Participation in sports offers exceptional pro-social opportunities. However, sport participation also contributes to uniquely experienced stressors that may interfere with athletes' achievement in sports and mental health. In this study, we describe the initial process of empirically developing The Optimum Performance Program in Sports (TOPPS). We first review the need to adapt evidence-based behavioral interventions to optimize mental health in athletes. We then review the innovative features of TOPPS and report the results of our initial piloting of TOPPS in a series of case trials. Throughout this developmental process, we underscore our methods of addressing obstacles (e.g., stigma) that appear to have influenced the conspicuous absence of performance programming specific to mental health optimization in athletes. Recommendations are offered in light of the results.

Background:Although several studies have examined risk factors for suicidal ideation among veterans, little is known about risk and protective factors for suicidal ideation in high-risk veteran samples. Thus, this study examined a broad range of risk and protective factors associated with the development of suicidal ideation in a high-risk sample of U.S. veterans who screened positive for current posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD). Methods: Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative, prospective cohort study of U.S. veterans. Veterans completed self-report measures to screen for PTSD and MDD and to assess for risk and protective factors. The sample included 222 veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline and completed at least one assessment over a seven-year follow-up period. A multivariable binary logistic regression analysis was conducted to examine baseline factors associated with incident suicidal ideation. Results: Nearly one in three (27.1%) of veterans with PTSD and/or MDD developed suicidal ideation over the seven-year follow-up period. Non-Caucasian race and lower scores on measures of purpose in life, conscientiousness, and frequency of religious service attendance were independently associated with incident suicidal ideation. Lower purpose in life (52.3%) and conscientiousness (33.2%) explained the vast majority of variance in incident suicidal ideation. Conclusion: Nearly 30% of veterans with PTSD and/or MDD who did not endorse suicidal ideation at baseline developed suicidal ideation over a seven-year period. Prevention and treatment efforts designed to bolster purpose in life and conscientiousness may help mitigate risk for suicidal ideation in this high-risk population.

Substance abuse in athletes is both prevalent and dangerous, leading to its international recognition as a public health concern. In recent controlled trials, behavioral prevention programs have been shown to reduce alcohol use in collegiate student athletes who are at-risk for alcohol abuse, with outcomes appearing to be enhanced when family members are prescriptively involved. However, no interventions have been found to decrease alcohol or drug use frequency in controlled trials involving athletes who have been diagnosed with substance abuse, and no prescribed clinical interventions for substance abuse have been tailored to accommodate the unique needs of competitive athletes. As an initial step in this development, we review an evidenced-supported behavioral treatment program modified for use with athletes. Optimizing the support of significant others, this innovative treatment approach comprehensively targets multiple areas of mental health while emphasizing cultural enlightenment. Recommendations are offered, including the great need for controlled treatment outcome research specific to substance abuse in athletes.

The integration of athletics into higher education enriches the experience of student-athletes, and the advantages are both immediate and lifelong. However, it is well-documented that athletes experience unique stressors, and a deficiency exists of evidence-supported programs to concurrently promote goal achievement in mental health and sport performance. Therefore, this case examination reviews efficacious implementation of The Optimum Performance Program in Sports (TOPPS) in a collegiate combat sport athlete evidencing alcohol dependence and concurrent elevations in mental health symptoms. An AB experimental design with followup assessments was utilized to determine the influence of intervention on the participant's substance use, mental health, HIV/sexually transmitted infection (STI) risk behavior (i.e., unsafe sexual practices), relationships, and factors identified to interfere with sport performance. Unique to existing campus counseling programs, TOPPS incorporated significant other support to assist in goal accomplishment. The intervention program included innovative components that were built upon evidence-supported Family Behavior Therapy protocols, including Cultural Enlightenment, Dynamic Goals and Rewards, Performance Planning, Environmental Control, Self-Control, Reciprocity Awareness, and Positive Request. Intervention components were evaluated to be reliably implemented. The participant reported substantial improvements in mental health and reduced substance use from baseline to post-intervention assessment, and these improvements were sustained at 1-and 3-month follow-up assessments. Future directions in performance programming with student-athletes are discussed in light of the results including the incorporation of significant others in the intervention plan.