Examining the Effectiveness of Psychological Strategies on Physiologic Markers: Evidence-Based Suggestions for Holistic Care of the Athlete

Abstract

Context: Current holistic rehabilitation blends both physical and psychological techniques. However, validation of the usefulness of psychological strategies is limited in the literature.Objective: To quantify the effects of psychological strategies on both physiologic (salivary cortisol) and subjective assessments of stress.Design: Randomized controlled clinical trial. Setting: Laboratory. Patients or Other Participants: A total of 97 college-aged students (age ¼ 20.65 6 4.38 years), most with little to no experience with psychological strategies.Intervention(s): A 15-minute script via an iPod led the participant through visual imagery (cognitive relaxation) or deep breathing exercises (somatic relaxation) cues. The control group listened to 15 minutes of ambient nature sounds.Main Outcome Measure(s): Two samples (pretest, posttest) of salivary cortisol were analyzed using an enzyme immunoassay kit; the average was used for statistical analysis. Descriptive statistics and correlations were conducted to examine group differences in time of day, salivary cortisol, sex, Stress-O-Meter values, and Perceived Stress Scale scores.Results: Salivary cortisol levels were lower in the treatment group than the control group (F 2,97 ¼ 15.62, P , .001). Females had higher scores on both the pretest Stress-O-Meter (5.15 6 1.796) and the Perceived Stress Scale (18.31 6 5.833) than males (4.25 6 1.741 and 15.272 6 5.390, respectively).Conclusions: Both cognitive and somatic relaxation strategies reduced cortisol levels. Participants who received verbal guidance achieved a larger cortisol reduction. However, the change in cortisol level was uncorrelated with the change in report of acute stress; females reported higher levels of stress. Clinical implications include attention to sex when assessing stress and providing coping skills during the rehabilitation process.Key Words: relaxation, somatic relaxation, cognitive relaxation, cortisol Key PointsCognitive and somatic relaxation strategies were effective in decreasing acute stress as measured by the change in salivary cortisol. Female college students reported higher levels of acute and chronic stress than their male counterparts. Athletic trainers should use relaxation strategies and consider sex differences while caring for injured athletes during rehabilitation.

A longitudinal study of perceived stress and cortisol responses in an undergraduate student population from India

“…This can be majorly attributed to the fact that salivary cortisol levels capture the current state whereas PSS14 or the K10 Distress scale used in our study captures perceived stress over a month-long period. Similar results are also observed in a large number of other studies which use PSS14 or PSS10 as a measure for psychological stress (Dawson et al, 2014; Manigault et al, 2018; Putterman and Linden, 2006), whereas the studies using immediate perceived stress measures such as Visual Analog Scale or Stress-O-meter tend to find a correlation between salivary cortisol and perceived stress measures (Chellew et al, 2015; Chong et al, 2017; Esch et al, 2007; Linnemann et al, 2015; Myint et al, 2011). Men in our study showed a decrease in both perceived stress score (PSS14) and distress score (K10) with progression of time.…”

“…We hypothesised that stress perception within-individuals would be associated with elevation in cortisol responses. We also anticipated differences in cortisol and perceived stress responses between men and women (similar to other findings by Austin et al, 2018; Dawson et al, 2014). We finally predicted a decrease in perceived as well as physiological stress response along the longitudinal scale as individuals were expected to adjust to the novel academic and social environment over time.…”

Long-term retention assessment after simulation-based-training of pediatric procedural skills among adult emergency physicians: a multicenter observational study

“…Participants’ perceived stress was assessed by the Stress-O-Meter (SOM) scale with score of 0 (None) to 10 (Maximal) at the beginning of the standardized debriefing [27, 28].…”

Randomized controlled trial of multidisciplinary team stress and performance in immersive simulation for management of infant in shock: study protocol

“…We considered stress assessment methods that were compatible with simulated team management of life-threatening events. Self-reporting of stress applies various scales: the Stress-O-Meter (SOM) [ 56 ] and the State-Trait Anxiety Inventory (STAI) [ 57 ], commonly used in simulation [ 29 , 58 ]. PSTD is detected by the Impact of Event Scale-Revised (IES-R) on the 7 th day after the event [ 59 , 60 ] and the Post-traumatic Check-List Scale (PCLS) 1 month later [ 61 ].…”