How Can Acceptance and Commitment Therapy Help with a Sports Injury?

When a person is injured playing a sport, the natural first step is to treat the physical ailment. The adrenaline pumping through their body often suppresses feelings of the full force of the pain. An immediate concern is stabilization and assessment of the physical body, the place where you can see a tangible disruption of normal functioning. It is understandable, especially when there are significant injuries, that mental health is not the immediate concern. First aid is often not a collaborative experience; it is an action that is performed on a person without them being an active participant.This role shift, from feeling autonomy over oneself to hearing people discuss their prognosis around or in front of them can have a significant impact. Often, the immediate thoughts or reactions of the injured person are those of denial (i.e., “I’m probably fine, this isn’t that bad”), fear (“What does this mean for me? I can’t afford this”), or resignation (“I’ll never play again”), trying to wrap their mind around what has occurred. Everyone may try to keep the person calm, but there is a level of knowing, especially in more severe situations, that there is a difficult road to healing ahead. There is little time to process or properly prepare oneself for the knowledge that life as you know it will change substantially, and there is much uncertainty about whether things will ever be the same.

While getting injured in any capacity is often debilitating (i.e., a non-sports-related injury), identity and community are so intertwined in an athlete’s pursuit of a sport. When your association with a group of people involves doing the same thing with them on a daily, weekly, or monthly basis, it is often difficult to maintain those connections in the same way once you are no longer directly involved in the activity. It is common to also begin questioning your sense of self upon becoming injured as an athlete, as you spend so much time honing a skill or associating your self-image with a set of characteristics (i.e., I am diligent, hard-working, collaborative, etc.) When there is no longer an opportunity to embody these attributes in the same way, many people with sports injuries feel isolated and directionless. 

As humans, many of us are averse to change or accepting when things are out of our control. The experience of injury, when a person’s situation can change in an instant, provides an opportunity to learn how to sit with discomfort and uncertainty or to try to push away the bad, prolonging our healing. In this blog, two of the six tenets of Acceptance and Commitment Therapy (ACT): contacting the present moment and acceptance, will be explored to move with, not against, the course of healing an athlete’s mental and physical well-being post-injury. 

CONTACTING THE PRESENT MOMENT

Many people who have undergone sports-related injuries or physical trauma will often agree that at first, the last place you want to be is in your body. We are often given medications to aid in pain management and distractions to allow us to disengage from our current experience. However, injuries are often debilitating for much longer than the novelty of the experience (i.e., support systems may move on, you may finish all of the shows you finally had time to binge, etc.). Eventually, a person will be left with a choice: be aware of what is happening in their external and internal worlds, no matter how painful, or continue to numb themselves by not paying attention. According to ACT, one goal of enhancing present-moment awareness may be to accurately understand what is happening around us and collect information about whether we would like to continue or change our behaviors (Harris, 2019). When we are disengaged from our experiences because of preoccupation with the future or the past (i.e., how will this impact me moving forward, what could I have done to change this situation), we become disconnected from our own thoughts and feelings, miss important details, or can overly identify with unhelpful beliefs we may have about ourselves (Harris, 2019). 

As with many athletes (both competitive and recreational), the mantra is “go, go, go.” However, in having such a significant portion of one’s life and routine removed, a person can reflect on how they actually feel and the needs they have in the present. Often, it is not until someone is forced to stop that they are able to look around and decide if they like the trajectory of the path laid out in front of them. Many of us do not allow ourselves to rest for the fear of being “lazy” or even understand how the engagement in our activity of choice can mask underlying feelings or mental health conditions. A skill to practice when engaging with feelings in the present moment can be to ask oneself a series of questions around the topic of noticing:

• “Do I notice what’s happening in my body right now?”

• “What am I feeling?”

• “Where am I feeling that?” What’s it like?”

• “Where is the feeling most intense?” 

• “What’s the size and shape of it?”

• “Is it at the surface or inside me?” (Harris, 2019)

Ultimately, a difficult part of injury is accepting what has occurred and how it has shifted one’s goals, path forward, or plans. The more we practice noticing, even the difficult thoughts and feelings, with curiosity, we begin to inch towards that step of acceptance. If acknowledging feelings around the injury still feels too difficult, it can be helpful to begin by practicing mindfully noticing one’s external surroundings with curiosity and openness. For example, focus on what you can see, hear, touch, smell, and taste (https://www.calm.com/blog/5-4-3-2-1-a-simple-exercise-to-calm-the-mind) to begin building up the practice of being present.

ACCEPTANCE

People often bristle at the word “acceptance” used in Acceptance and Commitment Therapy. The intention behind the word is often misconstrued as “just accept your situation” through a lens of resignation. Rather, it is the willingness to open ourselves up to our experiences, both pleasurable and painful, and allowing them to be what they are, rather than pushing them down, changing them, or lamenting why they cannot be different (Harris, 2019). It is a goal to make room for all of the thoughts, feelings, emotions, urges, impulses, or sensations without judgment so that we can begin to live more fully in alignment with our values (will be discussed in a future blog post). By acknowledging the unwanted experiences (ones that make us sad, angry, ashamed, feel guilty, etc.) along with the ones we enjoy, we create a space that allows us to be present and more effectively work with and not against the pain we encounter. Many painful memories, sensations, feelings, and emotions will arise throughout the healing journey for someone injured playing a sport. Facing this pain head-on and making room for everything to coexist teaches us that we do not have to “push through” an injury as many in athletics are trained to do. Acceptance allows us to see the reality of what has occurred, hold the hurt for what it is and how it has impacted us, and move forward towards a path of rehabilitation rather than frustration and burnout. While an understandable reaction to tremendous stress, it is unhelpful to deny the changes an injury will bring or avoid thoughts about the ways it will shape our new reality. Only through a realistic assessment of all parts can we regain a sense of purpose and strive for values-driven, committed action. Some exercises to utilize under the acceptance framework are as follows:

According to the ACT framework, pain is an inevitable part of the human experience. Whether it is physical, mental, or emotional anguish, we are capable of developing flexibility and resiliency even when faced with terrible situations. It is a difficult decision, albeit an important one, to turn toward our pain and examine it for what it is. By doing so, we begin to remove the weight that this experience holds over us, keeping us stuck. In encouraging an approach of acceptance, you do not have to enjoy what has occurred or be happy about the things it will teach you. An injury is often out of your control. The experience itself is painful, dysregulating, and often strips away a specific future you have envisioned for yourself. Your routine has changed, your support system may not show up the way you need, and your sense of self may be impacted. You did not ask for this experience, and yet you have it anyway. It is uniquely yours, and by being present with the pain, our understanding of ourselves is enhanced. You may notice your life opening up in ways you did not expect when you allow yourself to sit with the discomfort. Throughout the healing process, there may be moments where contradictory thoughts/feelings fight for dominance. But by practicing skills through an ACT lens, you will begin to realize that, unlike in sports, you do not have to declare a winner. You can just be here now. In situations where we feel vulnerable, we often feel disempowered, that life is just happening to us. However, according to ACT, choice is possible, and isn’t that a good place to start?

Reference

Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy, (2nd ed.). National Academies Press.