Athletes' access to, attitudes towards and experiences of help-seeking for mental health: a scoping review protocol.

INTRODUCTION: Athletes are not immune to mental health issues but are less likely to seek help than non-athletes and experience barriers including lack of access to services, lack of knowledge as to how to access services and negative past experiences for help-seeking. Formal (eg, university counsellors, general practitioners and psychologists) and semi-formal (eg, academic tutor, sports coach and physiotherapist) sources of support provided in healthcare, the sport context and higher education are key places for athletes to seek help for mental health, and there is a need to synthesise the evidence on athletes' access, attitudes to and experiences of these services, to understand how to improve these services specific to athletes' mental health needs. This protocol outlines a scoping review that will be used to map the evidence, identify gaps in the literature and summarise findings on athletes' access, attitudes to and experiences of help-seeking for their mental health. METHODS AND ANALYSIS: The methodological frameworks of Arksey and O'Malley (2005), Levac et al (2010) and the Joanna Briggs Institute (2020 and 2021) were used to inform this scoping review protocol alongside the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols checklist and published scoping review protocols within sport and health. The six stages of Arksey and O'Malley's (2005) framework have been used for this scoping review. The searches were conducted between 30 March 2022 and 3 April 2022 in the following databases: APA PsycINFO (via OVID), Embase (via Ovid), MEDLINE (via Ovid), APA PsycArticles Full Text (via OVID), Web of Science Core Collection, SPORTDiscus (via EBSCO), CINAHL (via EBSCO), Scopus, ProQuest (Education Database), ProQuest (Education Collection), ProQuest (Health & Medical Collection), ProQuest (Nursing & Allied Health database), ProQuest (Psychology Database), ProQuest (Public Health Database) and ProQuest (Sports Medicine & Education). The main inclusion criteria of this review are: papers that focus on past help-seeking behaviour, attitudes towards help-seeking and future behavioural intentions, papers that refer to formal and semi-formal sources of support and peer-reviewed literature, primary research articles, systematic or scoping reviews and interventions. During title and abstract screening and full-text review, at least two reviewers will be involved. Data to be extracted from studies includes: details of the study population, whether the paper focuses on formal and/or semi-formal sources of support and whether the focus is on access, attitudes or experiences to help-seeking for mental health. ETHICS AND DISSEMINATION: The evidence will be mapped numerically and through content analysis to describe studies and highlight key concepts, themes and gaps in the literature. The published scoping review will be disseminated to relevant stakeholders and policymakers including those in healthcare, the sporting context and the higher education system. The resulting outputs will be in the form of both peer-reviewed and non-peer reviewed publications (eg, multimedia in the form of a blog post and at conferences). The dissemination plan will be informed by patient and public involvement. Ethics approval was not required for this study.

A Kirkpatrick Model Process Evaluation of Reactions and Learning from My Strengths Training for Life™.

Underpinned by the New World Kirkpatrick model, and in the context of a community-based sport psychology programme (My Strengths Training for Life™) for young people experiencing homelessness, this process evaluation investigated (1) young peoples' reactions (i.e., program and facilitator evaluation, enjoyment, attendance, and engagement) and learning (i.e., mental skills and transfer intention), (2) the relationship between reaction and learning variables, and (3) the mediators underpinning this relationship. A total of 301 young people living in a West Midlands housing service completed questionnaires on demographics and reaction and learning variables. Higher levels of programme engagement were positively associated with more favourable reactions to the programme. Enjoyment positively predicted learning outcomes, which was mediated by transfer intention. Recommendations are made for (1) a balance between rigor and flexibility for evaluation methods with disadvantaged youth, (2) including engagement as well as attendance as indicators of meaningful programme participation, (3) measuring programme experiences (e.g., enjoyment) to understand programme effectiveness, and (4) providing opportunities for skill transfer during and after programme participation. Our findings have implications for researchers, programme commissioners, and policymakers designing and evaluating programmes in community-based settings.

A Feasibility Study of the My Strengths Training for Life™ (MST4Life™) Program for Young People Experiencing Homelessness.

My Strengths Training for Life™ (MST4Life™) is a positive youth development program for improving wellbeing and social inclusion in young people experiencing homelessness. MST4Life™ addresses a gap in strengths-based programs aimed at promoting healthy and optimal development in vulnerable older adolescents/emerging adults. The program was co-developed with a UK housing service as part of a long-term (>8 years) community−academic partnership. This mixed-methods study describes a key step in developing and evaluating the program: exploring its feasibility and acceptability with 15 homeless young people (Mean age = 19.99 years, SD = 2.42; 60% male, 40% female). Participants experienced 8 weekly sessions within their local community, followed by a 4-day/3-night residential outdoor adventure trip. In addition to their attendance records, the viewpoints of the participants and their support workers were obtained using diary rooms and focus groups. Feasibility was indicated via the themes of attendance, engagement, and reaction. The findings suggested that young people enjoyed and perceived a need for the program, that they considered the program and its evaluation methods to be acceptable, and that both the community-based and outdoor adventure residential phases could be implemented as planned. Minor modifications are needed to recruitment strategies before it is more widely rolled out and evaluated.

The My Strengths Training for Life™ program: Rationale, logic model, and description of a strengths-based intervention for young people experiencing homelessness.

Traditionally, UK housing services have focused on providing temporary accommodation, identifying risk factors, and preventing negative outcomes to young people experiencing homelessness. However, deficit approaches may lead young people to becoming dependent on services and face greater marginalization and stigmatization. Meeting long-standing calls to focus more on young people's positive attributes and abilities, the My Strengths Training for Life™ (MST4Life™) program was developed as a community partnership with a large housing service. This paper describes the rationale, logic model, and content of the MST4Life™ program using the TIDieR (Template for Intervention Description and Replication) checklist. MST4Life™ is a strengths-based and experiential psychoeducation intervention for young people aged 16-24 years who are homeless or at risk. Grounded in positive youth development and basic psychological needs theory, its aim is to provide meaningful opportunities for participants to recognize, use, and further develop their mental skills and strengths. In turn, enhancing intentional self-regulation is expected to improve physical, mental, and social health and wellbeing, and support positive transitions to independent living. The potential long-term impacts include a reduction in the number of young people returning as homeless, lower rates of mental illness and mortality, and a cost saving to the public purse.

Mastery Imagery Ability Is Associated With Positive Anxiety and Performance During Psychological Stress.

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N = 130; 55% male; M age = 19.94 years; SD = 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations.

An evaluation of My Strengths Training for Life™ for improving resilience and well-being of young people experiencing homelessness.

This community-based study investigated whether (1) a novel sport psychology informed positive youth development program, My Strengths Training for Life™, improved resilience and well-being and (2) young people differed in outcomes according to demographics (gender, ethnicity, social inclusion, and learning difficulty). A total of 246 young people (M age = 19.74, SD = 2.31) living in a large housing service completed questionnaires on demographics, mental skills, and pre and postprogram resilience and well-being. Baseline differences in resilience and well-being existed for ethnicity and learning difficulty status but did not influence MST4Life™ outcomes. There was a significant improvement in resilience and well-being over time, which was associated with mental skills development. Implications apply for policy, program commissioners, and research: (1) novel sport psychology interventions can improve the well-being of disadvantaged youth, and (2) demographics at baseline should be considered in intervention planning and evaluation with this population.

The Experiences of Homeless Youth When Using Strengths Profiling to Identify Their Character Strengths.

Individuals, particularly those considered "hard-to-reach," often engage well with assessment tools that involve active dialogue and the co-construction of knowledge. Strengths profiling is one such tool that enables a person-centered and autonomy supportive approach to the identification of character strengths. Strength profiling is an adaptation of performance profiling used in sport psychology, which has not yet been utilized in broader psychological research or clinical practice. Supporting an individual by raising awareness of their personal character strengths is an effective and growing mechanism for promoting psychological well-being. Strengths profiling involves several stages of exploring, defining, and assessing character strengths, leading to the identification of signature strengths and goals for future development. Informed by personal construct theory, the present study explored the experiences of homeless young people living in sheltered accommodation (N = 116), when using strengths profiling at the start and end of a 10-week, strengths-based intervention. Mixed-method data was obtained from the strengths profiles, questionnaires measuring resilience, self-worth, and well-being, and diary entries. Findings revealed a rich array of character strength terminology and individual meanings. Participants found strengths profiling to be highly engaging, particularly due to their active role in strength identification, which prompted interesting and meaningful reflections on character strengths that were pertinent to them. Participants felt their signature strengths were vital protective factors within their lives and strengths profiles were correlated with resilience, self-worth, and well-being. Character strengths and resilience were also significantly and meaningfully improved pre/post-intervention, providing support for the use of strengths profiling as a tool for monitoring change in character strength perceptions. Overall, this study demonstrates the utility and versatility of strengths profiling as a new method in the discipline of positive psychology and strengths-based research and applied practice.

Challenge and threat states: examining cardiovascular, cognitive and affective responses to two distinct laboratory stress tasks.

BACKGROUND: The theory of challenge and threat states in athletes (TCTSA) proposes psychological antecedents will predict psychological and cardiovascular responses to stress. The present study investigated this theory in two contextually different stress tasks. METHOD: 78 males completed a computerised competition and a public speaking task. Cardiovascular activity was measured with impedance cardiography and a blood pressure monitor. Challenge and threat antecedents, indicators of challenge and threat and emotions were assessed pre- and post-tasks. RESULTS: Both tasks induced significant perturbations in cardiovascular activity and were perceived as highly challenging. Reported perceived threat was higher in the public speaking task compared to the competition task. Associations between the proposed antecedents, self-report and cardiovascular indices of challenge and threat and emotions support the TCTSA for the competition task, but less so for the public speaking task. CONCLUSION: The TCTSA is supported during competitive stress, however during social stress there is dissociation between self-report appraisals and cardiovascular reactivity.

Challenge and threat imagery manipulates heart rate and anxiety responses to stress.

This study investigated the influence of different types of mental imagery on heart rate and anxiety responses to a standard psychological stress task. Using a within-design, 25 females (Mage=23.24; SD=4.19) imaged three different scripts (challenge, threat, and neutral) to manipulate appraisal of a speech preparation task. Following each script, participants completed the task. Heart rate was recorded during a resting baseline prior to each imagery script and during each speech preparation task. Cognitive and somatic anxiety and self-confidence were assessed prior to the speech preparation trials, and immediately prior to each speech preparation following imagery. Following threat imagery, participants reported the speech preparation task to be significantly more stressful and threatening, and experienced lower levels of confidence and more negative interpretations of their anxiety symptoms compared with the challenge and neutral imagery conditions. Additionally, there was a significantly greater increase in heart rate following threat imagery compared with challenge and neutral imagery. Findings demonstrate that imagery can alter stress appraisal and the accompanying cardiovascular and psychological responses to standardized stress tasks. Imagery interventions, acknowledging the stressful nature of events, but emphasising feelings of efficacy and control are likely to lead to more adaptive coping.