Drew Brannon, Ph.D.Licensed Psychologist

Brief backgroundCase of MadiDiagnosis and managementReturn to play considerationsPrevention and protocolDiscussion

Public’s understanding vs. actual service delivery

Variability in training has created confusion

DepressionAnxietyGrief/lossSexual traumaEating disordersAnger

Performance AnxietyBurnoutFocusInjuryConfidenceRole changesCareer transitionGoal setting Motivation

Collegiate student-athlete

High level soccer player

Key team contributor

Sister: diagnosed with ADHD

Mother: notable symptoms of anxiety

Madi: first collegiate student-athlete in family

Both parents busy/successful working professionals

One previous ACL tear during high school (11th grade)

Extensive physical therapy

Complicated rehab process

Slow recovery

Diagnosed with ADHD @ 7 y/o

Prescribed Focalin XR (20mg)

History of disruptive/risk taking behaviors

History of depressive episodes since age 14

Fall preseason camp prior to Sophomore year

Three-a-day practices

Day 9

MRI confirms tear

Surgery scheduled

Procedure performed

1. Denial2. Anger3. Bargaining4. Depression5. Acceptance

(Tracey, 2003; Leddy et. al.,. 1994; Udry, 1997; Heil, 1993)Greatest mood disturbance during initial phase

following injury

Early recovery process greatest period of emotionality

Critical point of psychological intervention occurs in first three weeks post-injury

Disengagement from team

Perceived lack of interest from coaching staff

Overly involved parents

Need for attention

Sense of helplessness

Absence of sport removes her only known coping mechanism

Now has more time on her hands

Peer group heavily involved in alcohol use/abuse

Disagreement regarding rehab

Poor compliance with rehab

Impatience from all parties

Initial consult mandated by team physician

Gathering of information difficult due to lack of cooperation

Was willing to discuss other things, which slowly built rapport

Madi becomes more willing to attend

Disclosure of family dynamics clarifies nature of several problem areas

Trusted information eventually shared

Onset of depressive symptoms

Poor self-care practices

Lack of regard for behavior

Effects of social choices

Inconsistent motivation

Unhappy with role on team

Lack of trust toward coaches

Identity confusion

Extensive clinical interviewing

Beck Depression Inventory

Collateral information

Psychiatric consult

Weekly counseling sessions

Medication management

Consults with sports medicine staff

Willing and motivated toward rehab

Improved sleep and dietary habits

Increased independence from parents

More engagement with support systems

Clearance from sports medicine staff

Psychological symptoms to benefit from return

Significant anxiety necessitated controlled return

Hesitation about return due to fear of regression

Cognitive-behavioral therapy

Self-talk affirmations

Guided imagery/visualization

Watched game tape

Read old press releases

Talked to high school and club coaches

Role of psychological services in long-term rehab

Sport psychology consult protocol (pre-op, post-op, monthly follow-up, PRN)

Comprehensive treatment team approach

Qualified team leaders

Life skills programming

Caring coaches

Power of the shared experience

Knowing you’re not alone

Receiving ideas for getting through adversity

Better use of time that other activities?

What could I have done differently in this case to improve the situation and/or outcome?

What are critical psychological factors for sports medicine professionals to consider in athletes during long-term rehab?