been found that the practice of mindfulness can help improve wellbeing (Brown& Ryan, 2003; Carlsson& Brown, 2005), physical health (Grossman et al., 2004), as well as to reduce pain, anxiety, and depression (Kabat-Zinn, Massion, Kristeller, Peterson, Fletcher, Pbert, Lenderking & Santorelli, 1992; Teasdale, Moore, Hayhurst, Pope, Williams & Segal, 2002).

This study aims to investigate the effect from a 12-weeks mindfulness intervention on perceived stress, perceived performance in school and sports, and athlete burnout among junior elite athletes. Based on the presented theoretical review we developed the following hypothesis:

Participants and Procedure

This study comprised of 77 Norwegian junior athletes in sports who all voluntarily participated in an experiment over a period of 12-weeks. The elite junior athletes came from different training groups at their schools in biathlon, cross-country skiing, shooting and track and field. The athletes from biathlon, cross-country skiing and shooting from one out of two schools were randomly chosen for the experiment group and the athletes from cross country skiing, biathlon and track and field from a second school were chosen for the control group. Thirty five athletes were asked to participate in the experiment group, whereas 29 of them chose to participate. Fifty athletes were asked to participate in the control group, whereas 48 chose to participate. All in all, 77 of the 85 athletes chose to participate in the study, which gives a response rate of 90, 5%. A gender breakdown of the subjects included 49 % men and 51 % women. Their average age was 18 ½ years old (ranging from 16 to 20).

Pre-test- Post-test Control- Group design

Experimental design of this study was a pre-test post-test control group design. After the junior elite athletes were randomly assigned into either the experimental or control groups, a pre-test was administrated. The junior athletes then participated in an online questionnaire, which measured the psychological variables in this study. Then a mindfulness program was administrated for a period of 12-weeks. Out of the 77 athletes who participated in the project at the pre-test, 50 athletes participated after 12-weeks, which give a response rate of 65% (23 in the experiment group and 27 in the control group).

The mindfulness program

The mindfulness intervention lasted 12 weeks in total, divided into 4 continuous periods of three weeks. After each of these periods athletes, who agreed to take part in this intervention, were invited to a 2-hour mindfulness-class conducted by an experienced mindfulness coach. There, the training was discussed, the planning for the next period was made and mindfulness was trained. The mindfulness-intervention program consisted mainly of 2 different types of mindfulness training: a) sitting meditation with focus on breathing and b) body scanning (laying and standing position) with help of audio files in different length varying from 10-30 minutes. All participants received the files before the start of the first period. The mindfulness training-periods differed in content, volume and intensity (Table 1). This specific program is highly influenced by the principles defined by Kabat-Zinn (1982, 1990, 1994).

Throughout the whole intervention, participants were asked to write a personal mindfulness training-diary, including type of training, training-volume, and personal thoughts and findings linked to the program to assure the program followed up as good as possible. These diaries were used to improve the follow-up of the athletes during the program. Additionally, the mindfulness classes every 3rd week were observed by the first author to secure the program-content and to gain deeper understanding of the influence of the intervention throughout the program. These observations helped also to gain wider understanding of athletes’ thoughts about the program and their follow up during the periods.

The general variables

The variables examined here include items and inventories such as age, gender, type of sport, performance level, type of school, need-satisfaction and degree of athlete-centered coaching. All measurements used in this study were based on previously developed scales proven to hold both satisfactory validity and reliability. The measurements were originally in English. The measurements were translated into Norwegian and slightly adjusted for the purpose of this study by the authors.

The Mindful Attention Awareness Scale (MAAS)

To measure the degree of mindfulness the validated Mindful Attention Awareness Scale (MAAS) was used (Brown & Ryan, 2003). By use of a double Translation-Back-Translation technique this version was translated from English to Norwegian by the author. Participants reported how often they believed they currently had experiences referenced by each of the 15 items (e.g. ‘‘I do jobs or tasks automatically without being aware of what I am doing” or ‘‘I find myself preoccupied with the future or the past”) on a 6-point Likert scale ranging from “almost always” (1) to “almost never” (6). Higher scores indicated higher degrees of dispositional mindfulness.

The Perceived Stress Scale (PSS-14)

To measure stress, the Perceived Stress Scale (PSS; Cohen, Kamarck & Mermelstein, 1983) was employed. The PSS measures self-appraised stress (e.g., ‘‘During the past month, how often have you felt that you were unable to control the important things in your life?’’), and consists of 14 items rated on a 5-point Likert-type scale from 0 (‘‘never’’) to 4 (‘‘very often’’). The questions are general in nature, are, therefore, relatively context-free (Cohen & Williamson, 1988), and measure the degree to which respondents find their lives unpredictable, uncontrollable, and overloading, all of which are central to the stress experience (Cohen, Kamarck & Mermelstein, 1983). This questionnaire has been reported to have good construct validity (Cohen et al., 1983; Cohen & Williamson, 1988) and has been used in research investigating stress as a mediator in the link between optimism and burnout (Chang, Rand & Strunk, 2000). The PSS is a state measure whose test-retest reliability is adequate for short time periods (2 days, r.85), Cohen et al., 1983). The Swedish version has been validated using confirmatory factor analysis and has been found to have acceptable factor validity with an internal consistency (Cronbach’s alpha) of .84 (Smith, Gustafsson & Hassmén, 2010).

Perceived satisfaction with progress in sport and school

Individual performance from the Athlete Satisfaction Questionnaire (ASQ) was used to measure athletes’ perceived satisfaction with their own progress in sport (Riemer & Toon, 2001). This subscale seeks to measure the athlete's perceived satisfaction with his/her own task performance. Task performance includes a perception of absolute performance, improvements in performance and goal achievement. An example of item: “I am satisfied with the degree to which I have reached my performance goals during the season.” The athletes were asked to consider 4 items and how satisfied they were with their own progress in sport during the last year on a 7-point scale ranging from not at all satisfied (1), to extremely satisfied (7). The Cronbach’s alpha for the ASQ was .94 (pre-test and post-test). The athletes were also asked to consider 4 items and how satisfied they were with their own progress in school on the same liking scale.

The Athlete Burnout Questionnaire

A reduced version of the Athlete Burnout Questionnaire (ABQ) was translated into Norwegian using a double-translation-back-translation technique (Raedeke & Smith, 2009) and employed in the present study. The stem for each question was ‘‘How often do you feel this way?’’ Athletes were requested to rate the extent to which the items address their participation motives on a five-point Likert scale anchored by (1) “Almost Never” and (5) “Almost Always”. The original ABQ has three five-item subscales assessing the three key dimensions of burnout: (1) emotional and physical exhaustion, (2) devaluation of sports participation, and (3) a reduced sense of accomplishment An example of items covering this dimension is “I feel so tired from my training that I have trouble finding energy to do other things”.

All measures have acceptable reliability as shown in Table 2.

Data analysis procedures

Data were analyzed by means of analysis of covariance (ANCOVA). ANCOVA is an extension of analysis of variance (ANOVA) and allows exploration of differences between groups while statistically controlling for an additional continuous variable. In the present study, the covariate is the participants’ scores on the pre-test. By considering these as the covariates one can account for pre-existing differences between the experiment and control group. In this study, ANCOVA uses a regression procedure to remove the variation in the dependent variable that is due to pre-existing differences between the experiment group and the control group before normal analysis of variance techniques are completed based on the adjusted/ corrected scores. By removing the influence of pre-existing differences ANCOVA increases the power or sensitivity of the F-test (Pallant, 2010). Thus, ANCOVA increases the likelihood that differences between groups are detected.

Descriptive statistics

Table 2 shows correlations between the study variables (measured at the pre-test) as well as number of items, statistical means, standard deviations, and Cronbach’s alphas at both the pre-test and post-test.

The zero order correlations between the study variables vary from low to strong. The Cronbach’s alphas of the variables in this study varied from excellent to good across the pre-test and post-test scores. We also calculated means and standard deviations for each of the study variables sorted by pre- post-test, and experiment- control group. The results are presented in Table 3.

The results may indicate that there are differences in the mean scores between the experiment- and control group. Initially differences in pre-treatment scores were examined on the MAAS, PSS, performance in school and sport, and ABQ and its dimensions. MAAS (P<.02) levels were higher in the control group than the experiment group, whereas ABQ devaluation (P<.02) levels were lower in the control group (Table 3). These inequalities are likely to have been compounded by block randomisation methodology but indicate the need to control for pre-treatment differences.

We therefore ran mixed between-within ANOVA to test differences in magnitude of change between groups. The results showed that for the MAAS the interaction between group and time was significant (F(1,48)=10.36, P=.002, n_p²=.18), with the experiment group increasing in MAAS significantly more than the control group which decreased in MAAS. For the sport performance measure there was a main effect of time (F(1,48)=24.16, P<.000, n_p²=.34), whereas both groups decreased in perceived performance. The ABQ showed a main effect of time (F(1,48)=18.26, P<.000, n_p²=.28), and the interaction between group and time was significant (F(1,48)=19.38, P<.000, n_p²=.29) with the control group increasing in ABQ significantly more than the experimental group. Exhaustion (F(1,48)=9.52, P<.005, n_p²=.17), accomplishments (F(1,48)=6.93, P<.02, n_p²=.13) and devaluation (F(1,48)=13.15, P=.001, n_p²=.22) showed a main effect of time and the interaction between group and time were significant (F(1,48)=6.43, P<.02, n_p²=.12),(F(1,48)=4.80,P<.05, n_p²=.09) nd(F(1,48)=25.36,P<.000, n_p²=.35) espectively.

Repeated measures t-test showed that the experiment group showed a significant change in the sport performance measure for pre to post test (t(22)=2.66, P=.014, r = .69), whereas the scores decreased. The analysis further showed that the control group showed a significant change in sport performance (t(26)=4.32, P<.000, r = .35), MAAS (t(26)=3.36, P=.002, r = .74), ABQ (t(26)=-6.28, P<.000, r = .80), exhaustion (t(26)=-4.30, P<.000, r = .71), accomplishments (t(26)=-3.36, P<.000, r = .69) and devaluation (t(26)=-5.69, P<.000, r = .69), for pre to post test.

ANCOVA analyses were employed to further investigate possible differences.

ANCOVA Analyses

Table 4 shows the results from the ANCOVA analysis.

ANCOVA was used to adjust for pre-treatment differences on outcomes when testing for group differences on the same outcomes at post-intervention. At post-treatment there was a significant difference between the groups with the experiment group showing less increase in burnout scores than the control group (F(1,54)=14.89, P<.000, η²=.24). The adjusted ANCOVA means for the burnout scores were 32.01 (experiment group) and 40.20 (control group). Devaluation scores (F(1,54)=18.33, P<.000, η²=.28) and accomplishment scores (F(1,54)=5.38, P<.05, η²=.10) increased less than the scores in the control group. The adjusted ANCOVA means for the devaluation scores were 8.92 and 13.26 (experiment- and control group respectively), and adjusted accomplishment scores were 12.21 and 14.38 (experiment- and control group respectively). The eta squared indicates that the effect sizes are large on the variables the sum of athlete burnout and the sub category devaluation (according to Pallant (2010) partial eta squared can be divided into small (.01), medium (.06), and large (.138)). There are medium effect sizes on the variables accomplishments, exhaustion and mindfulness.