Short-Term International Sport for Development and Peace Programs: A Retrospective Analysis and Critique Informed by Stakeholders’ Perspectives in a Two-Year Follow-Up WVU. For more information, please contact researchrepository@mail.wvu.edu. Running head: RETROSPECTIVE SDP CRITIQUE Short-Term International Sport for Development and Peace Programs: A Retrospective Analysis and Critique Informed by Stakeholders’ Perspectives in a Two-Year Follow-Up Adam H. Hansell Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, & Performance Psychology Dana K. Voelker, Ph.D., Chair Jack C. Watson, Ph.D. Cheyenne Luzynski, Ph.D. Kristen Dieffenbach, Ph.D. Lindsey Blom, Ed.D. Department of Sport, Exercise, & Performance Psychology Morgantown, West Virginia 2022 Keywords: sport diplomacy, community, culture, power, social change Copyright (2022) Adam H. Hansell RETROSPECTIVE SDP CRITIQUE ABSTRACT Short-Term International Sport for Development and Peace Programs: A Retrospective Analysis and Critique Informed by Stakeholders’ Perspectives in a Two-Year Follow-Up Adam Hansell Sport for Development and Peace (SDP) programs are a popular approach to promoting positive development throughout the world, spanning health, education, peace, and social issues. However, scholars have identified critical shortcomings of SDP work, including the potential to reinforce neoliberalist tendencies and values imposition from the Global North to the Global South. Deporte y Cambio Social was a short-term SDP program established through partnership between American and Mexican constituent groups with aims to empower girls and women through soccer. Through six semi-structured, two-year retrospective interviews, the purpose of the present study was to explore cross-cultural understandings of power and intercultural power relations from the voices of Mexicans and Americans involved in the program to offer reflective critique of, and generate participant-informed strategies for improving, the design and implementation SDP programs broadly. Using thematic analysis from a critical constructivist orientation, the meanings generated from the data showed that Mexican and American participants similarly defined power and acknowledged power imbalances informed by a limiting project framework and a sociocultural-informed deference to Americans as experts. Strong, positive intercultural experiences between Mexican and American constituent groups were reported amid often unseen social biases that can be experienced abroad and perpetuated in SDP programs. Critical reflexivity, prolonged cultural preparation, longer-term engagement, and careful construction of SDP leadership teams and program participants were among the strategies informed by the data that were further interpreted to account for the complex realities of SDP programs. RETROSPECTIVE SDP CRITIQUE Table of Contents iii Page Introduction………………………………………………………………………………………..1 The Setting: Deporte y Cambio Social……………………………………………………4 Method…………………………………………………………………………............................5 Research Design & Positionality………………………………………………….….......5 Participants………………………………………………………………………….…....6 Procedures…………………………………………………………………………….….7 Data Analysis…………………………………………………………………………….10 Results and Discussion…………………………………………………………………………..12 General Discussion………………………………………………………………………………26 Practical Implications……………………………………………………………………………29 Limitations and Future Research Directions…………………………………………………….32 Conclusion……………………………………………………………………………………….33 RETROSPECTIVE SDP CRITIQUE 1 Short-Term International Sport for Development and Peace Programs: A Retrospective Analysis and Critique Informed by Stakeholders’ Perspectives in a Two-Year Follow-Up Organized sport has played an integral role in human societies for ages, and it continues to be one of the most popular forms of social interaction and entertainment throughout the world. Experts in public health and exercise science have published an extensive body of literature suggesting participation in organized sport can promote the development of a myriad of positive physical, psychological, and social outcomes for youth, including improved health, social interactions, and the development of essential life skills such as discipline, accountability, teamwork, and responsibility that can be transferred to life outside sport (e.g., Holt, 2016). At the elite level, global sport competitions, such as the Olympics and the FIFA World Cup, attract millions of supporters worldwide to observe sporting phenomena believed to transcend race, religion, socioeconomic status, and politics (Murray, 2012). Due to the global popularity of sport, researchers, international organizations, and government agencies have increasingly advocated for sport for development and peace (SDP) programs which use sport to promote positive development in non-sport spheres (Schulenkorf et al., 2016), including social cohesion, health promotion, education, livelihoods, peace, gender equality, and disability (Giulianotti et al., 2016; Svensson, Andersson, & Faulk, 2018). Although improvement across these areas is ubiquitously beneficial, scholars have encouraged the use of SDP programs with individuals from underserved communities domestically and internationally (e.g., Coalter, 2010; Kidd, 2008; United Nations, 2003; Whitley, Forneris, & Barker, 2014). In an integrated literature review, Schulenkorf et al. (2016) found that SDP programs have been most commonly conducted with underserved youth participants, used soccer as the sport of choice, and incorporated either qualitative or mixed method approaches for evaluation. RETROSPECTIVE SDP CRITIQUE 2 Among the critical gaps limiting their effectiveness, however, was the use of apolitical and outcome-focused theoretical frameworks, such as positive youth development (PYD) or social capital, within which culture and context are peripheral. While the authors recognized the use of any theoretical framework as a noted strength, they suggested sole reliance on frameworks that neither acknowledge, nor deepen, understanding of the sociopolitical and cultural landscape within which SDP programs occur, is misguided. Schulenkorf et al. further noted a significant gap related to the intentional engagement of multi-level stakeholders in the evaluation of SDP programs. Thus, evaluation is often limited to understanding whether program participants changed according to a predefined outcome, yet other stakeholders with considerable influence in shaping the SDP experience, including funders, researchers, and program developers, are seldom examined. Other scholars have highlighted critical directions for the field (e.g., Darnell et al., 2018; Giulianotti et al., 2019; Welty-Peachey, Schulenkorf, & Spaaj, 2019). Among these recommendations, researchers have been encouraged to move beyond solely outcome-based approaches that measure short-term, transactional ‘impact’ of SDP initiatives on underserved program participants (e.g., pre-posttests), toward critical reflection of how extant SDP approaches, intended to empower participants, may counterintuitively reinforce dominant ideology. International SDP programs, for example, are often conducted in low- and middle income communities located in the Global South but are typically funded and evaluated by Western stakeholders from the Global North and often rooted in neoliberal beliefs and values (Darnell et al., 2018; Giulianotti et al., 2019; Schulenkorf et al., 2016). Neoliberalism is broadly characterized as the belief that disadvantaged nations, most of which are located in the Global South, would benefit from the adoption of Western systems, values, and institutions (Brown, RETROSPECTIVE SDP CRITIQUE 3 2019; McCarthy & Prudham, 2004). Despite the intention of helping other nations, critics assert a neoliberal approach can reinforce systems of subordination and disempowerment (Svensson & Loat, 2019). Although SDP programs are frequently advertised as meeting the needs of underserved communities, they often entail the imposition of Western expertise and assumed truths about a different culture without the careful and intentional involvement of local voices – an immersive process that would offer the best opportunity for positive change, as defined by the local community, as well as the development of meaningful intercultural relationships (Darnell et al., 2018; Harris, 2018; Hayhurst, 2016; Oatley & Harris, 2020; Welty-Peachey et al., 2019). Importantly, neoliberalist critiques are not unique to SDP, but are rather reflective of a complex, global sociopolitical and cultural landscape across societal sectors. Nilsen (2016) asserted neoliberalism is one of the primary, yet hidden, drivers of any international development agenda. Similarly, scholars of anthropological phenomena have critiqued monolithic definitions of power within international collaborations and encouraged conceptualizations that increasingly consider complexity, fluidity, and context (Adler & Aycan, 2018). Some evidence, for example, suggests cultural perceptions are influenced by the balance, or imbalance, of power observed between members of the same or different cultural groups such that greater power symmetry may be a primary determinant of positive cultural perceptions (Heijes, 2010). Collectively, these critiques call into question how SDP programs can be better designed, implemented, and evaluated to prioritize the expertise of local communities and meaningful intercultural relationships that maximize contextual understanding of local culture, values, norms, and long-term aims. The purpose of the present study was to retrospectively critique a short-term international SDP program from the voices of varied stakeholders involved in the program’s development and implementation, and related specifically to cross-cultural RETROSPECTIVE SDP CRITIQUE 4 understandings of power and intercultural power relations, to generate participant-driven strategies that meaningfully inform future SDP engagement. The Setting: Deporte y Cambio Social Deporte y Cambio Social was an international SDP and sport diplomacy initiative developed to promote girls’ and women’s empowerment and leadership in Mexico using soccer as a platform – a topic selected based upon a sub-award received from a larger grant funded by the U.S. Department of State. Academic professionals and graduate students from two large public universities in the United States (U.S.) and Mexico developed and implemented the program using a train-the-trainer model designed for current and future sport coaches of girls and women based on the Social Change Model of Leadership Development (SCM) – a values-based model that views leadership development and social change as a dynamic process within individual, group, and community domains (HERI, 1996). The program involved two phases with 56 days in-between: the first in Mexico for seven days and the second in the U.S. for 13 days. The American constituent group included faculty members, graduate students, and community coaches who were native U.S. citizens or originally from regions of the Global South, including Mexico. Collectively, this group selected the guiding theoretical framework, managed the budget, coordinated the international travel, designed the program in consultation with members of the partnering institution in Mexico, and facilitated the workshops. The Mexican constituent group included faculty members who were native to Mexico. Together, they recruited participants (e.g., community coaches, college and graduate students, and girl youth soccer players from the community), procured facilities and supplies, and facilitated the workshops in a supporting role (e.g., providing directions, explaining activities) for the RETROSPECTIVE SDP CRITIQUE 5 programming in Mexico. Program participants were current and future sport coaches of girls and women who were predominantly Mexican in addition to a small sample of Americans in similar coaching or student roles. In addition to outcomes-based assessment of the program (i.e., quantitative and qualitative examination of learning relative to the program’s content; España Pérez et al., 2021), Hansell et al. (under review) explored a subsample of Mexican participants’ impressions of the U.S. and Americans immediately following their program participation via focus groups. Participants reported feeling connected to Americans in realizing they experience some of the same struggles and shared optimism in forming future intercultural partnerships. Interestingly, participants also described considerable deference to Americans as ‘experts’ in sport-related professions and idealized sport training and resources in the U.S. Hansell et al. purported it is possible the mere structure of the program reinforced a perceived imbalance of power, in what was meant to be a shared intercultural exchange, which inspired the present study. Research Design & Positionality Method A critical constructivist epistemological framework was used to frame the present study, which acknowledges the influential role of culture, context, and power, both hidden and overt, across human social interactions as individuals navigate, and make meaning of, their experiences (Amineh & Asl, 2015; Bentley, 2003; Hopf, 1998; Levers, 2013; Price & Reus-Smit, 1998; Stetsenko & Arievitch, 1997). Within qualitative research, assuming a critical constructivist lens entails the co-creation of meaningful information through interactions between researchers and participants to promote transformation, critique, and the generation of novel ideas (McCabe & Holmes, 2009). Scholars have highlighted the importance of adopting a critical lens to challenge RETROSPECTIVE SDP CRITIQUE 6 existing societal status quos by questioning, untangling, and constantly reevaluating entrenched ideologies, beliefs, values, and assumptions (Denzin & Giardina, 2016). From this perspective, a critical lens not only welcomes diversity, disagreement, and dissent, but views them as essential components of the research process to garner new theoretical insights, possibilities, and explanations. Qualitative researchers have highlighted the philosophical similarities between constructivism and critical theory (Price & Reus-Smit, 1998). Both are rooted in ontological relativism, which posits that reality is constructed through an individual’s unique interpretation of their environment, context, and identity, and therefore multiple realities can exist simultaneously (De Ronde & Mouján, 2019). From this orientation, semi-structured individual interviews were conducted to provide participants with opportunities to respond to the same questions within a flexible framework and, in turn, promote rapport building, depth of responses, exploration of unique insights, and co-construction of meaning with participants through elaborative discussion (Dearnley, 2005). The present study was informed by a seven-person research team with various roles to include two interviewers and two critical friends whose respective roles are discussed herein as well as an auditor who oversaw the project with the consultative support of a dissertation committee representing experience in SDP, PYD, intercultural collaboration, girls’ and women’s leadership, and the youth sport experience and who offered insights iteratively through the writing process. Participants Participants (n = 6; Mage = 41.5 years; SD = 10.4 years) were a purposive sample of Mexican and American citizens (n = 3 self-identified women; n = 3 self-identified men) involved in both phases of Deporte y Cambio Social in Mexico and in the U.S., respectively. Using maximum variation sampling methods, participants were selected according to select RETROSPECTIVE SDP CRITIQUE 7 variables that influence, or are influenced by, power (i.e., nationality, gender, professional role, role in the program). The participant sample included two Mexican university students training to become sport coaches and/or physical activity teachers of girls and women at the time of their program participation; two Mexican faculty members and one American faculty member from the collaborating universities who were involved in the design and implementation of both program phases; and an American coach of girls and women involved in the program’s implementation. Procedures Following IRB approval for this study, eligible participants (i.e., involved in design, implementation, and/or participation in both phases of Deporte y Cambio Social; 18 years or older) were contacted via email, text message, or private social media message with invitation to participate in the study. This communication described the purpose and nature of the study, the tasks involved in participating, and invited them to further discuss the study via video call. Participants were also provided informed consent and a background questionnaire asking them their name, age, hometown, place of residence, current occupation, and occupation at the time they were involved in Deporte y Cambio Social. All eligible individuals responded to the initial inquiry; participants who opted out cited personal events. Six participants agreed to participate through electronic return of a signed consent form and scheduled their virtual interview. Each interview, ranging from 28 to 60 minutes (M = 45 minutes), was conducted collaboratively by two research team members. The first interviewer was an American citizen and doctoral student at the American university who identifies as a White man. He has been passionate about the potential role of sport in promoting positive social change through his experiences traveling internationally, his soccer career, and his continued non-profit work in a RETROSPECTIVE SDP CRITIQUE 8 rural community in Ghana. Although he is fluent in Spanish, he acknowledged his role as a cultural ‘outsider’ given his limited immersion in Mexican cultures, customs, and traditions. The second interviewer was a Mexican citizen who completed her doctoral degree at the American university and identifies as a Latina woman. Born and raised in Mexico for 18 years before attending university in the U.S. as a student-athlete, she had personal experience with gender inequity in Mexico both within and outside sport, and openly acknowledged her role as a cultural ‘insider’ given her lived experience as a Mexican citizen. Both were involved in the program development and implementation across the two phases of Deporte y Cambio Social. They attended all planning meetings and provided feedback connecting sport-based activities with program objectives and their alignment with Mexican cultural norms. Each assisted the primary workshop facilitators and served as translators between Spanish and English speakers. The interviewers stayed in contact with many of the representatives, Mexican and American, who were involved in Deporte y Cambio Social in the time since the program ended. These continued personal relationships primarily consisted of occasional (e.g., bi-weekly) conversations in-person or via text messaging services and social media. The formation of sustained relationships beyond participation in SDP programs has been labeled as ‘friendship potential,’ which is a common outcome stemming from SDP programs involving stakeholders from different cultures (Dixon et al., 2019). Having relationships (e.g., personal, professional) beyond traditional researcher-participant dynamics is not uncommon in ethnographic studies within anthropology. Day (2012) asserted that role conflicts for qualitative researchers are not inherently problematic, as long as the researchers engage in a robust reflexive process to understand their different roles, their impact on the research, and how and when they alternate between multiple, and sometimes conflicting, roles. Other scholars have noted that pre-existing RETROSPECTIVE SDP CRITIQUE 9 relationships between researchers and participants can counteract perceived power imbalances, enhance vulnerability and honesty, and foster more meaningful discussions during qualitative interviews (Eide & Kahn, 2008; Råheim et al., 2016). Following guidance outlined by Whiting (2008) for facilitating semi-structured interviews, the interviewers began each interview by explaining the study purpose, use and dissemination of findings, their rights as research participants, and protection of confidentiality. The interviewers additionally encouraged discussion of concerns or questions to allow participants to explore the prompts freely and interact with the interviewers comfortably. Interview items (See Appendices D and E) were developed to prompt critical reflection related to participants’: (a) experiences in the program (e.g., describe your experience participating in Deporte y Cambio Social); (b) understandings of power (e.g., what does power mean to you?); (c) perceptions of power within the present intercultural collaboration (e.g., during the program, tell us when you perceived a power balance/imbalance); and (d) additional hypothetical prompts related to intergroup dynamics and power (e.g., would you ever consider coming/returning to the U.S./Mexico to deliver a similar program?). The audio-recorded interviews were transcribed and translated into English by a professional editor who is fluent in Spanish and English. Each participant was contacted to complete a virtual, individual member reflection with the interviewers (Smith & McGannon, 2018) during which participants were prompted with questions regarding their initial interview experience (i.e., what was it like for you to critique, with strengths and areas of improvement, the Deporte y Cambio Social program?). Participants were then provided with a case summary, developed by the interviewers, with initial interpretations from their first interview and encouraged to question, clarify, or expand. All participants engaged in member reflections, RETROSPECTIVE SDP CRITIQUE 10 ranging from 10 to 17 minutes (M = 13 minutes), which were additionally transcribed as data and integrated into the remaining phases of data analysis (Smith & McGannon, 2018). Data Analysis The core data analysis team included the interviewers, as well as two individuals with ‘critical friend’ roles, both of whom are American citizens who identify as White women; the first is pursuing her doctoral degree, and the second is the primary author’s doctoral advisor, at the American institution. Neither critical friend was involved in the design or delivery of Deporte y Cambio Social and, accordingly, were well-positioned to offer perspectives external to direct programmatic experiences. Given the analysis teams’ variable roles, experiences, and relationships to the participants, reflexivity was prioritized – a critical thinking practice to identify and bring into conscious awareness specific personal, cultural, social, theoretical, and political factors that influence the research so meaning can be understood and evaluated in context (Attia & Edge, 2017; Day, 2012; Georgiadou, 2016; Lazard & McAvoy, 2017). The researchers followed guidance provided by Meyer and Willis (2019) to intentionally engage in a structured and reflexive process using journaling and critical collective discussions to elucidate unconscious biases and tendencies that may influence their interactions with participants and the data (Cunliffe, 2004; Malacrida, 2007; McNair, Taft, & Hegarty, 2008). Prior to data collection, analysis team members discussed their role in the program, identity, and positionality (Day, 2012; e.g., What are your underlying assumptions about the production of knowledge? How does my role/identity/education/experience influence my perspective and interpretation?). They additionally responded to prompts, in written form, related to power (e.g., in my community, power means…) and their views on SDP (e.g., my impressions of SDP work are…). The purpose of the analysis team’s engagement with themselves and each other was to process, clarify, and be RETROSPECTIVE SDP CRITIQUE 11 transparent about what each member brought to the analysis and explore how the study, in turn, would be informed by that awareness. This process encouraged exploration of multiple interpretive possibilities while supporting participants’ voices as the primary source of meaning derived from the data (Halcomb & Peters, 2016). The data were analyzed using a reflexive thematic approach (Braun & Clarke, 2019; 2020). Importantly, Braun and Clarke (2020) asserted their guidance is not meant to be followed rigidly, as the process should be fluid, recursive, and flexible. Prior to reading transcripts, the analysis team met to discuss, establish, and clarify norms, roles, and expectations for the coding process that were subsequently revisited at the start of each analysis meeting. These initial conversations included sharing from each member’s reflexive journals (e.g., What thoughts and feelings emerged for you as you read the data this week?); invitations to respectfully dissent with another member’s perspective (e.g., Could this interpretation more deeply consider the sociocultural context?); and acknowledging insights from each team member as equally valuable regardless of their role (e.g., What was it like as a student to receive that feedback from me, as your doctoral advisor? What resonates? What doesn’t?). Each member of the analysis team reviewed the data individually and pre-coded, one transcript at a time, using open coding (Charmaz, 2014; Saldaña, 2006) and an analytic memo to document impressions before discussing as a group. Together, the analysis team deductively organized the codes according to all facets of the study purpose and inductively organized them according to meanings generated. Over several months, the organization of codes, drafted in text form and via conceptual mapping, were iteratively revised, refined, and re-defined as new transcripts were read via constant comparison (Braun & Clarke, 2020) as well as throughout the writing of the study in which all research team members were consulted for clarity, RETROSPECTIVE SDP CRITIQUE 12 interpretation, and context based on their unique role in the program and the study. In the following narrative, participants’ names were replaced with pseudonyms to protect confidentiality (i.e., Mexican participants were Fran, Guillermo, Mariana, and Miguel; American participants were Jennifer and Jeremy). Results and Discussion The following narrative begins with participants’ broad impressions of the program. Understandings of power and culture that shaped their experience are then examined and interpreted to inform recommendations for SDP engagement. Within each section, main ideas generated from the data are italicized for emphasis. Participants’ names were replaced with pseudonyms to protect confidentiality (i.e., Mexican participants were Fran, Guillermo, Mariana, and Miguel; American participants were Jennifer and Jeremy). General Impressions of the Short-Term SDP Experience Mexican and American participants expressed significant enjoyment of, and deep gratitude for, their experience in Deporte y Cambio Social. Participants reported sentiments such as: “…Everyone who travelled, based on what I saw, they really enjoyed the trip. They really had a great cultural experience” (Jeremy); “This trip was an example of how relationships that are formed in sport can be lifelong and life changing” (Jennifer); and “…we still talk on some occasions about the subject of [state]. The truth is we loved the treatment we received from all of you. What happened is that a very nice, very fraternal integration was made” (Miguel). Miguel elaborated: “The truth is that it is an experience I will cherish throughout my life.” Participants’ gratitude for their rich intercultural experiences was deeply rooted in their belief that sport can be used as a powerful, unifying mechanism that can “…teach that sort of balance and responsibility” (Jennifer). Miguel shared: “Sport moves masses. Sport prevents crime. Sport RETROSPECTIVE SDP CRITIQUE 13 unites cultures...Sport creates values. If I am a child, a six-year-old or seven-year-old, and I learn teamwork, communication, friendship, honesty, tolerance, respect, companionship, etc., society is going to be better.” Such positive reflections of participants’ overall experience are much like those reported in response to similar SDP programs conducted between, for example, the U.S. and China (LeCrom & Dwyer, 2013), Jordan and Tajikistan (Blom et al., 2019), as well as countries in Latin America and the Caribbean (Baker et al., 2018). Although belief in the power of sport to support positive and productive social change is hopeful, Coakley (2015) cautioned against overcommitment to the Great Sport Myth that assumes participation in sport is automatically good. According to Coakley, policymakers and others in positions of power have historically taken advantage of this assumption, particularly because sporting endeavors generate significant popular and financial support. While describing the positive “impact on society” that sport can have for “all the problems that currently exist in terms of violence, drugs, dropping out of school, etc...,” Miguel also emphasized “it all depends on the people involved." Germane to Coakley’s (2015) assertion and Miguel’s poignant perspective, sport does not inherently ‘do good;’ its potential depends on how people within a socially and culturally-informed sport context, are positioned to promote positive change. In turn, though often unexplored in broad stroke assessments of participants’ impressions of SDP programs, astute consideration of ways to acknowledge and address power-related disparities within SDP partnerships are additionally vital to the integrity and sustainability of SDP work (Darnell et al., 2018; Giulianotti et al., 2019; Svensson & Loat, 2019). In the following sections, we share insights from participants of Deporte y Cambio Social with respect to the dynamic intersections of power and culture that are foundational to the impact of SDP programs and, based on the data, explore how these programs RETROSPECTIVE SDP CRITIQUE 14 can be approached to maximize cultural understanding, and minimize the reproduction of inequities, while acknowledging the constraints under which SDP work is often conducted. Understandings of Power and Power Relations with the Short-Term SDP Experience Mexican and American participants described power as a paradoxical concept. Guillermo reported: If you want to know a person, you give them power. It’s going to give us the best of themselves or it’s going to give us the worst of themselves. Power…is a great responsibility that can lead us to a positive or negative side with a very thin line. When used appropriately, power was characterized as involving the “capacity to influence others” (Jeremy); a “basic need” that “defines our safety overall” (Jennifer); and a “tool” that can “break barriers and help other[s] grow alongside you” (Miguel), allow one to “do things for others…or society” (Fran), and “reach your goals” (Mariana). Two participants, both of whom were Mexican women, further described power as an aspiration; that is, “a strong word that we should all have in our minds as a value” (Mariana) because it can lead to “more educational and economic opportunities” (Fran). Although acknowledged by everyone, only Mexican participants robustly elaborated on the negative potential of power with contextual examples (i.e., “…in Mexico, power means to do what you want whether it is right or wrong…Many powerful people do things only for them and their family and not their community. I think it’s wrong” [Miguel] and “power in the Mexican context can be understood as an abuse” and a “negative authority” [Guillermo]). Within Deporte y Cambio Social specifically, power dynamics between Mexican and American stakeholders were informed by a complex intersection of privileges rooted in nationality, language, culture, race, sex, and gender. Foundationally, Mexican and American RETROSPECTIVE SDP CRITIQUE 15 participants acknowledged that SDP programs involving a partnership between a country from the Global North, like the U.S., and a developing country, like Mexico, are inherently built upon a pre-existing power imbalance. Jeremy shared: “I think the imbalance of power started from day 1...you’re an American university, so you are automatically considered good.” In reflection of a mandated visit to the U.S. Consulate during the first program phase in Mexico, including its “nice” appearance, “ready to respond” formalities in case of emergencies, and resources “had I needed anything,” Jennifer shared: “I think that just speaks to the power that Americans have and also think we’re entitled to…” Miguel explained: Maybe I'm a little biased because personally I’m a big fan of American culture. I can say that I grew up with their philosophy that I learned through their movies, through their sports, their leagues, but I think that the university issue is amazing; how they live, how they get to campus, how doors are opened for people to be able to be in these institutions of such high prestige. Deference to Americans and other Global North actors and institutions regarding knowledge, ideals, and expertise is well-documented in the SDP literature (i.e., Dao & Chin, 2021; Hansell et al., under review; Hayhurst et al., 2021d). Such deference fuels a foundational imbalance of power on which SDP programs are often built that, despite intentions to facilitate equitable partnerships, nonetheless influences the process through which SDP programs are designed and delivered (Dao & Chin, 2021; Harris, 2018). In the present study, Jeremy shared: “I think we sort of like were dictating the program…the program was in our, the ball was on our side.” Concordantly, Mariana observed: “I noticed Americans had a lot of power.” Mexican participants, however, did not perceive the control that Americans had over the program and its implementation as problematic. Mariana elaborated: “I did not notice any RETROSPECTIVE SDP CRITIQUE 16 [power imbalance]. It was more like [Americans] reached an agreement, you talked about it and told us, and we had to do it no matter what. It was not like an option.” Fran similarly acknowledged the American constituent as the leaders who arrived to “present” while Mexicans “participate,” but only problematized the observed power imbalance between Americans who could and could not speak Spanish: “When you [Americans] came [to Mexico], you were the ones who were organizing everything. So, it could be a number one imbalance, the language, because [American] spoke Spanish and English and had more decision-making power on that side.” Together, these findings suggest that, as an identified world power, ‘American expertise’ and leadership were expected (Collison et al., 2016; Darnell et al., 2018). Further, Mexican participants reported they were treated as equals by the American constituent, which strengthened their cultural perceptions. Feelings of equality were observed most when Mexicans and Americans were jointly engaged in the program’s functions (i.e., “When we were doing the activities in the field I believe that was more of a power balance” [Mariana]; “…in all the activities, those that were done in classrooms, when you shared a talk with us, when we had practices on the fields, when we were in the camp” [Miguel]). Fran reflected positively on Mexicans’ homestay experiences during the program phase in the U.S., which she believed were met with not only equality, but also consideration: I told them that we Mexicans must eat together at least once a day, and what they did was to invite their son to dinner so that I wouldn't feel so out of my house. They told me ‘We have dinner together on a few occasions, but we are inviting him for you to see what a family dinner is like because we do not really have them often. RETROSPECTIVE SDP CRITIQUE 17 Despite positive interpersonal connections with the American contingent in the program, Mexican participants also candidly described, with expectation and acceptance, experiences of racial discrimination while in the U.S. Guillermo explained: …when we were at [name] airport, there was a dark-skinned policeman who just noticed that we were Mexicans and threw our bags. Then I said, ‘I will do it and put it up.’ He saw what I did, returned it, and threw it back again. It seems to me that there was an abuse of power from an authority there. He wanted to show, here I command…However, I insist, we are in the process of social development, and we must be tolerant of this type of action and just understand the reasons why these things occur, only that. But I'm not talking about a generality, it was simply an isolated event that that occurred on that trip, but at least in Deporte y Cambio Social we were treated wonderfully. Fran shared: …we have an idea of the profile of the nationalities in Mexico. Unfortunately many times we see racism, that you are not being loved, that they don't see you as equal, but we see that in this type of program, it was super good, and this perception was not in it…this paradigm that many people have was changed...Many Mexicans think that Americans are not interested in us. But, they were quite interested in knowing our culture, in knowing our food, how we thought and how we interacted with each other. I saw it as a good thing…I see that in this type of program, nationality does not matter, the important thing is people... While intercultural interactions within the insulated context of SDP programs are positive, they also serve as barriers to meaningfully identifying, discussing, and working through authentic intercultural conflict in real world settings. Jeremy, for example, cautioned that the American RETROSPECTIVE SDP CRITIQUE 18 contingent who partook in Deporte y Cambio Social was largely comprised of individuals who were already educated with significant travel experience: …I really would have liked to actually take kids that actually maybe think that Mexicans are rapists, Mexicans are bad people. These are the people that actually we should have selected to really go there, because that’s the aim of the program, the people to people. Although defaulting to university-affiliated professionals and students is a convenient recruitment tool, it prevents the expansion of SDP opportunities to a more diverse group of Global North participants without prior access to this type of exposure and learning and who might benefit most. Further, other literature cautions that marketing SDP volunteer positions to college students as opportunities to enrich their educational experience and boost future employment prospects detracts from the intended purpose of these programs to serve with another cultural community (Clarke & Norman, 2021; Giulianotti, Collison, & Darnell 2021). Specific to sex and gender, Mexican and American participants observed when biases were perpetuated, and at other times challenged, amid program execution. Jennifer shared: …sexism showed up in the management of our trip in that it was too hot for the women’s event to happen, so we didn’t get to connect with just women only…It’s like we’re here for [women’s empowerment] and you’re telling a bunch of women that it’s too hot for us to play instead of asking us if we want to do it. In observation of the American constituent group, Mariana reported: “In the case of [American woman], who was with us a lot, she would say something and then later it was changed to what [American man] wanted; then yes, I saw two unequal powers.” Other scholars have described how, although SDP programs are intended to facilitate positive social change, often unseen biases, specifically with respect to sex and gender that are deeply entrenched in our sociocultural RETROSPECTIVE SDP CRITIQUE 19 worlds, still manifest in program execution. For instance, del Socorro Cruz Centeno (2021) reflected on ways in which the prescribed curriculum of an established SDP program that used soccer to target gender equity and environmental stewardship in Nicaragua subtlety reinforced existing gender norms in the local context. Specifically, women program participants assumed cleaning and organizational tasks (traditionally feminine) while men program participants neglected these chores to play soccer (traditionally masculine). Chawansky (2015) used autoethnographic vignettes to similarly reflect on ways in which her identity as an American White woman influenced her experience and interactions as a Global North SDP researcher; specifically, she recounted experiences of gender bias and sexualization while aiming to empower girls and women in a Global South context. Parallel to these types of experiences were instances in which sex and gender disparities were contemplated and challenged. Mariana explained how, in response to a training received in the U.S., the Mexican girls reflected on the differences in societal norms regarding the legal protection of girls and women: …the girls were saying, ‘so, here, if somebody turns to see you, it is almost a felony, if somebody touches your hair, it is a felony.’ They didn´t know that. Some had the openness to tell me some very strong things that happened in their community [in Mexico], and I think it doesn’t happen here in the United States, not even half of it, because you would be taken to jail or arrested... Such reflections suggest that takeaways for Mexican participants from this training included being more conscious observers of their surrounding environment as well as an awareness of differences in gender protections across cultures. However, although the presence of institutional systems intended to protect the rights of girls and women was both surprising and inspiring, RETROSPECTIVE SDP CRITIQUE 20 these structures have been frequently criticized for operating under the guise that they protect girls and women, when, that is not always the case. For instance, critics of Title IX, which was designed to provide institutional protection for girls and women within higher education, assert that navigating it’s policies can be complicated, traumatic, and unsuccessful for many survivors of sexual violence. Instead of taking firm, no tolerance stance on sexual misconduct, administrators, and others in positions of power often maintain a silent, neutral position to protect their own public image as well as their institution’s (Cruz, 2021: Delaet & Mills, 2018). Thus, Mexican participants may have been left with an incomplete idea of the effectiveness and procedures for complex institutional policies designed to protect girls and women in the U.S. Explicating the Realities of SDP Programs with Recommendations Forward Despite perceptions of Deporte y Cambio Social being generally “well-designed” and “super well-organized,” time was a significant barrier (e.g., “…it was just too much to fit into a week” [Jennifer]; “…everything was in a hurry” [Mariana]). Mexican participants reflected on the busy daily itineraries developed by the American cohort. Miguel shared: …honestly, nobody wanted to go back home. We all wanted to stay a few more days because a very good atmosphere was created...Why do I tell you more time? Because almost every day was very busy and went by very fast. Mariana echoed: “Take it more slowly, only that. I know it was tight since you had to fulfill a lot. But you can give them time to relax or do their own things and let them be with each other.” Mexican participants’ observations of the program itinerary, which largely aligned with American cultural norms on productivity and punctuality, are one example of the problematic discordance between meeting the demands of a grant originating from a Global North context and norms of local culture in many Global South communities (Hayhurst et al., 2021c; Oxford & RETROSPECTIVE SDP CRITIQUE 21 McLachlan, 2018). Within the noted time constraints, participants also explained they had limited role clarity (e.g., “I feel like if [my role] was a test question, I would probably not get it correct” [Jennifer]; “I believe that knowledge, to know what we were going to do and why, would have facilitated everything that happened” [Mariana]). Concordantly, Jeremy described the coordination of lodging, meals, budgeting, and transportation as a significant constraint on time and resources that made for an “intense” experience. He further acknowledged significant investment from the Mexican constituent group: “We were just asking them to be partners, collaborators without any cost, but of course they had costs… not only during the event but prior to the event…if you put money into the time of the people.” Thus, the very structure of the funding opportunity and its associated demands were believed to significantly complicate the ability to more meaningfully engage with the Mexican stakeholders during the program’s design. Jeremy added: …it was not a program that I would say was totally built with them…at the very beginning, we talked about ‘we need to build this program with them, so it’s going to be more inclusive’…I think it was more a logistics issue…I think we had the intentions to build something with them, but it was so complicated to really have a clear idea of what we want to do...we were moving, right? Because of the logistics, because of the time… Managing complex logistical barriers, including navigating the landscape of SDP funding sources, has been discussed extensively in the literature as a competitive, detailed, and exhausting process (e.g., Darnell et al., 2018; Svensson & Loat, 2019). Scholars have identified considerable discordance between the primary, outcome-focused objectives of funders (e.g., to demonstrate evidence of pre-post change and positive experiences) and additional, process focused objectives of SDP researchers and practitioners (e.g., empowering communities and RETROSPECTIVE SDP CRITIQUE 22 building sustainable programs; Giulianotti et al., 2019). To this point, Jeremy explained: “It’s a little bit artificial…when you create this positive feeling. And by creating these positive feelings, I think you are achieving in a certain way the [funder’s] purposes...” He elaborated: “…They require a lot of time and involvement into setting up the programs with all these demands, but sometimes you lose focus of what is the core problem.” Jennifer reflected on the broader implications of a short-term SDP program: "With more time and experience we could have made this a richer experience about women, coaching, social change, and sport.” She added: …I don’t really think we impacted another generation of women. We just impacted the women that were there. So, I would have liked to be able to encourage females more specifically to take and apply what they learned. I thought we were kind of able to encourage the group generally, but I would have liked more in that. Although a subsample of Mexican participants designed and implemented abbreviated workshops with pupils at two Mexican high schools following their own workshop participation, there may not have been sufficient opportunity for participants to apply and/or share their knowledge and experience from the program. Indeed, Mexican participants described their cultural learning, including site seeing, as their “favorite” or “best parts of the trip.” While cultural learning is foundational to any SDP initiative, coupling an immersive, first-time cultural experience with a social change program simultaneously is a known challenge of short-term SDP endeavors (e.g., Dao & Chin, 2021; Giulianotti et al., 2021; Whitley et al., 2018). Scholars have also problematized the frequent prioritization of funding new investigators that make learning from experience and sustained careers in SDP difficult (Coalter, 2010; Harrison & Boehmer, 2020; Kidd, 2008). Jeremy RETROSPECTIVE SDP CRITIQUE 23 explained: “I think I would like to really take the time to understand how people have done it. Because I think many of the programs probably experienced the same as we did.” Accordingly, participants offered their ideas toward SDP programs that can reasonably accomplish their central purposes to support meaningful intercultural engagement while fostering culturally relevant learning and reflection of key social issues. Among these recommendations, members of the Mexican contingent suggested SDP programs be longer in duration and that the experiences across countries be increasingly parallel. Fran explained: I saw how an American family lived. I realized the great differences. Maybe if you had stayed with a family when you came to Mexico, you would have also realized it too. You would not only have seen it from the outside…I would not change anything more than to see the way that, when you come, you could stay in the house of Mexicans and not in a hotel because it is very different. Guillermo similarly reported: [I wish] that Americans had more time in our country, that it was at least balanced. Because we stayed two weeks and it seems to me that you were only six or seven days. Then I would like it to be the same time so that it was wider, be calmer, and we could enjoy it a little more, and that this opportunity could be used to present more things about our country…of its people who are wonderful, that you could live it in a better way… Other Mexican participants added, “…it would have been better if it would have been more days, obviously. I know it is not simple to be accepted one month” (Mariana) and “at least four weeks instead of two” (Miguel). Relatedly, participants reflected on the importance of follow-up opportunities for continued, long-term engagement with program stakeholders and the programming. Mariana RETROSPECTIVE SDP CRITIQUE 24 shared: “I believe there should be a follow up...Let’s see what we did or how this has impacted.” Jennifer similarly explained: “…had there not been a global pandemic, I would have really hoped that there was some sort of follow-up, because I think that would have been where we saw how sustainable this was or how to make this sustainable.” Interpersonally, Miguel noted Mexicans and Americans “are still in contact” and “developed a very nice friendship.” As an indicator of the importance of sustained engagement, several Mexican participants expressed sincere appreciation for the opportunity to discuss their experiences toward the present research. Mariana reported: “…you are considering me in something that maybe can be of impact on the next generation, then I feel great; I feel considered.” Without strategic and intentional continuity, however, the ability to transfer ownership and responsibility of the program to local communities is compromised. Fran explained: “Since we came back, 80% of participants asked if there was going to be something similar and if they could volunteer for another program or another visit...We told them ‘We did not bring the program, it isn’t ours.’” Participants further described the importance of engaging in considerable introspection, reflection, discussion, cultural preparation, and relationship building prior to travel and throughout the experience. Jennifer explained: “When we design programs, we have these great ideas, but we don’t know the participants yet. I see more successful mentoring programs being more organic where there’s possibility for connection.” Fran stated: Maybe [more preparation] on what our culture is like. Although you do not know a person well, even if they have just been introduced to you, we greet with a kiss and a hug…Telling Americans this would have been useful so they wouldn't be scared… Guillermo added: RETROSPECTIVE SDP CRITIQUE 25 It probably would have been good if the [Mexicans] who visited knew more about [the United States]. Maybe 80% had never visited the United States before. Many had never left Mexico before. The ones for whom it was the first time did not know practically anything about it…Maybe if they knew a little about the cultural aspect before going. Jennifer, in her interview, reflected upon her experience as an English-speaking American in Mexico that serves as an example of the type of critical reflection that is warranted throughout the SDP experience from beginning to end: I was in the middle of a group, and I suddenly could not remember anything in Spanish. I had been speaking in Spanish, I mean not well, but at least enough that the group understood me. And as I kept talking, I was like ‘yeah…I don’t know anymore’ (laughter). It’s just this silly example but in that moment, I felt a distinct shift in how much power I had and how much I could help. I pretty much felt worthless to the group and to the project. She added: “This expectation that we went there and didn’t have to speak Spanish speaks so much to our power and privilege. People wanting to learn from us regardless of if they can understand us is pretty amazing.” Central to the core purpose of SDP programs, women participants across cultures recommended considerable attention to understandings of sex and gender and the intentional construction of representative leadership teams. Specifically, Mexican and American women participants discussed the prominent role of women within the project, but also wished more had been involved given the program’s emphasis on women’s empowerment. Fran shared: I saw when you visited Mexico that most of the visitors were women; both the girls who coached soccer, the organizers, and many of the researchers who came were women, so I RETROSPECTIVE SDP CRITIQUE 26 think it was already focused on women’s empowerment and all the activities that were done were usually led by women. Mariana added: I would have liked more women teachers and not as many men teachers. Also, more people from the sports arena, because if your goal is to use sport and empower women through that sport, more sport professionals should have been [involved]…there were teachers that had nothing to do with that sport and they were men. I don’t mean that only women should be included, but I think that if we want to empower girls, we [the Mexican constituent group] should have taken more women teachers. General Discussion Although our findings suggest that Mexican and American participants valued their experience in Deporte y Cambio Social, our subsequent analysis underscores the importance of engaging in critical and constructive reflection as a vital component of the SDP experience for all stakeholders. Indeed, garnering participants’ perspectives on some of the common challenges and related power dynamics within the SDP sphere is a noted strength of the current study, as is the significance of the candid accounts shared by participants and the humility of those engaged in the project who were willing to critique their own work and experience. To create dissonance with the potentially unsettling data shared in this study, it is easy to perceive the challenges discussed herein as unique and isolated to Deporte y Cambio Social. However, the alignment of the present data with a preponderance of recent conceptual critiques of SDP work (Darnell et al., 2018; Giulianotti et al., 2019; Hayhurst et al., 2021a; Whitley et al., 2018) suggest the conclusions are indeed transferable to a larger body of SDP programs that have, and continue to be, conducted. Following a process of critical and admittedly difficult introspection and RETROSPECTIVE SDP CRITIQUE 27 reflection, we encourage others associated with SDP programs to engage in a similar reflexive experience as a solution toward greater awareness, understanding, and increasingly effective navigation of known challenges. Indeed, the purpose of this study was not to dismiss the important potential of SDP programs and the overwhelmingly positive experiences that have been described here and in other literature (Baker et al., 2018; Blom et al., 2019; LeCrom & Dwyer, 2013), but rather to suggest that the broad stroke impressions of SDP programs capture only one chapter of a much longer and more nuanced story that will meaningfully inform the future of SDP work, if told. To begin, while the Mexican participants in this study reported enjoying and appreciating the opportunity to interact with and learn from Americans and engage in American culture, at a deeper level, these cultural experiences also served to reinforce a neoliberal view of Americans as experts and the U.S. as ideal compared to Mexicans and Mexico (Hansell et al., under review). In fact, when Mexican participants were asked whether they would consider leading a similar program in which they would share their expertise with Americans, they responded with repeated confusion over the question to suggest this possibility was difficult to conceive. As a world power, Americans assuming the role of deliverers of expertise and experience, mostly in English, was expected, which reflects the larger power disparities upon which this, and other SDP programs are built. While positive interpersonal exchanges with those directly in the American constituent promoted feelings of value, worth, and equality, discriminatory experiences while abroad were also expected and viewed as a normal aspect of human existence and development. Other research has highlighted understandings of power as core foundations of SDP programs (e.g., Hayhurst et al., 2021a). Our findings suggest that conceptualizations of power can differ across stakeholders and cultures, which underscores the importance of explicitly discussing RETROSPECTIVE SDP CRITIQUE 28 power (im)balances both within and across cultural groups and how they will be addressed, potentially as part of the relationship-building and familiarization process early on. As one example, understanding that others may come to know power as abusive comes with tremendous responsibility to attend to power dynamics so as not to reproduce harm. Participants’ responses further suggest that the most rewarding elements of the program were the cultural experiences and the person-to-person activities. Interestingly, Mexican participants’ responses related to their experiences during the second program phase in the U.S. were almost entirely about the cultural activities, which included excursions to local landmarks, tours of the university campus, spending an entire day in a major American city where participants were given money to shop, and tours of professional baseball and American football stadiums, all of which were included as part of the program’s itinerary. Mexican participants’ responses suggest what was unaddressed was a truly parallel experience in Mexico that would have allowed Americans to similarly engage and learn about Mexican culture more deeply. Aligned with contact theory (Allport, 1954) and SFDT (Dixon et al., 2019; Lyras & Welty-Peachey, 2011), the person-to-person interactions within the program seemingly helped members of each group connect over shared human experiences, which resulted in the formation of personal and professional interpersonal relationships across cultures, many of which have been sustained since the program ended. Admiration of American ideals such as work ethic and motivation were described by Mexican participants in focus group interviews conducted immediately after the first program phase in Mexico (Hansell et al., under review), and findings from the present study suggest the cross-cultural experiences were valued by both Mexican and American stakeholders within Deporte y Cambio Social. Yet, while the program’s emphasis on cultural activities emphasized by the funder is an important part of intercultural engagement, it RETROSPECTIVE SDP CRITIQUE 29 also served to distract from the program’s emphasis on women’s empowerment in attempting to accomplish both simultaneously. Such distraction is evidenced across participants’ responses that were largely devoid of commentary about the program itself and is an important indicator of how to position SDP work differently in the future. Practical Implications Participants’ recommendations for future endeavors to have longer-term opportunities to engage with program stakeholders and materials corresponds with a common critique of SDP programs and their typical short duration. Limited information exists regarding the long-term implications of SDP programs, and researchers have asserted that collecting follow-up data over time is a major challenge due to barriers such as misunderstandings of the role of data collection among community members, logistical constraints for Western researchers in the balance of other professional responsibilities such as teaching, and limited professional and financial support for long-term objectives (Blom et al., 2015; Schulenkorf et al., 2016; Welty-Peachey & Cohen, 2016). Within the present study, and particularly in the member reflections, participants’ expressions of appreciation and gratitude toward the researchers for including them in the present study demonstrates a willingness to, or even desire for, such opportunities as well as acknowledgement of the significant logistical barriers (e.g., costs, travel, time, etc.) that accompany longer-term endeavors. Collectively, our experiences underscore the importance of allocating more time and resources toward relationship-building, cultural learning, and examination of power across intercultural stakeholders and a prolonged period through which organic intercultural connection, collaboration, and sustained involvement can truly occur. Approaching SDP work differently is largely dependent upon significant transformation of the strategic priorities and structure of dominant funding mechanisms. Other researchers have RETROSPECTIVE SDP CRITIQUE 30 suggested, for example, that funding opportunities move away from short-term programs with aims to demonstrate positivist evidence of ‘impact,’ which has been critiqued as an extension of neoliberalism, and toward more comprehensive and holistic approaches that acknowledge power and culture as core components of the SDP experience (Darnell et al., 2018; Hayhurst et al., 2021b; Giulianotti et al., 2019). Multi-year funding that supports seasoned professionals, who mentor early career professionals and students to conduct SDP with prolonged intercultural engagement, would facilitate such efforts. Open eligibility with respect to ge

Drivers of Change in Mindfulness- and Acceptance-BasedDrivers of Change in Mindfulness- and Acceptance-Based Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes Thomas O. Minkler tom0007@mix.wvu.edu Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Exercise Science Commons, Other Kinesiology Commons, Other Psychology Commons, and the Sports Sciences Commons Recommended Citation Minkler, Thomas O., "Drivers of Change in Mindfulness- and Acceptance-Based Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes" (2023). Graduate Theses, Dissertations, and Problem Reports. 11968. https://researchrepository.wvu.edu/etd/11968 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. Drivers of Change in Mindfulness- and Acceptance-Based Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes Tommy Minkler, MA A Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Sam Zizzi, Ed.D., Chair D. Jake Follmer, Ph.D. Johannes Raabe, Ph.D., CMPC Zenzi Huysmans, Ph.D., CMPC Department of Sport, Exercise, and Performance Psychology Morgantown, West Virginia April 2023 Keywords: Mindfulness, MABI, Student-Athlete, Dosage, Readiness, Attitudes Copyright 2023 Thomas O. Minkler Abstract Drivers of Change in Mindfulness- and Acceptance-Based Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes Tommy Minkler, MA Mindfulness- and Acceptance-based interventions (MABIs) are being used with increasing frequency with sport participants. Research suggests that such interventions may promote sport performance and impact performance-relevant factors, although the current quality and quantity of research is low. Specifically, questions about intervention engagement (i.e., dosage), potentially impacted by stage of change and attitudes toward sport psychology, need clarification. The present study utilized a multi-method, quasi-experimental longitudinal design with female- and male- identified NCAA collegiate athletes to investigate the effects of an MABI. Specifically, one NCAA Division II team (n = 16) and three NCAA Division III teams (n = 43) from two universities in the Appalachian region engaged in 6-week Mindful Sport Performance Enhancement (MSPE) interventions during their offseason or pre-season training period. Two teams served as the primary treatment group while two others served as the non randomized waitlist control group; they were all assessed on measures of flow, psychological distress, mindfulness, emotion regulation difficulties, satisfaction with life, readiness to engage in mindfulness practice, attitudes toward sport psychology, and subjective ratings of performance and enjoyment. Mindfulness dosage was also measured throughout and following the intervention. Compared to controls, initial MSPE participants reported reductions in depressive symptoms and emotion regulation difficulties, and improvements in self-rated sport performance; at 6-week follow-up, initial MSPE participants reported significant increases in mindfulness and sport enjoyment, in addition to sustained reductions in emotion regulation difficulties. Though pre-intervention readiness did not predict changes across the intervention, higher post-intervention readiness classification was associated with improvements in mindfulness, life satisfaction, and sport enjoyment. Higher post-intervention readiness was also associated with significantly more engagement (i.e., dosage), though neither dosage nor attitudes toward sport psychology demonstrated evidence of moderation on the relationship between readiness and outcomes. These data suggest that readiness may impact engagement in MABIs, though it is still unclear whether there are indirect effects of dosage and attitudes toward sport psychology on outcomes in MABIs with athletes. DRIVERS OF CHANGE IN MABIS Acknowledgements iii For the support I have received from all who have been a part of my journey so far, I am exceedingly thankful. My path had been forged in large part because of my family. I would not be doing what I am without the memory of my dad—thank you for modeling decency and integrity, and for igniting a fierce curiosity in me. I owe an incalculable debt of gratitude to my mom for her strength and unselfishness in her vital role in our family. I am also especially grateful for Jamie, Annie, Patrick, Adam, Meg, Lilly, and Sophie, who have kept me grounded and continue to remind me what is truly important in life. I love you all and deeply value the unique contributions you all provide to me and the world. Liefje Megan: I am so fortunate to have been supported by you over the last five years. Your presence in my life elevates me and helps me to be a better person every day. Louie and I love you, and I am so thankful for all you do, and have done, in helping me and us grow. One day I’ll find the words, in Dutch, to describe how I feel, but for now—Ik hou van ons leven samen. To Dr. Zizzi: My doctoral studies were made exponentially more enjoyable due to the support and mentorship I received from you. Your ability to connect with and support people where they are is exceptionally rare. My development under your guidance has left an indelible mark, and I will aspire to be the kind of person and professional that you are for the remainder of my life. To Carol and my friends at Catholic: Without your mentorship, Carol, I would not be in the position I am today. Your support has catalyzed my growth and development. I cannot thank you enough for introducing me to this field and continuing to mentor me through retirement. Your devotion to your students is something I will always take with me. To Laurel, Josh, Ashley and everyone at Whole Brain Solutions: Thank you for taking a chance on me and supporting my growth process in so many ways. My professional excitement has grown considerably since having the opportunity to learn from and collaborate with you all. To Coach P, Jay, Todd, and my other mentors and friends from Ohio Wesleyan: My time in Delaware, OH launched me on a path I could have never imagined. The experiences I had and lessons I learned with and from you all have shaped me in countless ways, and I am grateful. To BR, Coach Bordley, and my mentors and friends from Landon: Thank you for nurturing and pushing me to pursue curiosity and excellence when I needed it most. The foundation I gained during my time within the white rocks was formative in every way possible. To friends, colleagues, and mentors at West Virginia: Before starting at WVU, I heard how phenomenal our program and the community was from so many people—from exceptional training and mentorship opportunities to professional connections, I knew that I would be learning from and with the best in our field. What I did not fully comprehend was the camaraderie and connection that I would be getting, which has been integral in my completion of this program. To my cohort, Blake and Luna, in particular, I feel so incredibly grateful for your friendship. You have supported me in ways that words cannot describe. “This is a fine chance to let go, to ‘win my life by losing it,’ which means not recklessness but acceptance, not passivity but nonattachment” – Peter Matthiessen DRIVERS OF CHANGE IN MABIS Table of Contents iv Introduction………………………………………………………………………………. 1 Method…………………………………………………………………………………… 9 Research Design……………………………………………………………………… Sampling and Recruitment…………………………………………………………… 9 9 Participants…………………………………………………………………………… 10 Assessments…………………………………………………………………………… 11 Intervention…………………………………………………………………………… 19 Procedure………………………………………………………………………………. 19 Consulting Orientation, Experience, Education, and Positionality……………………. 22 Data Analysis………………………………………………………………………….. 24 Results……………………………………………………………………………………... 25 Discussion…………………………………………………………………………………. 36 Limitations and Future Directions………………………………………………………… 42 Conclusion………………………………………………………………………………… 45 References…………………………………………………………………………………. 46 Tables……………………………………………………………………………………… 58 Extended Review of the Literature………………………………………………………... 71 Extended References……………………………………………………………………… 136 Appendices………………………………………………………………………………... 153 DRIVERS OF CHANGE IN MABIS 1 Drivers of Change in Mindfulness- and Acceptance-Based Interventions with Athletes: Investigating the Influence of Dosage, Readiness, and Attitudes Mindfulness, which “has to do with particular qualities of attention and awareness that can be cultivated and developed through meditation” (Kabat-Zinn, 2003, p. 145), is associated with a range of psychological benefits (Keng et al., 2011). Due to the positive outcomes connected to the cultivation of mindfulness, interest in the construct and practice among sport, exercise, and performance psychology (SEPP) researchers and practitioners has grown tremendously in the past two decades. Systematic reviews in SEPP suggest that mindfulness may confer benefits for sport participants, including heightened levels of mindfulness and flow, and reductions in sport anxiety (Noetel et al., 2019; Sappington & Longshore, 2015), with less robust evidence suggesting that mindfulness- and acceptance-based interventions (MABIs) can directly benefit sport performance (Bühlmayer et al., 2017). Although many professionals in SEPP and other related fields have raised concerns about quality and standards of reporting in MABI research (McAlarnen & Longshore, 2017; Noetel et al., 2019; Van Dam et al., 2017), extant literature with athletes evaluating the effectiveness of MABIs is promising. Due to their rising popularity, it is important for both researchers and practitioners to understand with a more nuanced perspective how and under what circumstances such interventions may benefit sport participants. While there is evidence that MABIs lead to change on outcomes related to performance-relevant factors and well-being, much less is known about who changes, and why. In Bühlmayer and colleagues’ (2017) meta-analysis, consisting of nine studies with 290 adolescent and adult sport participants, MABI length ranged from just four weeks to almost two years using a variety of protocols and comparison groups. While it may be reasonable to assume that longer interventions lead to more robust change, that statement is yet to be empirically DRIVERS OF CHANGE IN MABIS 2 validated in SEPP. Investigating a seven-week mindfulness-acceptance-commitment (MAC) intervention (see Gardner & Moore, 2007) compared to an active control group with 18 NCAA Division III female-identified basketball players, Gross and colleagues (2018) suggested that more time to practice mindfulness could have contributed to their findings—which included little change from pre- to post-intervention but significant improvements with large effects (η2 > .19) from post-intervention to 1-month follow-up on measures of emotion regulation, hostility, and substance use (but not mindfulness) for the MAC group. Also notable is that both the MAC group and the active control (a traditional psychological skills training intervention) reported improvements over time in symptoms of anxiety, eating concerns, psychological distress, psychological flexibility, and self-rated sport performance, with large effect sizes (η2 > .17), suggesting that MABIs may be similarly affective as more-commonly integrated interventions (e.g., positive self-talk, goal-setting). Goodman and colleagues (2014) used a similar eight-week MAC intervention with 13 NCAA Division I male-identified basketball players but added an extra 60 extra minutes per week of hatha yoga. MABI participants reported significant improvements on measures of perceived stress and mindfulness with small to moderate effect sizes (d = .26 and .48, respectively) immediately after the intervention. While both Gross et al. (2018) and Goodman et al. (2014) clearly described the amount of in-session mindfulness practice in which participants engaged, the amount of between-session practice was not evident. Josefsson and colleagues (2019) also evaluated the effectiveness of a seven-week MAC intervention compared to an active control group consisting of traditional psychological skills training (PST) with 69 elite athletes in Sweden. MAC participants reported significantly greater improvements compared to controls on measures of mindfulness and emotion regulation, with moderate to large effect sizes (d = .96 and DRIVERS OF CHANGE IN MABIS 3 .74, respectively). Moreover, mindfulness and emotion regulation were found to independently mediate the association between intervention condition and self-rated performance, such that greater increases in mindfulness and decreases in emotion regulation difficulties were associated with higher subjective performance ratings for MAC participants compared to controls. MAC sessions were 50-minutes in length resulting in just under six total hours of intervention dosage, although the degree of home practice was not reported. More condensed MABI have also been evaluated, including a study by Rooks and colleagues (2017). With 100 male-identified NCAA Division I football players, researchers assigned participants to either a 4-week MABI or a time-matched relaxation training control group during the high intensity pre-season period; both interventions included 5.4 hours of instruction and proctored training, and 3.6 hours of assigned home practice over the intervention period. Within-groups analyses indicated that attention decreased, and depressive symptoms, anxiety, and positive affect increased during the intervention—which was described as a high intensity physical training period. Although they failed to reject the null hypothesis in aggregate (i.e., the MABI would promote positive outcomes related to attention and wellbeing), the researchers observed that greater adherence to home mindfulness practice was inversely related to anxiety; moreover, adherence was associated with smaller decreases—and in some cases increases—in attention. Scott-Hamilton and Schutte (2016) similarly observed that competitive adult athletes (Mage = 33.57) who engaged in more home practice between sessions of an MABI improved more on measures of mindfulness, flow, and anxiety with large effects (η2 > .38), though results were not statistically significant—potentially due to a small size (n = 12). Glass and colleagues (2019) also reported that college athletes who engaged in more frequent mindfulness practice reported significant improvements in flow and self-rated sport performance. DRIVERS OF CHANGE IN MABIS 4 Regardless of dosage, the 43 athletes who completed the intervention—a six-week Mindful Sport Performance Enhancement (MSPE) training—reported improvements in flow, mindfulness, life satisfaction, and aspects of sport anxiety, with moderate to large effects (|0.47| < d > |0.81|; Glass et al., 2019). These studies support the idea that dosage could influence MABI outcomes with athletes, though more investigations studying dosage more specifically and as a moderator are needed. The potential dose-response relationship in MABIs has been explored more explicitly outside of sport with varied populations. A review by Parsons and colleagues (2017) found that 28 studies (out of 43) reported positive associations between amount of home mindfulness practice (i.e., dosage) and outcomes, indicating significant pooled results. Reported effects, though significant, were small (r = .26). Although these data indicate that dosage may be related to outcomes, Parsons et al. (2017) reported evidence for publication bias as well as broad variability in the amount of practice across studies. In a sample of 174 adults (Mage = 47.05) who had been referred to an eight-week Mindfulness-Based Stress Reduction (MBSR) group based on their clinical diagnoses, Carmody & Baer (2008) observed that between-session mindfulness practice was associated with reductions in unhelpful psychological symptoms and stress and improvements in wellbeing, which were mediated by increases in mindfulness. They also found that specific practices were correlated with different reported outcomes (e.g., positive association between minutes practicing body scans and psychological wellbeing). In a cross-section of 1,668 meditators (Mage = 45) across various traditions of practice, Bowles et al. (2022) observed a non linear effect of lifetime meditation practice on outcomes related to psychological wellbeing; specifically, the largest effects of meditation were observed in the first 500 hours practice before plateauing. Though causal claims are impossible, these data further suggest that dosage is a DRIVERS OF CHANGE IN MABIS 5 useful avenue to explore particularly early in one’s practice. Little attention has been placed on this issue in the SEPP literature, and it is unknown if these effects will translate to non-clinical samples. Related to, yet distinct from, research with sport performers is the growing body of MABI and dosage research with tactical populations (e.g., EMS, military). Stanley and colleagues (2011) conducted an MABI with pre-deployment marines—following a structured protocol that resembled a shortened MBSR protocol—and observed that more mindfulness practice between intervention sessions contributed to significant increases in mindfulness; mindfulness was also inversely associated with perceived stress among the group of marines that engaged in more mindfulness practice. Jha et al. (2017) observed that mindfulness training emphasizing practice of specific exercises (as opposed to didactic instruction) contributed to a protective effect against working memory degradation in a military cohort including 80 soldiers. The body of work produced by Amishi Jha and her colleagues suggests that ~12 minutes per day of mindfulness practice between four and eight weeks is a threshold at which mindfulness practice begins to produce salutary effects related to cognitive functioning and stress (Jha et al., 2017, Stanley et al., 2011, Stanley, 2014). This number has not been confirmed in SEPP studies of MABIs, but was partially replicated by Basso et al. (2019) in a sample of healthy adults between the ages of 18 and 45 who had no previous meditation experience. Compared to control group participants who listened to a daily 13-minute podcast, participants engaging in 13 minutes per day of meditation (i.e., breathing meditation and body scan) reported significant reductions in mood disturbances and emotion regulation difficulties, and improvements on a range of cognitive functioning tasks. (e.g., Stroop task, Mnemonic Similarity Task). Future research would benefit from replication studies with more targeted samples—like sport participants. It is DRIVERS OF CHANGE IN MABIS 6 also important to note that Dr. Jha’s work has primarily been conducted with tactical populations using an MABI that is slightly different than MABIs typically integrated with athlete populations (e.g., MSPE, MAC). Up to this point, MABIs have been discussed more generally, but it is important to note that the structure, content, and delivery of MABIs differs depending on the program; further study is needed to compare opposing MABI training programs to determine potential differential effects. In addition to the possible influence of dosage, readiness to engage in MABIs is another possible driver of change—which also may be related to dosage such that readiness may impact the degree of engagement, which ultimately could influence outcomes. In the context of PST, readiness has been assessed via The Transtheoretical Model (TTM) of behavior change which proposes that individuals progress through different stages of change as they work toward adopting or extinguishing a specific behavior (Prochaska & DiClemente, 1984). From early to later readiness, the stages of change include precontemplation, contemplation, preparation, action, maintenance, and termination (Prochaska & DiClemente, 1984). TTM, which includes the aforementioned stages of change as well as specific processes of change associated with movement between the different stages, has been used as a theoretical model with various populations and presenting concerns that people wish to change; some of these presenting concerns include dependence on alcohol, tobacco, or other substances, unhealthy exercise and health behaviors, and engagement in psychotherapy (Krebs et al., 2018; Prochaska et al., 2008). Some research in SEPP has used TTM to understand engagement in sport psychology consulting and use of psychological skills, though the evidence base is small. For example, Leffingwell and colleagues (2001) found circumstantial evidence suggesting that stage of change as measured by DRIVERS OF CHANGE IN MABIS 7 TTM predicted future mental skills consultation—participants in the action stage were more likely than contemplators and pre-contemplators to seek consultation at follow-up. Keeler and Watson (2009) also found that no pre-contemplators sought individual sport psychology consultation after a five-day intervention period (consisting of team-based sport psychology workshops) with their team of 31 elite, female-identified rugby players in the U.S. Though readiness has been used sparingly to understand how participants may engage in interventions in the context of PST, it has not been used as a moderator to predict if and how participants engage with and change following PST interventions—and has not been used at all to understand change following MABIs in sport. Outside of sport, Krebs and colleagues (2018) observed in the clinical literature that pre-psychotherapy stage of change might predict outcomes; specifically, later pre-treatment stage of change was associated with better post treatment outcomes. Therefore, it is reasonable to predict that later stage of change may predict more engagement in, and better outcomes following, an MABI with athletes. While quantitative studies provide details about possible MABI effects or mechanisms through which they may influence athletes, qualitative investigations provide another perspective on athlete experiences with and attitudes toward MABIs. Baltzel et al. (2014) interviewed seven female-identified NCAA Division I soccer players who participated in a 12-session Mindfulness Meditation Training for Sport (MMTS) intervention consisting of 30-minute modules. Many participants reported benefits related to the training, while also noting that they were hesitant to participate in the training at first and found meditation more difficult to engage in at the start of the intervention. Interviewees experienced a positive shift in their attitudes as they practiced more and were able to connect the practice to sport participation. This finding could suggest that pre-intervention attitudes or readiness influenced engagement or outcomes to some degree, and DRIVERS OF CHANGE IN MABIS 8 that attitudes and readiness may change through an MABI. Cote and Colleagues (2019) similarly interviewed nine collegiate tennis players following an MMTS 2.0 intervention, and while they observed many benefits in practicing mindfulness, they also observed some associated difficulties and discomfort. This important perspective is less often reported in the MABI literature in sport, which tends to focus more on the benefits of mindfulness practice than drawbacks or negative experiences. Research investigating attitudes toward sport psychology services suggests that some sport participants are still hesitant to engage in sport psychology consultation (Martin et al., 2012), though athletes with previous experience to sport psychology services generally have more positive attitudes toward sport psychology (Martin et al., 2005). It is thus reasonable to expect that not all athletes would be open to engaging in an MABI. Understanding how readiness and attitudes potentially interact to influence outcomes following MABIs with athletes could clarify questions about for whom MABIs are more effective. It would also be useful to understand how athlete readiness and attitudes related to mindfulness changes over the course of an intervention. These issues are of particular salience in SEPP research because randomization often occurs at the team level, and interventions are delivered to groups. Though some studies have explored the role that dosage and attitudes could play in influencing outcomes, no specific study in the MABI and sport literature has investigated the explanatory power of these variables either as predictors or moderators. Therefore, the present study has three primary aims. The first aim is to replicate previous findings associated with change following an MABI—specifically related to flow, psychological distress, mindfulness, emotion regulation, performance, and other constructs empirically linked to MABIs (Glass et al., 2019; Josefsson et al., 2017; Kostrna & D’Addario, 2022)—using a comparison group and a manualized protocol (Mindful Sport Performance Enhancement; Kaufman et al., 2018). The DRIVERS OF CHANGE IN MABIS 9 second aim is to understand if stage of change regarding engagement in mindfulness training (i.e., readiness) and attitudes toward sport psychology impact change during an MABI. The third and final aim of the present study is to explore the potential associations between readiness, dosage, and outcomes, and specifically whether dosage (i.e., between-session practice of mindfulness exercises) and attitudes toward sport psychology moderate any associations between readiness and outcomes. Research Design Method To address the aims of the study, a longitudinal, non-randomized control group design was utilized to evaluate the immediate and short-term follow-up effects (i.e., six weeks) of an MABI. Quantitative outcomes of interest in the present study included flow, psychological distress (i.e., depression, anxiety, and stress), mindfulness, emotion regulation, attitudes toward sport psychology, self-rated sport performance and enjoyment, stage of change as it relates to engagement in mindfulness practice (referred to as “readiness” from this point forward), and life satisfaction. Another relevant outcome was the amount of between-session mindfulness practice (referred to as “dosage” of mindfulness) in which participants engaged—measured by weekly self-report. Sampling and Recruitment Convenience sampling was utilized to recruit study participants. Specifically, 28 head coaches at two NCAA Division II and III universities in the Appalachian region were contacted in the fall of 2021 via email and offered mindfulness training for their teams in their spring 2022 preseason or offseason periods (i.e., January-May of 2022) in one of two six-week timeframes: either mid-January to late-February, or late-February to early April. Additionally, the first author DRIVERS OF CHANGE IN MABIS 10 and one research associate attended athletics department staff meetings at both universities to share details about the intervention and research opportunity. Research participation was introduced as a voluntary component, and athletes would be able to opt out of the research and still participate in the MABI. Five coaches from two universities demonstrated interest, and ultimately four coaches (one men’s team and three women’s teams) agreed to have their teams participate. Though randomization to condition (i.e., intervention or waiting-list (WL) control) was initially communicated as a requirement to their participation in recruitment messages, all four coaches said that only one of the two timeframes was feasible, so randomization was not possible. Thus, all teams were assigned to the intervention or WL groups based on availability. Participants Sixty-five student-athletes (SAs) from Acrobatics and Tumbling (Acro; N = 22), Women’s Volleyball (Volleyball; N = 13), Men’s Soccer (MSOC; N = 13), and Women’s Soccer (WSOC; N = 17) initially consented to research participation, though there was a 12.31% attrition rate during the intervention period and a 26.15% attrition rate between pre-intervention and follow-up; 57 SAs across all four teams completed MSPE and pre- and post-intervention assessments, and 48 SAs completed MSPE as well as pre-, post-, and follow-up assessments. The sub-sample that completed both pre- and post-intervention assessments (i.e., n = 57) consisted of 13 male-identified SAs and 45 female-identified SAs, with a mean age 19.36 (SD = 1.10). The sub-sample that completed pre-, post-, and follow-up data (i.e., n = 48) consisted of eight male identified athletes and 40 female-identified athletes, with a mean age of 19.44 (SD = 1.15). Most of the participants who completed the intervention identified as Caucasian (n = 49). A fraction of participants practiced mindfulness or meditation at the start of the MABI (9.23%), though a larger number had been exposed to sport psychology in some capacity (23.08%). Volleyball, DRIVERS OF CHANGE IN MABIS 11 MSOC, and WSOC competed for an NCAA Division III institution, and Acro competed for an NCAA Division II institution. Assessments Background Questionnaire (Appendix A) A ten-item background questionnaire assessing demographic data was included before the first round of data collection. Participants were asked to provide information related to age, gender identity, ethnicity, grade level, sport history, and experience with mental skills training and mindfulness. Because engagement in meditation has been linked with trauma re experiencing (Britton et al. 2021; Farias et al., 2020), two trauma screening measures were included on the background questionnaire to flag participants who were at-risk for adverse experiences: participants were asked to respond to a close-ended (i.e., yes or no) question inquiring if they had a history of trauma. An abbreviated, two-item PTSD Checklist-Civilian (PCL-C; Lang & Stein, 2005) was used as a PTSD screening tool. Though normed when the DSM-IV was still in use, Lang and Stein (2005) observed that the two-item measure was strongly correlated with the original 17-item PCL-C measure (r = .89) in use at the time. The two items also included in the trauma re-experiencing sub-scale of the current 20-item PTSD Checklist for DSM-V assessment (Blevins et al., 2015). Lang et al. (2012) commented that the two-item PCL-C can serve as an effective screening tool, though they recommend using the six item PCL or the full version for symptom monitoring (which was not done in the present study). The Cronbach’s alpha value for PCL-C items used in the present study was .86. Cognitive and Affective Mindfulness Scale – Revised (CAMS-R; Appendix B) Feldman and colleagues (2007) created the 12-item CAMS-R as a multi-dimensional assessment of mindfulness, including four first-order factors: attention, present focus, awareness, DRIVERS OF CHANGE IN MABIS 12 and acceptance. Participants respond to each item on a four-point Likert scale ranging from one (“rarely/not at all”) to four (“almost always”), yielding one total score; higher scores indicate higher levels of mindfulness. A CFA, conducted by Feldman et al. (2007), indicated that the data fit the hypothesized model, χ2(50) = 110.58, p < .0001, RMSEA = .064, SRMR = .052, CFI = .92. Evidence of convergent validity was observed through strong correlations with existing mindfulness measures (i.e., Freiburg Mindfulness Inventory, Mindful Attention and Awareness Scale), with correlation coefficients greater than .50 (Feldman et al., 2007). With college students, Baer and colleagues (2006) reported acceptable internal consistency of the CAMS-R (α = .81) and found that the CAMS-R was moderately and positively associated with three other commonly used mindfulness measures (.51 < p > .67; Mindful Attention Awareness Scale, Freiburg Mindfulness Inventory, and Kentucky Inventory of Mindfulness Skills, respectively). Internal consistency reliability from CAMS-R data the present study was acceptable at all three time points. See Table 1 for a list of Cronbach’s alpha values for all measures included in the present study. Depression, Anxiety, and Stress Scales (DASS-21; Appendix C) The 21-item DASS-21, used to assess three dimensions of psychological distress, was adapted by Lovibond and Lovibond (1995) from the original 42-item measure (Lovibond & Lovibond, 1993). Three seven-item subscales assess participant levels of depression, anxiety, and stress on a four-point Likert scale ranging from zero (“did not apply to me”) to three (“applied to me very much, or most of the time”). Higher scores on each subscale indicate higher levels of psychological distress, and a total score is taken and multiplied by two to correspond with scores on the original DASS measure. A CFA conducted by Henry and Crawford (2005) indicated that this 21-item measure of psychological distress had adequate factor loadings, with a DRIVERS OF CHANGE IN MABIS 13 mean loading of .60 on the general factor and a mean loading of .34 on specific factors. Though some individual factor loadings were low (i.e., below the .40 convention), DASS-21 subscale scores demonstrated evidence of convergent validity with other commonly used inventories (e.g., Beck Depression Inventory, Beck Anxiety Inventory; Henry and Crawford, 2005). Henry and Crawford (2005) also reported acceptable Cronbach’s alpha estimates in their study of a non clinical sample of adults in the UK, with values ranging from .82 to .93. Like Henry and Crawford, Osman and colleagues (2012) observed that some individual items loaded onto individual factors below the .40 guideline (Kline, 2016). Because second order factor loadings were all above .60, and because the total DASS-21 score was moderately to strongly associated with other measures of psychological distress (e.g., Beck Anxiety Inventory, Beck Depression Inventory-II, respectively), Osman et al. (2012) recommend utilizing a total score. Both sub scale scores and a total score were calculated and utilized in analyses in the present study. Difficulties in Emotion Regulation Scale – Short Form (DERS-SF; Appendix D) The 18-item DERS-SF was adapted by E. A. Kaufman et al. (2015) from the original, well-validated 36-item DERS (Gratz & Roemer, 2004) assessing emotion regulation difficulties. The measure yields one total score and scores on six, three-item subscales of emotion regulation strategies, non-acceptance, impulse control, goals, awareness, and clarity where higher scores indicate more emotion regulation difficulties. Participants respond to each item on a one (“almost never”) to four (“almost always”) Likert scale. A CFA with a sample of 797 American college students indicated acceptable data fit to the hypothesized model, RMSEA = .05, TLI = .96, SRMR = .04; Cronbach’s alpha estimates for each subscale and total score in the study by E. A. Kaufman et al. (2015) all exceeded .70, demonstrating acceptable reliability, and correlations DRIVERS OF CHANGE IN MABIS 14 coefficients between the DERS-SF and DERS ranged from .90 to .97—indicating strong associations. Mindfulness Dosage and Between-Session Practice Assessment (Appendix E) Mindfulness dosage (i.e., amount of mindfulness practice between intervention sessions) was assessed at seven different time points: before sessions two through six, one week after the final session, and 6 weeks after the conclusion of the intervention. Prior to MABI sessions two though six, participants were asked to complete either a paper/pencil or Qualtrics questionnaire assessing how many times they completed the home practice exercises as described by Kaufman et al. (2018; see appendix L), as well as the type and duration (e.g., YouTube meditation for five minutes) of any other mindfulness practice in which they engaged above and beyond the recommended home practice. Three markers of dosage were thus derived: total dosage (minutes per day) between pre- and post-intervention, total dosage between pre-intervention and six-week follow-up, and percentage of prescribed home practice completed by participants between pre- and post-intervention. Because adverse effects can occur during or after mindfulness practice, particularly when interventions are not tailored to meet the needs of specific populations (Farias et al., 2020; van Dam et al., 2018), researchers have suggested that it may be best practice to actively monitor for negative experiences as to mitigate harm (Britton et al., 2021). For monitoring purposes, participants were asked after the dosage assessment on a yes/no question whether they had experienced an adverse effect during mindfulness practice between sessions. If they had, they were invited to describe the negative experience and posed with a yes/no question assessing whether they would like to be referred to support services. Open-ended questions also assessed barriers and/or benefits associated with home practice. DRIVERS OF CHANGE IN MABIS 15 Program Evaluation Questionnaire (PEQ; Appendix F) The seven-item post-intervention PEQ—derived from previous investigations of the intervention under study (i.e., Mindful Sport Performance Enhancement; Glass et al., 2019)— was used to understand participant experiences with the program. On the assessment, participants were first asked to indicate the number of intervention sessions they attended. They were then invited to rate their perceived success of the program in helping them make improvements in flow, anxiety, focus, nonjudgement, awareness, and emotion regulation on a one (“not helpful at all”) to seven (“extremely helpful”) Likert scale. These questions were followed by an assessment of how confident participants were that they would continue utilizing mindfulness in sport and everyday life. Finally, open-ended responses assessed what they found most challenging about the intervention, what benefits they felt they received from engaging in the training, and whether they consented to being contacted for a follow-up interview. Readiness University of Rhode Island Change Assessment (URICA; Appendix G). Readiness to engage in mindfulness practice was assessed by adapting a version of the URICA used by Massey et al. (2015), who evaluated the utility of their adapted version to understand readiness in the context of traditional psychological skills training with college athletes. The original URICA (McConnaughy et al., 1983) was developed as a 32-item measure to assess behavior change using the Transtheoretical Model (TTM). Massey et al. (2015) used a variation of Leffingwell et al.’s (2001) version of the URICA as a 12-item measure, and found that a four factor (pre contemplation, contemplation, action, maintenance) structure demonstrated acceptable model fit, RMSEA = .078, CFI = .92. Participants are asked to respond to comments on a five-point Likert scale ranging from one (“strongly disagree”) to five (“strongly agree”), with three questions DRIVERS OF CHANGE IN MABIS 16 corresponding to one of four separate factors. The highest sub-scale score indicates the stage of readiness (e.g., if participants score highest on the pre-contemplation sub-scale, the participant is labelled as such). Though the URICA provides continuous data, it was treated as categorical for analyses (i.e., participants fell into one of four possible stages depending on the highest subscale score). The language of the URICA was modified to assess readiness to practice mindfulness as opposed to readiness to use of mental skills (e.g., “I have used mindfulness for at least six months and plan to continue working on being mindful” was modified from the original “I have used the mental skills I have learned for at least 6 months and plan to continue working on them”). Cronbach’s alpha values for time one subscales in the present study were .68, .70, .88, and .90 for precontemplation, contemplation, action, and maintenance, respectively. Single-Item Readiness Assessment. A second, single-item assessment of readiness used by Minkler et al. (2022) was also included. The item includes a brief description of mindfulness, after which participants are invited to indicate one of five responses that best categorizes their relationship to mindfulness. The five responses are based on one of five stages of change as described by TTM. This item was included on the Background Questionnaire (Appendix A), and it was primarily used to help with categorization if participants had reported equal scores on multiple sub-scales of the URICA. For example, if a participant reported equal scores on the contemplation and action sub-scales and indicated that they were in contemplation on the single item readiness measure, then they were categorized as contemplators given that there was more evidence for that stage classification. Satisfaction with Life Scale (SWLS; Appendix H) The five-item SWLS (Diener et al., 1985) assesses global life satisfaction on a seven point Likert scale ranging from one (“strongly disagree”) to seven (“strongly agree”); higher DRIVERS OF CHANGE IN MABIS 17 scores indicate greater life satisfaction. In the original validation study, Diener et al. (1985) found that the SWLS demonstrated moderate to strong correlations with other assessments of well-being (r > .30). In summarizing the updated psychometric information from over two decades of research, Pavot and Diener (2008) reported a high degree of internal consistency reliability across several studies (Cronbach’s alpha levels greater than .80). Divergent validity has been demonstrated via strong, significant inverse correlations between the SWLS and clinical measures of distress (e.g., BDI, Symptom Checklist-90; Pavot & Diener, 2008). Short Dispositional Flow Scale-2 (SDFS-2; Appendix I) The SDFS-2, adapted by Jackson and colleagues (2008) from the original 36-item DFS, includes nine items assessing each of the nine elements of flow as described by Csikszentmihalyi’s (1990) conceptualization. Participants are asked to rate how often they experience each component of flow during their sport on a five-point Likert scale from one (“never”) to five (“always”). One total score is reported, with higher scores indicating more frequent flow experiences. There is good evidence for reliability and validity of this measure: through confirmatory factor analysis (CFA), Jackson et al. (2008) provided evidence of validity and internal consistency reliability, demonstrating that that the nine-item measure had acceptable model fit, RMSEA = .08, CFI = .95, SRMR = .04. Moreover, Martin et al. (2006) reported an acceptable Cronbach’s alpha estimate of .82. Sport Performance, Enjoyment, and Expectancy Effects (Appendix J) Self-rated sport performance was assessed with one-item on a 1 one (very poor) to 9 (very good) Likert Scale. Josefsson and colleagues (2019) assessed sport performance in a similar fashion, although they utilized a 10-point Likert scale. On the same nine-point Likert Scale, participants are also asked to rate their sport enjoyment. Moreover, to assess pre DRIVERS OF CHANGE IN MABIS 18 intervention expectancy effects, participants were also asked to assess how they expected to rate their performance and enjoyment after the MABI. Sport Psychology Attitudes – Revised Form (SPA-R; Appendix K) The 25-item SPA-R, developed by Martin and colleagues (2002), assesses athlete attitudes toward sport psychology services on a seven-point Likert scale from one (“strongly disagree”) to seven (“strongly agree”) with four sub-scales: stigma tolerance, confidence, personal openness, and cultural preference. Higher scores indicate more positive attitudes toward sport psychology and the utilization of services on all sub-scales except stigma tolerance—where lower scores indicate higher tolerance of stigma (and therefore better attitudes toward sport psychology). A CFA with over 1,000 athletes from the United States, Germany, and British athletes was conducted by Martin et al. (2002), testing a four-factor solution, which indicated acceptable fit indices, RMSEA = .06, CFI = .96, SRMR = .05. With a similar population of athletes from the United States, Germany, and Great Britain, Martin et al. (2005) reported Cronbach alpha values of .82 and .84 for confidence in sport psychology consulting and stigma tolerance, respectively; for personal openness and cultural preference, alpha values were below the .70 guideline at .61 and .66, respectively. A recent study by Ballesteros and colleagues (2019) using the SPA-R with high school athletes also reported low Cronbach alpha values on the personal openness (.56) and cultural preference (.60); due to the repeatedly low Cronbach alpha values, those subscales were not included; only the confidence in sport psychology consulting and stigma tolerance subscales were used (15 items in total). Compared to previously studied samples of college student athletes (i.e., Martin et al., 2005), athletes at baseline in the current study reported higher confidence in sport psychology DRIVERS OF CHANGE IN MABIS 19 and less stigma (5.5 compared to 4.9, and 2.00 compared to 2.46 on confidence and stigma tolerance, respectively). Intervention Participants engaged in a 6-week Mindful Sport Performance Enhancement (MSPE) training, using the protocol created by Kaufman and colleagues (2018). Each session was 60 minutes in duration. In this structured yet adaptable MABI that includes elements from Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy (MBCT), sport participants are taught mindfulness both didactically and experientially in weekly, hour-long sessions. Exercises are initially sedentary in nature (e.g., diaphragmatic breathing, sitting meditations) and evolve to include practices during which mindfulness is practiced in motion (i.e., mindful walking, mindful hatha yoga). The culminating practice is a sport-specific mindfulness exercise. The sport-specific meditation is typically practiced in the final two sessions, but the protocol had to be adapted for MSOC and WSOC because of weather and availability of space—therefore the sport meditation for those teams was only practiced in session five and discussed (but not practiced) in session six. In addition to various mindfulness practices, a discussion component is also included in each session. Prescribed home practice includes roughly 377 minutes between weeks one through five (~11 minutes per day), with no practice assigned after the final session. See Appendix L for an outline of each session, with prescribed home practice included. Procedure Coaches were contacted about receiving a free sport psychology workshop before Institutional Review Board (IRB) approval was obtained. After teams agreed to participate and schedules were finalized, final IRB materials were submitted, which included documents signed DRIVERS OF CHANGE IN MABIS 20 by each coach agreeing to have their teams participate and recognizing the optional nature of research participation. Once IRB approval was received, the first author held informational meetings with each team, where participants were informed about the conditions of research participation and that they could engage in the MABI without participating in the research component. The initial MSPE teams (Acro and Volleyball) were given details about MSPE and information about mindfulness at the informational meeting, including the range of experiences they might have while engaging in mindfulness practices. In consultation with the counseling centers at each institution, referral plans were also established based on institutional policies. Participants were given information about how to seek help if they had a negative or adverse experience; weekly dosage assessments served as regular monitoring for adverse experiences needing clinical intervention. To protect against expectancy effects and limit the degree to which they could learn about and potentially begin practicing mindfulness before the intervention, WL control participants were given less information about the MABI at time one. Instead, at the initial informational meeting, control participants were told they would be engaging in a sport psychology mental skills training program during their off-season training period (which was set to begin six weeks later), and that we would be collecting pre-intervention data at two time points and comparing that data to teams who would be engaging in the same intervention before them. One week before they were to engage in the MABI, WL control participants were given details about the nature of the intervention (as described in the previous paragraph) and provided with another opportunity to opt out. After describing the voluntary research component and the fact that the intervention leader would be blind to those who agreed to participate and those who did not agree, the first DRIVERS OF CHANGE IN MABIS 21 author left the room for participants to review and choose to sign (or not sign) the informed consent document. After reviewing the consent document, participants were invited to complete the battery of pre-intervention assessments described previously. The informed consent document served as the cover page of the questionnaire booklets, which were placed in individual envelopes and sealed by each athlete upon completion. Each participant created a six digit identification number based on the last four digits of their cell-phone numbers and the first two digits of their home ZIP code for anonymization. All identifying information was removed from questionnaire booklets by the senior author, who recorded names and identification numbers in a Microsoft Excel File to which the first author did not have access (to keep the intervention leader blind to research participation). De-identified questionnaires were kept in a locked file cabinet. The questionnaires were completed by initial MSPE participants at three time points (pre intervention, post-intervention, six-week follow-up) and four times by WL control participants (pre-intervention 1, pre-intervention 2, post-intervention, six-week follow-up). Questionnaires were completed via pencil and paper at times one through three, and via Qualtrics at time four (as WL control participants had gone home for the semester). The questionnaires were counterbalanced using a Latin Square design at each time point. Following the intervention, participants were asked to complete the same battery of assessments minus the background questionnaire but including the PEQ. Immediately preceding sessions two through six, participants were asked to complete the dosage and between-session practice assessment via paper and pencil or Qualtrics; the intervention leader left the room during that time. Because the initial MSPE group concluded their training in the middle of the semester, one of the conditions recommended by initial MSPE group coaches was that follow-up meetings DRIVERS OF CHANGE IN MABIS 22 be scheduled after the conclusion of the formal MSPE program. Kaufman et al. (2018, p. 14) recommend that practitioners avoid “parachuting in”—in other words, dropping in for the duration of the intervention and then ceasing contact upon program completion. For meaningful integration of mindfulness into the culture of the team, according to Kaufman et al. (2018), the MSPE protocol is meant to set the foundation for continued future contact and engagement. Considering the recommendations of Kaufman et al. (2018) and meeting the needs of the coaches in the study, initial MSPE teams had weekly follow-up meetings ranging in duration from 30-60 minutes where sedentary MSPE exercises were practiced, and discussions of home practice and application took place. These follow-up meetings took place between post intervention and follow-up data collection, and they were voluntary. Because WL control teams concluded the training at the end of their semesters, follow-up meetings were not feasible. See Appendix L for a description of MSPE and follow-up sessions. Consulting Orientation, Experience, Education, and Positionality The first author, who also served as the intervention leader, has been engaged in supervised mental performance consulting for nearly five years, having worked as a collegiate coach prior to pursuing formal education in SEPP. He also currently works as a mental health counseling intern, providing individual and group psychotherapy to emerging adults in a college counseling center and a private practice. His consulting theoretical orientation is largely humanistic and person-centered, though he draws heavily on mindfulness- and acceptance-based interventions and principles (e.g., Acceptance and Commitment Therapy, Dialectical Behavior Therapy, Mindfulness-Based Cognitive Therapy) and Polyvagal Theory (Porges, 2001) in his applied work and conceptualizes cases through the lens of the Adaptive Information Processing (AIP; Shapiro, 2018) model. Crane and colleagues (2012) have commented on the need to DRIVERS OF CHANGE IN MABIS 23 develop a certain level of competence with regards to training and education for mindfulness teachers; to that end, the first author has taken formal mindfulness courses, pursued and completed MSPE teacher training, consulted with and continues to seek supervision in both his delivery and personal practice of mindfulness, and has maintained a consistent personal mindfulness practice for over five years. Moreover, the first author and the senior author have been engaged in mindfulness research, applied work, and practice for nearly three decades combined. The intervention leader’s experiences all contribute to an important perception and expectation about what might be expected to occur during and after mindfulness training with athletes. His position as a mindfulness researcher, applied practitioner, teacher, and student of mindfulness and Buddhist philosophy in general colors the lens through which he and the research team have approached this study and the data that has been produced. To balance the degree to which these experiences might influence data analysis and interpretation, the project includes authors with expertise in SEPP applied practice and clinical psychotherapy as well as an external author from another field (i.e., Educational Psychology). Including these differing perspectives was intentional in an attempt view the data and results from a less biased perspective and compartmentalize personal values as much as possible. A postpositivist stance was adopted in the data analysis and interpretation, which posits that an objective reality exists but can only be imperfectly understood (Ponterotto, 2005), and attempts at triangulation were sought by including multiple perspectives and bracketing of personal expectations and biases (first becoming aware of and documenting such biases through reflexive journaling). DRIVERS OF CHANGE IN MABIS 24 Data Analysis In addition to computing descriptive statistics regarding baseline characteristics, data were analyzed in four separate approaches. First, to assess between-group change over time (i.e., MSPE vs. WL control), a series of 2x2 and 2x3 mixed repeated-measures analyses of covariance (RM ANCOVAs) were conducted using SPSS (IBM, 2020). Time and condition (MSPE or WL control) served as independent variables (IVs), and both attitudes SPA-R sub-scales served as covariates (unless the independence of the covariate assumption was violated, indicated in Tables 3 and 4). Dependent variables (DVs) included flow, psychological distress (i.e., depression, anxiety, and stress), mindfulness, emotion regulation difficulties (and associated sub scales), life satisfaction, sport performance, and sport enjoyment. Sport psychology attitudes were also examined as DVs in RM analyses of variance (ANOVAs) For sport performance and enjoyment RM ANCOVAs, post-intervention expectations were also included as covariates. Second, to investigate the potential effects that readiness had on DVs, a series of within groups RM ANCOVAs were conducted in which readiness served as the IV. Pre-intervention, post-intervention, and 6-week follow-up data from all participants regardless of condition was combined across three time points. Due to low numbers in most of the readiness conditions, readiness was condensed from four stages to two; therefore, participants fell into either high (action or maintenance) or low (contemplation or pre-contemplation) readiness to preserve power. RM ANCOVAs explored differential effects of both time one and time two readiness on outcomes over time, with sport psychology attitudes modelled as covariates. Third, to explore moderation effects of attitudes toward sport psychology and dosage on the potential relationship between readiness and outcomes, a series of bivariate Pearson correlations, independent samples t-tests, and regressions using the PROCESS macro (Hayes, DRIVERS OF CHANGE IN MABIS 25 2022) were conducted in SPSS (IBM, 2020). Descriptive statistics regarding dosage during the intervention were calculated, as well as percent of home prescribed home practice completed by participants. Bivariate Pearson correlations explored associations between sport psychology attitudes and dosage, and between dosage and change scores on outcomes. Independent samples t – tests were used to examine potential differences in dosage depending on readiness and group (i.e., initial MSPE or WL control). Finally, the PROCESS macro was used to explore moderation effects of dosage and attitudes. Finally, PEQ ratings of program success were explored with descriptive statistics; moreover, potential differences in ratings of program success depending on readiness and attitudes toward sport psychology were probed using independent samples t – tests and bivariate Pearson correlations, respectively. Qualitative data assessing benefits, barriers, and challenges faced throughout the intervention was coded using inductive thematic analysis (Braun et al., 2016) and influenced by the coding used by Minkler and colleagues (2022). Results Descriptive Statistics and Baseline Characteristics Independent samples t-tests were conducted at baseline (N = 65) to determine if any differences existed between conditions on DVs. The initial MSPE group, compared to the WL control group, reported significantly higher confidence in sport psychology services, t(63) = 2.28, p < .05), and less stigma associated with sport psychology service provision (though not statistically significant) at time one, with small effects. There was also a significant difference between the initial MSPE group and WL control group on the DASS-21 sub-scale of depression, t(63) = 2.04, p < .05, such that MSPE participants reported significantly higher depression scores than control participants. There were no other statistically significant between-groups differences DRIVERS OF CHANGE IN MABIS 26 at baseline on outcomes (see Table 1). For readiness frequencies at times one through three, see Table 2. Regarding dosage, initial MSPE participants practiced MSPE exercises for an average of 6.54 minutes per day (SD = 4.84) between time one and time two and 5.17 minutes per day (SD = 4.00) between time one and time three; WL control participants—once they had completed the intervention—practiced MSPE exercises for an average of 6.67 minutes per day (SD = 5.70) between time two and time three and 5.10 minutes per day (SD = 5.67) between time two and time four. There were no significant differences in amount of practice between groups. With the overall sample (N = 65), a series of within-groups Pearson correlations also probed the degree to which expectancy effects and attitudes toward sport psychology were associated. There were significant inverse correlations between stigma tolerance and expected improvements in both performance and enjoyment (r = -.59 and -.50, respectively), such that higher ratings of expected post-intervention performance and enjoyment were associated with less stigma. Moreover, there was a significant, positive association between expected improvements in sport enjoyment and confidence in sport psychology (r = .32). See tables 8, 9, and 10 for means, standard deviations, and correlations among primary outcomes at each time point. Between-Groups Differences: Time 1 and Time 2 A series of 2 x 2 repeated measures analyses of covariance (RM ANCOVAs) were conducted to compare change between time 1 and time 2 on DVs between conditions. The sub sample supporting these analyses was 57. Due to statistically significant differences between groups at baseline on attitudes toward sport psychology (i.e., confidence in sport psychology services and stigma), they were included as covariates in these analyses. See Table 3 for RM ANCOVA results and estimated marginal means, including notations indicating when certain DRIVERS OF CHANGE IN MABIS 27 assumptions were violated (the independence of the covariate assumption was violated on analyses of anxiety, depression, DERS-SF impulse control, DERS-SF awareness, and sport enjoyment; covariates that violated the assumption were thus removed). There were no significant condition-by-time effects on flow, anxiety, stress, and life satisfaction, and effect sizes were negligible. There were also no significant condition by time effects on sport enjoyment and mindfulness, though effect sizes were small to moderate, respectively; the MSPE group reported non-significant improvements in both sport enjoyment and min

Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings Kevin R. Lou West Virginia University, krl0018@mix.wvu.edu Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Education Commons, Psychology Commons, and the Sports Studies Commons Recommended Citation Lou, Kevin R., "Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings" (2023). Graduate Theses, Dissertations, and Problem Reports. 12214. https://researchrepository.wvu.edu/etd/12214 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings Kevin R. Lou, M.S., M.A. Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Jack Watson II, Ph.D., Co-Chair Valerie Wayda, ED.D., Co-Chair Scott Barnicle, Ph.D. Matthew Campbell, Ph.D. School of Sport Sciences Morgantown, West Virginia 2023 Keywords: learning theories, qualitative, coaching, sport psychology, education Copyright 2023 Kevin Lou Abstract Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings Kevin Lou The purpose of this study was to identify how integrating learning theories into the design of a formal university course helps facilitate students’ resources, goals, and orientations (Schoenfeld, 2011) of learning theories for their future career work in coaching, sport psychology consulting, or other sport-related professions. Sixteen students signed up for a fifteen-week fall semester course at a Mid-Atlantic university in America and were asked to annotate, create, and reflect upon examples of future work in their desired fields for their three major written assignments in the course. Students reflected on their learning experience through pre-and-post semistructured interviews and most stated that they benefitted from the way the course was designed with learning theories in mind and that it helped their understanding and application of learning theories. Results showed large increases in resources associated with learning theories, changes in goals from being ego-centric to learner-centric and shifts in orientations to recognize how helpful learning theories could be to participants’ future careers. Future directions include increasing the number of face-to-face meetings each week, making this course available for Master’s level students, and improving clarity around the definition of orientations shared with participants from Schoenfeld’s framework (2011). Practical implications include adding learning theories courses to sport-related programs which could increase the quality of the work that coaches, sport psychology consultants, and other sport-related professionals will engage in with their athletes after taking a learning theories course. Keywords: learning theories, qualitative, coaching, sport psychology, education LEARNING THEORIES IN SPORT SETTINGS iii Acknowledgements I could not have undertaken this journey without my advisor and (former) chair of my committee, Dr. Scott Barnicle, for his guidance, support, and help throughout this entire process. It has been a long five and half years but I am happy to say that we reached the finish line after all the ups and downs together. I am also grateful to my current co-chair of my committee, Dr. Jack Watson, for all your help and support over these five and half years. Although more recently, it has become more hands on, I have always felt that you were there to support me throughout my time at West Virginia and to that I am very grateful. I would also like to thank my other co-chair, Dr. Valerie Wayda, for being a support throughout this journey as well and for being the only person left on my committee who is still in the department. I would like to thank you for your time and support even from when I first came to you with this idea. I would also like to thank Dr. Matthew Campbell for being willing to guide me through this qualitative journey. It has been a wonderful last three years working with you and learning how to conduct qualitative research from never having done it before. I always appreciated your time and weekly calls! I would like to thank the person who first took me on and gave me a job when I moved to Morgantown when I had thought I had missed all GTA deadlines and gave me the inspiration for this project in the first place, Dr. Malayna Bernstein. There was a big hole when you left WVU but I am proud to say that I saw this project through to the finish line and was able to put what we talked about into reality. I would like to thank Megan Hut for her time and support through not just this qualitative project, but my qualifying project as well. Thank you for your time and support throughout both projects and I couldn’t have done all this without you! I am eternally grateful for your qualitative and editing support! I would also like to thank Kristen Bowman, David Lerner, Joe Wargo, and Matthew DiFonzo for all their time and help with my research. I also wouldn’t have been able to make all this happen without you. Thank you to my sixteen students who trusted me to go on this semester-long journey with me. It was your curiosity, eagerness, and engagement that made teaching a course for my dissertation possible and I had a joy showing up each week getting to work with you all. I know you all will do well in your futures! I would like to thank my cohort members (Karly and Andrea) and all my friends and colleagues that I met while in Morgantown at WVU. My life and five-year experience wouldn’t have been the same without you all and the bonds made and time spent together have helped me get through the tough times but also made me the person and professional I am today and I couldn’t have done it without you all. Thank you to my mom (Emily), my sister (Sophia), and my dad (Chad) for their support over all these years. I don’t think we all knew what was going to happen when I moved from a block from the beach in San Diego to Morgantown, West Virginia but after five and a half years, I am happy to say I did it! And last, but certainly not least, I would like to thank my partner, Ashley, for all her time and support throughout this process. When we first met, this project had just barely started and what a journey it has been to go through all this together. I couldn’t have done this without your love and support, and I can’t wait to see what the future has in store for us! LEARNING THEORIES IN SPORT SETTINGS iv Table of Contents Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings ........................1 Learning Theories in Sport-Related Professions ................................................................................1 Learning Theories in Formal Sport-Related Course Settings...............................................................3 Methods............................................................................................................................................7 Design............................................................................................................................................7 Positionality Statement...................................................................................................................7 Setting ...........................................................................................................................................9 Participants....................................................................................................................................9 Data Collection Instruments ..........................................................................................................10 Assessments from the course.............................................................................................................10 Individual interviews...........................................................................................................................10 Quantitative objective self-report scales in interviews......................................................................12 Weekly journals...................................................................................................................................12 Instructor logs.....................................................................................................................................12 Procedures...................................................................................................................................13 Recruitment ........................................................................................................................................13 Data Analyses...............................................................................................................................13 Results.............................................................................................................................................14 Increases in Resources ..................................................................................................................14 LEARNING THEORIES IN SPORT SETTINGS v Discussion........................................................................................................................................24 References.......................................................................................................................................72 Appendix A: Positionality Statement..................................................................................................32 Appendix B: List of Semi-Structured Interview Questions....................................................................45 Appendix C: Written Assessment Rubric Example ...............................................................................32 Appendix D: Syllabus ........................................................................................................................39 Appendix E: Review of the Literature .................................................................................................46 Learning Theories in Education ......................................................................................................46 Learning Theories in Physical Education .........................................................................................49 The Sport Coaching Profession.......................................................................................................50 Sport Coaches’ Various Roles.........................................................................................................52 Coach as a Performer..........................................................................................................................53 Coaches as Counselors........................................................................................................................55 Learning Theories in Coaching Education........................................................................................56 Applied Strategies of Learning Theories.............................................................................................56 Learning Theories in Sport Psychology ...........................................................................................61 Learning Theories in Athletic Training ............................................................................................66 Learning Theories in Physical Therapy ............................................................................................67 Learning Theories and Positive Youth Development........................................................................68 Conclusion and Future Directions ..................................................................................................71 LEARNING THEORIES IN SPORT SETTINGS 1 Exploring the Conceptualizations and Utilizations of Learning Theories in Sport Settings The Evolution of Learning Theories Across Research Fields Learning is often at the core of many daily activities and largely goes unnoticed or done without awareness or intention (Collins et al., 1991; Rumelhart, 1980). Most current research on learning theories resides within the field of education (Woolfork Hoy et al., 2013) as the research emphasis naturally started with youth learning in school settings. Learning theories can be defined as theories that “guide one’s actions in terms of how one goes about learning new skills, knowledge and attitudes” (Wang, 2012, p. 5). Drawing from the field of education, learning theories became more prevalently researched after the turn of the 21st century in the fields of physical education (Light, 2011; Moura et al., 2020), sport coaching (Cushion et al. 2010; Lyle, 2007; Roberts & Potrac, 2014), athletic training (Peer & McClendon, 2002), physical therapy (Jensen et al., 2016), and sport psychology (Barker-Ruchti et al., 2016). Aspiring sport-related professionals can utilize learning theories when developing practices, training sessions, or mental skills sessions by focusing beyond the content of the sport or mental skill, and more on how the concept is introduced and transferred to usable knowledge for the athlete. This relates to Shulman’s (1986) work of identifying the differences between content knowledge (what one knows) and pedagogical knowledge (how to teach that knowledge) and may differ depending on one’s previous experience, education, or role. Implementing learning theories from educational psychology can help sport-related professionals develop pedagogical skills to help athletes learn and improve their performance (Barker-Ruchti et al., 2016). Learning Theories in Sport-Related Professions At their core, learning theories can be helpful tools while to enhance the quality of communication and interaction between sport-related professionals and their athletes. Learning theories can be used by instructors to focus their attention on how their athletes learn in an attempt to LEARNING THEORIES IN SPORT SETTINGS 2 better convey information in a manner that is most likely to result in learning and skill improvement. In the professions of sport coaching and sport psychology, learning theories have received differing amounts of attention. For sport coaching, as demands on sport coaches increase, so have the number of coaches who have made coaching their full-time profession. As of 2016, there were 276,100 full-time sport coaches in the United States and many more who were volunteer coaches (Fawver et al., 2020). This is an increase of approximately 60,000 full-time coaches over seven years, when in 2009, 217,000 individuals reported themselves to be full-time coaches in the United States (Duffy et al., 2011). Not all, and possibly not even most, of these coaches have received formal coach education. To help coaches draw upon more than just their own personal experience (Lou et al., 2023), learning theories could help coaches provide the best learning environments for their athletes and enhance their training. In previous literature, researchers have explored which learning theories would be useful in the coaching realm. Knowles and colleagues (2005) identified expert and novice coaching differences that are linked to a coach’s critical thinking and decision-making skills. Mesquita and Riberio (2014) identified that reflection is a vital skill to help coaches grapple with new and modifying information. Bowes and Jones (2006) discussed scaffolding, first introduced as an educational concept by Vygotsky (1978), as one theory that could benefit coaches in their work as reflective facilitators to make sense of their own and other’s actions within a particular culture. Learning theories help provide a theoretical basis for coaches to help facilitate information and learning for athletes. Although some current research on learning theories in coaching exists, researchers (Lyle, 2007; Stodter & Cushion, 2016) contend that coach learning research is insubstantial and coach education could be bettered by incorporating more learning theories into formal coach education coursework. On the other hand, in the field of sport psychology, very few studies have examined the use of learning theories on mental skills instruction. Gilbert (2007) wrote an applied article that bridged the gap for coaches and their use of sport psychology concepts when working with teams. Gilbert (2007) LEARNING THEORIES IN SPORT SETTINGS 3 recommended the use of a 12-week sport psychology curriculum called UNIFORM which emphasized goal setting, imagery, relaxation, and routines. Although not specifically related to learning theory, the researcher recommended a game-plan format, a teaching system, that helped make sport psychology concepts more applicable for coaches to use when working with teams. To evaluate a graduate level sport psychology program, Kraft and colleagues (2021) asked three participants through semi-structured interviews to reflect upon what was helpful to their learning experience. The researchers found that reflection and experiential learning theory were most helpful to the overall graduate sport psychology program experience. Headrick and colleagues (2015) identified that learning and affect would be a fruitful avenue of research to help create the most effective learning environments. Outside of a few research studies, future recommendations have emphasized the importance of continued research in mental skills instruction that incorporates the use of learning theories (Barker-Ruchti et al., 2016). Across the sport psychology and sport coaching fields, some initial research has been conducted, however, more research is needed to identify the impact of using learning theories in practice. Such information would help to design formal coursework to effectively train aspiring professionals in these fields. Learning Theories in Formal Sport-Related Course Settings In sport-related professions, there have been some initial studies that have examined the implementation of learning theories on formal course design. In sport coaching educational programs, students often learn in formal settings (coach education courses and certifications), informal settings (knowledge acquired from personal experiences and social interactions), or semi-formal settings (conferences, clinics, seminars and workshops provided to coaches; Pope et al., 2015). However, in the United States, “one of every three youth sport coaches have been trained in sport skills or tactics and fewer than one in five are trained in effective communication techniques” (Fawver et al., 2020, p. 240). Coaches are not typically required to complete or attain a certain level of education, experience, or LEARNING THEORIES IN SPORT SETTINGS 4 certification and if they are mandated to complete any training, it is usually related to first aid safety and safe sport training, but this varies by state and league (Fawver et al., 2020). In a review of literature conducted by Cushion and colleagues (2010), coaches generally believed that formal learning opportunities are overwhelming with the amount of information taught at once and that theories that are provided in an abstract way do not seem relatable to their practices. Cushion and colleagues (2010) found that only one study as of 2010 had investigated formal learning implications on coach development and that many approaches to coach learning were without a focus of how people learn. Jones and Turner (2006) did investigate how problem-based learning was used in a formal course setting for eleven undergraduate coaches over the course of a semester in the United Kingdom. The course was split in half including groups of students assigned to work with each other and getting a problem to work through in their groups. Problem-based learning entails students grappling with realistic and problematic scenarios to challenge thinking and potentially be used in future similar situations (Jones & Turner, 2006). The students provided reflection and participated in semi-structured group interviews as the researchers used continuous observation throughout the course. The researchers found that students started to think differently about coaching after being in the problem-based learning intervention and recommended that future research could help coaches with their learning, transfer knowledge, and create effective practices. These calls to action provide rationale for a formal learning theories course structured around how people learn in sport related academic programs. Sport psychology researchers have recommended that more focus be placed upon learning theories in the sport performance literature (Barker-Ruchti et al., 2016) and that formal course settings could be improved by offering opportunities to directly apply the theories learned (Ardelean, 2019; Hutter et al., 2017). Sato and Laughlin (2018) implemented Kolb’s experiential learning theory to teach sport psychology theories to nine students using weekly golf-putting tournaments to create sport psychology-based learning situations throughout the course. After the 15-week course, the authors LEARNING THEORIES IN SPORT SETTINGS 5 found that experiential learning was helpful in teaching students about sport psychology theories like goal setting and imagery. The researchers recommended instructors be more flexible by including more learning theories when teaching sport psychology. Other research has looked at structuring weekly coursework to teach in a formal setting as well. One such study utilized the implementation of a 15- week course focused on sport psychology theories (Aoyagi, 2013). The instructor recommended future courses focus on just one theory a week instead of trying to fit many theories in at a time. Other approaches were used with gamification of the classroom to build learning opportunities (Shipherd & Burt, 2018), an active learning approach to improve engagement in the classroom (Stowe & Whitfield, 2020), and assessing sport psychology students’ employability (Heaviside et al., 2018). However, no other studies have focused on learning theories being implemented into the course design while also being the main course content to improve athlete learning. Within the sport-related fields of physical therapy and athletic training, researchers have assessed the implementation of learning theory into educational curriculum. For athletic training, Gillette (2017) used problem-based learning in a 15-week athletic training course to evaluate its impact upon the learning environment. During this course, problem-based learning was utilized to help provide a framework with which to develop a beneficial and effective learning environment. These researchers recommended educators work to include or incorporate learning theories into their future instruction. In another investigation into pedagogic strategies used in a classroom setting, Mensch and Ennis (2002) identified through interviews students’ and instructors’ perceptions of their educational experiences that case studies, genuine experiences, and creating a positive classroom environment were key to the learning of 21 athletic training students. Similar incorporation of learning theories were done with sociocultural learning theory in athletic training courses (Peer & McClendon, 2002) as well as Kolb’s experiential learning theory in a 15-week athletic training course (Schellhase, 2008). Research has also been conducted to explore the effect of analogy learning, implicit learning, and explicit learning in LEARNING THEORIES IN SPORT SETTINGS 6 physical therapy settings (Bobrownicki et al., 2019; Lam et al., 2009; Liao & Masters, 2001; Lola & Tzetzis, 2021; Tzetzis & Lola, 2015). Graham (1996) also explored the factors that help develop conceptual knowledge in a 15-week sport-related course and identified that sociocultural elements of group learning, collaboration and cognitive apprenticeship were influential in physical therapy students’ learning. Across the sport-related fields, more studies exist on learning theories in athletic training and physical therapy literature than in sport coaching and sport psychology. Due to the benefits of implementing learning theories into the classroom on student learning and application seen in other fields, it would be beneficial for sport coaching and sport psychology research to explore how engagement with learning theories related coursework could help improve the training of future professionals and move the fields forward. To address these gaps in the literature, this study provided aspiring sport professionals with a formal university introductory course designed by learning theories to help novice practitioners use learning theories in their future work with athletes. Essential Framework for Study Two studies from the field of education were used to frame the current study. The first study, conducted by Schoenfeld (2011), researched teachers’ abilities to make decisions while teaching in the classroom. Through this study, Schoenfeld identified that teachers relied on their resources, goals, and orientations while teaching. When referring to resources, Schoenfeld defined resources as, “his or her knowledge, but also the social and material resources that are available to him or her” (p. 459). This also includes the “knowledge inventory that he or she can potentially bring to bear in a teaching situation” (p. 459). Goals are defined as “things that people consciously or unconsciously set out to achieve” and help the decision-making process as “decision making can be seen as the selection of goals consistent with the teacher’s resources and orientations.” Schoenfeld defines orientations as “beliefs, values, preferences, and tastes” (Schoenfeld, 2011, p. 460). These three categories help provide a framework through which students’ learning will be assessed in this study. Bloom’s (1956) taxonomy is the second LEARNING THEORIES IN SPORT SETTINGS 7 framework being used to frame the current study. Within this framework, the stages of learning are described as remembering, understanding, applying, analyzing, evaluating, and creating. This is a very commonly used framework for understanding learning in educational settings and this framework was used in this study to identify how learning could be measured with aspiring sport professionals. The purpose of the current study is to identify how learning theories utilized in the design of a formal course impacts students’ resources, orientations, and goals for their future career work in sportrelated professions. To be clear, the aim of this study is not to identify or prescribe particular learning theories to use over others, but to provide sport-related professionals with an understanding of how people learn and implement learning theories into practice. This study will aim to answer the following research questions: 1) How did students’ resources change over the span of the course for engaging in their work? 2) How did students’ goals change over the span of the course for engaging in their work? 3) How did the students’ orientations change over the span of the course for engaging in their work? Method Design This qualitative study utilized a descriptive single case study design (Baxter & Jack, 2008). The single case in this study focused on a learning theories course offered for fifteen weeks at a kinesiologybased Mid-Atlantic university during the fall semester of 2022. The case study approach offered the ability to chronicle the instructional design of the course, pedagogical decisions made throughout the course, and the students’ learning experience within the course. The descriptive case study design also lent itself to answering “how” questions and being able to describe the intervention in the real-life context in which it occurred (Baxter & Jack, 2008). Positionality Statement The lead author occupied both the role of the main instructor for the course and lead researcher for this study. The lead author had previously taught pedagogical studies courses as a graduate assistant LEARNING THEORIES IN SPORT SETTINGS 8 within an educational psychology department. As the main instructor and researcher of this study, the lead researcher accounted for his insider positionality by engaging in reflexive journaling to establish transparency and trustworthiness. A single-blind consenting process was also utilized to help eliminate any knowledge of which participants were involved in the research study from the instructor so as not to have an impact upon grading. The instructor used an objective rubric (Appendix A) while grading to help minimize any preferences that were developed with students while interacting with them in class. Instructor logs were also kept reflecting upon decisions about course design and the first author’s positionality statement can be found in Appendix B. Critical friends helped process the data to improve trustworthiness. The second author is a fourth-year Ph.D. student in educational theory and practice who served as a critical friend in the data analyses, bringing perspectives that were distinct from the other researchers. The third author was a senior undergraduate student who helped transcribe interviews and provided support as a critical friend during data analysis. The fourth author is an associate professor in the School of Education who served as a critical friend and mentor of the qualitative framing of the study. Given the nature of the work, the varied perspectives of the members of the research team helped build trustworthiness during data analysis. Regarding an epistemological perspective and theoretical framework, the main researcher primarily aligns with interpretive and constructivist perspectives that the social world is constantly being constructed by group interactions and can be understood through the actors and their own experiences (Creswell et al., 2003). This belief drives the methodology to understand the learning experience of the students and the instructor who both shape the learning environment. To understand how the students’ understanding changed over the course of the semester’s class, interviews were conducted with students both at the beginning and end of the course to examine their learning. This constructivist approach aligned well with the main researcher’s insider positionality as the instructor and researcher, who was a part of the active change of students’ conceptualizations of learning theories. LEARNING THEORIES IN SPORT SETTINGS 9 Setting The course ran once a week for 15 weeks in a hybrid format where readings, interviews, and assignments were distributed and completed online while lectures were conducted in person weekly. Participants were provided with all information about the course and its requirements in a syllabus and students were given an opportunity to opt out of the study or drop the course on the first day. The inperson class lasted two hours weekly and allowed students to engage with the material and provided students with an opportunity to share with one another and how they foresaw using learning theories in their work. The course was adapted from a previously taught Educational Psychology course that was used to teach learning theories to aspiring undergraduate teacher candidates in an education program. Participants Originally, eighteen junior and senior standing students signed up for this learning theories course. However, one student never showed up to class and withdrew from the course while another student dropped the course after not completing any of the assignments. This left sixteen undergraduate students in the course, with each of the students majoring or minoring in sport and exercise psychology. Of the sixteen students, one’s future professional aspirations included being a university professor and another a physical therapist. These students were treated as outliers. Two other students did not complete all the work necessary and were left out of the final participant group of twelve. In total, six students with aspirations of working in coaching and six students with aspirations of working in sport psychology were included in the study (Table 1). To participate in this study, participants needed to: (1) be enrolled in this special topic course, (2) have interest in working in either the coaching or sport psychology profession, (3) be at least 18 years old, and (4) have completed all work required in the course. Screening for the course occurred during the enrollment process as students expressed interest, demonstrated they met the criteria, and understood the goals of the class. LEARNING THEORIES IN SPORT SETTINGS 10 Data Collection Instruments Assessments from the course The main three assessments from the course occurred throughout the semester (Syllabus for course included as Appendix C). The three assessments included 1) an annotation of an example utilized within their aspiring profession that uses learning theories, 2) a created artifact implemented with a group of athletes or with other students as athletes during class, and 3) a reflection of participants’ resources, goals, and orientations of learning theories while implementing their created artifact using learning theories. These written summative assessments were graded according to a rubric (Appendix A) that assessed the participants’ abilities to identify or use learning theories, its disciplinary authenticity, responsiveness to athletes, ability to be athlete-focused, and amount of detail. Individual interviews Two semi-structured interviews were conducted with each student, one at the beginning and another at the end of the course, to provide the most efficient use of time. The semi-structured interviews asked questions flexibly while gathering specific data for previously prepared questions but did not have a predetermined order (Merriam & Tisdell, 2016). Due to the nature of developed relationships over the course of the semester and insider orientation as the instructor, the inclusion of a research team and critical friends with varying backgrounds helped build trustworthiness in the process. T1 interview with students. The initial semi-structured interview served to understand the participant’s history, collect demographic information, student’s aspiring career goals, and their experiences working with athletes. This initial interview helped build rapport with students as these interviews occurred over the first week of class. The interview guide for the initial interview (Appendix D) was adapted from a previous project exploring teacher-coaches’ conceptualizations of learning theories in both athletic and classroom settings (Lou et al., 2023). LEARNING THEORIES IN SPORT SETTINGS 11 Table 1 Participant Demographics Participant “Name” Year Gender Group Ideal Future Career Goals Majors Minors? Objective Change from Beg to End P3 (Nina) S F SP CMPC & Master’s in Counseling (University Sport Setting) Sport Psych Scholastic Coaching, Human Services & Counseling (2) 0 – 6 P6 (Cathy) S F SP Mental Health Counseling for Clients in Pageants Sport Psych & Exercise Physiology None 4 – 8.5 P7 (Neil) S M SP Applied Sport Psychology Consultant (Cycling) Sport Psych Leadership Studies, Professional Sales (2) 3.5 – 7.5 P13 (Elaine) S F SP Applied Sport Psychology Consultant (Olympics) Sport Psych Nutrition & Food Studies 0 – 8.5 P15 (Bella) S F SP Applied Sport Psychology Consultant (Professional Sport) Sport Psych Human Services, Sport Communication, Communication Studies (3) 2 – 9 P16 (Carlos) S M SP Applied Sport Psychology Consultant (Professional Sport) Sport Psych None 1 – 7.5 P4 (Joe) S M C Collegiate College Basketball Coach Athletic Coaching Education Strength & Conditioning, Sport Psych, Sport Communication (3) 5.5 – 8.5 P5 (Zane) S M C Division I Power 5 Football Coach Coaching Performance Sciences Strength & Conditioning, Sport Psych (2) 1.5 – 7.5 P8 (Elena) S F C Personal Training & Professor Sport Psych Personal Training 4 – 8 P9 (Eliza) S F C Professor & Applied Work with Twirlers Sport Psych Human Services and Addiction Studies 0 – 7 P10 (Trent) S M C Director of Player Personnel & Recruiting for DI Football Athletic Coaching Education Sport Psych & Sport Communication (2) 2.5 – 9 P11 (Cade) J M C Football Coach (Professional) Sport Psych Sport Coaching, Sport Communication (2) 3.5 – 8.5 SP = Sport Psych C=Coaching LEARNING THEORIES IN SPORT SETTINGS 12 T2 interview with students. The second interview occurred during the last week of the course and operated as an evaluation of students’ overall learning in the course. The semi-structured interview recounted students’ experiences within the course, identified which learning theories they found most applicable to their future career, and identified future settings where they may use learning theories. Questions were more open-ended and asked about student’s understanding of learning theories. Quantitative objective self-report scales in interviews Additionally, as a part of this case study, participants were asked to create objective self-reports in both the beginning interview and end of class interview. Participants were asked to assess their understanding of learning theories on a scale of 1-10 at the time. During the second interview participants watched a 3-minute video clip of how they answered the same question during their first interview prior to answering this question. Answers were included in Table 1. Weekly journals Participants engaged in weekly journal writing activities for each week’s reading. The weekly journal prompted students to pull one quote from the reading, tie the quote to a personal experience where they may have encountered that learning theory, and identify how that week’s learning theory could be helpful in their future work. These weekly journals helped chronicle students’ engagement and metacognition as they read and learned about each learning theory. Instructor logs The instructor kept weekly logs to keep track of explicit decisions about course content and course design. As part of an instructional design approach, the pedagogical decisions made with learning theories in mind helped facilitate students’ learning throughout the course. The instructor logs helped assess if certain pedagogical moves impacted the learning experience for students. In addition, weekly reflexive journaling was included as part of the instructor logs to help increase trustworthiness. LEARNING THEORIES IN SPORT SETTINGS 13 Procedures Recruitment Participants were recruited via convenience sampling. The main researcher asked academic advisors to advertise the course to students. Students were offered course credits in exchange for their participation in the course. After obtaining IRB approval, participants were given a syllabus for the course and were notified on the first day that the information from the course may be used for research purposes. Participants were given an opportunity to opt out of the study or drop the course if desired. This consent process was conducted with the main researcher’s advisor and the students’ consent status was blinded from the researcher until after the course was completed to not bias any grading. Data Analyses Qualitatively, a document analysis process was used to illuminate the experiences of participants shared in the semi-structured interviews and written assignments (Bowen, 2009). The document analysis combed over the instructor logs, semi-structured interviews, and the three major assessments student completed as a part of the course. The main researcher and two critical friends utilized an iterative three-step process for document analysis: skimming, reading, and interpretation, combining elements of both content and thematic analysis (Bowen, 2009). The analysis of the transcripts and the students’ interviews used a three-step process: 1) gaining familiarity, 2) selecting and focusing, and 3) interpreting. After interviews were transcribed verbatim from Zoom, the first step of gaining familiarity included the main researcher and critical friends taking time to read over all transcripts and assignments from each participant. Two critical friends were included in these reviews to help balance any biases. The critical friends helped look over all material collected throughout the course and how the instructor shaped the overall learning experience. The second step of the analysis included the research team selecting and focusing on parts of the interviews and assignments that were meaningful. Analytic questions were developed to help the LEARNING THEORIES IN SPORT SETTINGS 14 research team as a more practical and actionable extension of the research questions. Using an inductive approach, the research team read over all the data and then utilized an open coding process to answer the analytic questions. As each interview was coded, there were certain themes that provided meaningful moments of information (Merriam & Tisdell, 2016). Each member of the research team identified their own open codes and themes to answer the analytic and research questions and brought them to the joint interpretation process. The third step included joint interpretation meetings where the lead researcher and two critical friends met weekly to discuss codes and themes gained from step two. Elements of the interview gleaned multiple themes that were tracked and discussed within the research team. The data were analyzed together to see how conceptions of learning theories changed over the course of the semester. Using this inductive approach, meaningful units were identified through an interpretive approach to data analysis. Results To explore the research questions, Schoenfeld’s framework of decision making (resources, goals, and orientations; Schoenfeld, 2011) and Bloom’s Taxonomy were used to identify the different levels of learning that participants in the course engaged in (i.e., remember, understand, apply, analyze, evaluate, & create; Bloom, 1956). Students from the course identified, either implicitly or explicitly, their stage through their responses in an interview or through their written work on their three major assignments throughout the course. Increases in Resources To answer the first research question (How did students’ resources change over the span of the course for engaging in their work?), the findings indicate a large increase in students’ resources or knowledge about learning theories from when they started the course to the end of the course. The findings of the current study suggest that students’ ability to interplay with learning theories increased LEARNING THEORIES IN SPORT SETTINGS 15 from just being able to remember learning theories in the beginning of the semester to being able to evaluate and create plans as they moved through the course throughout the semester. Three themes that were discovered about students’ resources include: (1) students’ resources changing from remembering to creating using learning theories through Bloom’s taxonomy; (2) students’ increased resources helping provide confidence as a future professional and (3) improved resources helped identify learning theories from other theories. Remembering to Creating: Changes in Resources through Bloom’s Taxonomy Nina, a senior sport psychology student, who had previous experience with many sport psychology courses, was able to name the sport psychology theory of the inverted U when asked about learning theories. However, during her second interview at the end of the semester, she stated: I don’t think I learned a learning theory until this class, like I’ve learned sport psychology theories, and, like I guess they could apply to learning. But this was actually about learning. Well, I've heard of like schema and stuff like that. But I didn’t know it was a theory, you know. And, yeah, I know the difference between sports psychology theory and learning theory now. This quote demonstrates that after completing the course, Nina was much better able to tell and evaluate the difference between a learning theory and a sport psychology theory. Similarly, Neil, another sport psychology student, also conveyed an increase in resources. When asked about this during his second interview. Neil responded, “being able to see the theories in action. Before that, I had a very academic understanding, and I could probably regurgitate an academic example, but actually getting to see where they would be used in daily life was huge.” Neil’s understanding changed from a regurgitation, which is oftentimes how college students are evaluated through multiple choice tests, to being able to use his increased understanding of learning theories to create and teach imagery to swimmers whom he conducted his second annotated assignment with. LEARNING THEORIES IN SPORT SETTINGS 16 These increases in resources were conveyed not only during interviews, but also through student writing assignments that asked students to annotate, create, and analyze an artifact in their future career field. In an annotation associated with her created artifact, Bella wrote: A major part of pedagogical knowledge is knowing students' zone of proximal development, which is where individual students fall on a learning continuum for a particular task, in this case attentional focus. My students are in the zone of proximal development throughout the entire lesson since attentional focus is a new concept to the class. Different levels of scaffolding are shown throughout the lesson, as I teach the students what attentional focus is and guide them in skills to improve and induce attentional focus. They are not out of the zone of proximal development until learners elicit articulation, by proving their understanding. This quote demonstrated that Bella not only understood various learning theories gained from the course but was able to apply what she had learned to a sport psychology session on attentional focus. With this understanding and awareness of her learners’ zones of proximal development, Bella was able to do a better job of creating and implementing a plan that actively bolstered her athletes’ learning. Changes in Resources Helped Improve Confidence as a Future Professional Students came into the course with different levels of previous knowledge, which was important for the course design to be responsive to. Bella, a sport-psychology student, shared how she used behaviorism, previous to the course, while working at a daycare where they would reward or take rewards away from children based on their behavior. Naturally, with younger children, behaviorism can be a default learning theory to use. As a result of the course, Bella gained self-efficacy and confidence in her ability to work in the sport psychology field: I have more confidence in being able to teach sports psychology. Like before I felt like I had all the content in my brain, but I didn't know how to present it or explain it to anyone. But now I can actually give a description, and I feel like I know what I’m talking about. LEARNING THEORIES IN SPORT SETTINGS 17 In this example, Bella was able to describe her increased confidence compared to the start of the semester when she only had subject matter knowledge. After this course, she believed she had the ability to teach, present, or explain what she knows to athletes better than before. Joe, a coaching student with a minor in sport and exercise psychology, seemed to have come in with more initial resources. In the initial interview, Joe succinctly described the concept of scaffolding as something that he did in his coaching: One thing I've always loved to do in my practice plans when you’re doing a drill is a progression model. I think if you just start with the basic form, you can get more complex as time goes on. So basically, just starting where it's easy and where everybody can understand it, and then moving on to making it more complex. If you’re doing a dribbling drill, start out with the simple form of it and then start to add more combinations to it. It is evident that Joe entered the course with some baseline knowledge about learning theories even though he did not explicitly name scaffolding as a theory he knew. As he self-reported in his first interview, on a scale of 1-10, Joe felt like he came in with a quantified knowledge base of 5.5. As he moved through the course, he was able to improve his knowledge base to 8.5 which is evidenced by his response in his third assignment where students were asked to reflect on their created coaching plan: For my plan, there was a group of athletes that was struggling with the second portion of the drill in terms of how to move around the cones. The first level of support I offered was demonstration of the actions. The athletes still struggled after this instruction, so the second level of support was slowing down the action. After this, the group athletes showed improvement and could complete the drill successfully without me. Finding the zone in which these athletes felt the most comfortable was paramount to their success in the drill. Joe accumulated a good understanding of the Zone of Proximal Development to add to his incoming knowledge of scaffolding and combined these concepts to change goals while executing his coaching LEARNING THEORIES IN SPORT SETTINGS 18 plan. This level of awareness and thoughtfulness during his coaching is an ideal outcome of Joe’s understanding of how learning theories could be beneficial to his work and increased his confidence to apply this in future settings. Changes in Resources Improved Understanding of Learning Theories from other Theories Eliza, a sport psychology student who had coaching interests, was able to name SelfDetermination theory that is commonly used in motivational research but mistook it for a learning theory in her first interview. Through her learning during the course, Eliza articulated in her second interview how she has a changed understanding of learning theories because of the course: I know what they're called and how to apply them better and make a plan that utilizes them specifically. But yeah, I think I learned what they were called, and I also learned that they're all connected. It's not just one singular thing. It's all connected, and then they all work together to create the perfect plan. Eliza summarizes her change in Bloom’s taxonomy from going from not even being able to remember the learning theories to now being able to understand how multiple learning theories work together. She had characterized her own self-reported knowledge as a 0 initially but at the end of the course Eliza perceived that her knowledge had grown to a 7 on a scale of 1-10. Lastly, in Cade’s final written assignment for the course where students were asked to reflect on their changes in learning theories, Cade was able to articulate: When designing my plan, the biggest resources that I drew upon were implementing my plan with the use of all types of knowledge (pedagogical, curricular, subject matter) … to best convey understanding and to add a purposeful display of information. I also wanted to scaffold the information so that the learners could gradually learn and understand the skill from its very basic to its complex form in a game situation. I found this important, as many of the learners could be from varying skill levels of the sport as a whole, and by starting at its basic and LEARNING THEORIES IN SPORT SETTINGS 19 scaffolding towards the more complex concept, it allows for growth as a group regardless of the past understanding and skill level of the sport or concept of this particular skill. Cade’s description of his growth of understanding of learning theories was evident as he weaved the various learning theories from the class in his description of what helped him when implementing his coaching plan. Additionally, Cade was able to articulate in his second interview: I think I had an idea about those concepts, but not the specifics of them, and how to apply them. Specifically, for scaffolding I understood, how the building on top of knowledge on top of each other, but I didn't understand how to actually make that effective, and what information to utilize when that was kind of important for me to learn and how I can potentially even use that in my future field now. Cade articulated the difference between understanding the basics of the concepts of learning theories and being able to apply them and utilize them in the work he wanted to do in his future field. The changes in resources that students experienced also helped shape the goals for learning with athletes. Goals Changed from Egocentric to Learner-Centric To answer the second research question (How did students’ goals change over the span of the course for engaging in their work?), the findings indicated that students were able to change from focusing on what they, as the instructor, were doing (egocentric) compared to what their students were learning or experiencing (learner-centric). As a theme, it was found that students tended to change from worrying about what they were doing or trying to achieve to what the learner was going to be able to take away from either the sport psychology or coaching session. For this section of results on students’ goals, results were split by either participants’ interests in being future sport psychology consultants or future coaches as the goals they had in mind while working with athletes were driven by what role they were working towards and what they were trying to accomplish in each session. Students’ previous LEARNING THEORIES IN SPORT SETTINGS 20 experiences and the course helped build their existing content knowledge while the course also helped students increase their pedagogical knowledge (Shulman, 1986) to fit the goals of their future ideal role. Sport Psychology Group As Elaine, a sport psychology student, was creating a session plan to help gymnasts work through mental blocks while doing a beam routine, she did a wonderful job of articulating her goals for how the learning theory would impact how she was designing her session plan. Elaine says: I wanted to scaffold it up as much as possible because I feel if you start from learning the skill from the basics and get comfortable it will help the athlete feel more comfortable. In my plan I had it organized in levels. As the levels went up, the difficulty did as well. I feel this helped the athlete feel more comfortable doing cartwheels so when they were on the high beam, they would have confidence in their abilities to do a cartwheel. I used scaffolding at the meso-level. Having the plan athlete-focused was my main goal while still asking questions so I could better improve their learning and their abilities to complete the skill. When Elaine came into the course, she was only thinking about what to do as the instructor but now, as evidenced by the quote, Elaine was able to explicitly explain how she used scaffolding as a learning theory to help her athletes as they worked through mental blocks. Similarly, Bella also stated her change in goals for her session plan when creating an attentional focus plan for athletes with physical disabilities. In her third written assignment, she wrote: My goal was to prime students with ideas surrounding attentional focus and initiate thoughts on their focus-abilities. The change in my goal, benefitted my lesson and the students because I was able to add more real-life examples outside of sports, which allowed for an easier understanding of attentional focus and created more opportunities for transfer. The theory I structured my lesson plan around was Vygotsky’s Scaffolding Theory. Furthermore, Bella also talked about how her increased resources in learning theories helped her goals: LEARNING THEORIES IN SPORT SETTINGS 21 For students to have the ability to transfer their attentional focus skills from activities they enjoy to more challenging tasks or activities. I was able to accomplish this through pedagogical knowledge I gathered on the students before and during the lesson. While implementing the relation to hobbies/interests activity, I thought of Schulman’s types of knowledge and the importance of my own pedagogical knowledge. I used it in the moment by asking the bowlers to share their experience with attentional focus while bowling. I then thought of Jonassan’s ideas of problem-solving while implementing my plan. I used her theory in the moment by setting up a problem of being unfocused. They then solved the problem through the breathing activity and came to this conclusion through the questions I asked, initiating procedural facilitation. In a similar way to how Schoenfeld (2011) describes how math teachers make decisions during their teaching to help meet the goals they have set out for a lesson plan, Bella is able to explicitly identify which learning theories she is aware of or is considering when making decisions during her session plan. In Bella’s initial interview, she was able to name some overlying categories of learning theories due to the first day of class coming the day beforehand. However, throughout the span of the course, it is evident that Bella was able to internalize her understanding of the theories and think of them in the moment when making decisions about her session plan. Coaching Group After Joe created a basketball practice plan, he reflected upon his goal for the session: The main idea and goal I had in mind when creating this plan was to effectively teach defensive technical concepts while steadily increasing the complexity of the task at hand. Increasing the complexity of the tasks allows me as a coach to scaffold my athletes’ learning and tailor the practice plan to their levels of understanding. Once I, as the coach, am able to analyze and determine where my athletes are the most comfortable, skill wise, then I can start to help them improve. Putting the athletes in a comfortable environment gives them a sense of security. LEARNING THEORIES IN SPORT SETTINGS 22 Joe talked about his own learning process in the initial interview when he was faced with a question asking about his goals for utilizing learning theories. But as he reflected upon his practice plan, it became clear that Joe was able to think about how his athletes were going to go through the lesson and conceptualize it in a way that was best for them. Another coaching student, Zane, entered class with some baseline knowledge using a type of coaching method he referred to as the “EDGE method”, which included explaining, demonstrating, guiding, and enabling his athletes while coaching them. Zane talked about how important it was for him to recognize a shift in how he was conceptualizing his goals about coaching: I think [the course] shifted my mindset from more of what I’m teaching to how I teach it. I just knew that athletes needed to know certain things and I talked about a lot at the beginning of the course, about EDGE. But I didn't think there were all these different learning theories that I could use, that could be applied in different settings that could enhance the athletes learning. Zane summarized his takeaways from the course well, shifting from content knowledge to pedagogical knowledge and stated that the course helped provide him with background and knowledge that he could use. Although Zane didn’t talk about “in the moment goal shifts” as Bella did, it seems like his shift was more of a global change and outlook upon how learning theories could be better implemented in his future coaching work. Overall, there were large shifts in goals from the beginning of the course to the end for both groups. This demonstrates the change in some students being able to consider what is best for the goals of their students and how imbedding learning theories influenced their decisions and goals when implementing a session plan. Shift in Orientations To answer the third research question (How did the students’ orientations change over the span of the course for engaging in their work?), the results indicate that students’ beliefs, ideas, and attitudes about learning became more robust and more applicable to their future work. For example, Carlos, a LEARNING THEORIES IN SPORT SETTINGS 23 sport psychology student, talked about his beliefs and recognition of how helpful learning theories could be to his future work when he asked about how he would design a session plan after the course: Well, designing it now, before I would have, I guess … put things that I would have thought would be helpful to the athletes and I wouldn't have thought about how they would be learning the things. I think I would have just used my own reference before, but now I can use things like scaffolding, which I think is really helpful when working with athletes, especially youth athletes. I think that's super important, with the skill difference and their schemas, and even the transfer to like when, I guess, working with youth athletes, the transfer to their like real-life skills. Carlos talked about how he used to think about learning and how he might have just relied upon his own experience to reference how to help his athletes. But after going through the course, Carlos recognized that he now has learning theories at his disposal to help him better structure and create an environment that best fits the athletes’ learning experience. Nina also shared a shift in her beliefs and attitudes about learning. Nina was able to explicitly share her perceptions of her change when asked about her orientations for learning: Learning is more fluid than I expected if you can engage with the way everyone learns best, which is not always in lecture. Some need activities, some need discussion, some need to face failure or discomfort to understand the importance of learning altogether. I definitely see more of a need to scaffold practices as a coach after seeing the way understanding blossomed when it became impactful personally, starting in a small manner and slowly growing. Nina shared some of her changes in beliefs about learning and how the course was able to help with that shift. The course design was intentionally scaffolded to provide students with a way to first understand the theories, then apply and create their understanding in a created plan and to actually implement that plan with athletes. Walking away from the course, Nina shared that she felt capable of using these learning theories to inform and improve her future. LEARNING THEORIES IN SPORT SETTINGS 24 Cade also talked about a change in his orientation that was similar to the themes from the goals section. When asked to describe his changes in beliefs about learning in the last interview, Cade shared: My beliefs have become more dependent on the learners themselves rather than on the informati

“Building the Roots”: A Delphi Study Examining the Aims of a Multicultural Competency Graduate Course in Sport and Exercise Psychology“Building the Roots”: A Delphi Study Examining the Aims of a Multicultural Competency Graduate Course in Sport and Exercise Psychology Multicultural Competency Graduate Course in Sport and Exercise Psychology Matthew Paul Gonzalez West Virginia University, mg0041@mix.wvu.edu Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Sports Studies Commons Recommended Citation Gonzalez, Matthew Paul, "“Building the Roots”: A Delphi Study Examining the Aims of a Multicultural Competency Graduate Course in Sport and Exercise Psychology" (2023). Graduate Theses, Dissertations, and Problem Reports. 11907. https://researchrepository.wvu.edu/etd/11907 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. “Building the Roots”: A Delphi Study Examining the Aims of a Multicultural Competency Graduate Course in Sport and Exercise Psychology Matthew P. Gonzalez Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Sam Zizzi, Ph.D., Chair Terilyn C. Shigeno, Ph.D. Jack C. Watson, II, Ph.D. James Wyant, Ph.D. Department of Sport, Exercise, and Performance Psychology Morgantown, West Virginia 2023 Keywords: multicultural, competencies, education, training Copyright 2023 Matthew P. Gonzalez Abstract “Building the Roots”: A Delphi Study Examining the Aims of a Multicultural Competency Graduate Course in Sport and Exercise Psychology Matthew P. Gonzalez Historically, opportunities to develop cultural competency in sport and exercise psychology graduate programs have been limited (Lee, 2015). Recently, major sport psychology organizations across the world have started to require cultural competency in their credentialling requirements. While this represents progress, these requirements can be met with a single course, which falls below the ideal of integrated cultural competency education (Martens et al., 2000). The present study investigated how to maximize the quality of a single course by coming to agreement on a proposed set of impactful and feasible learning outcomes and assessments in that proposed single course related to cultural competency. Eleven sport and exercise psychology professionals with significant expertise in teaching and/or researching cultural competency development completed a three-round Delphi study which resulted in 71 learning outcomes and 33 learning assessments. Of those, the panel fully agreed on the impact and feasibility of 11 learning outcomes and 3 assessments. Further, these professionals provided critical feedback on how to continue to enhance cultural competency in sport and exercise psychology graduate education. iii Table of Contents Acknowledgements ............................................................................................................... vi Introduction ..................................................................................................................................... 1 Research Questions ......................................................................................................................... 5 Methods ................................................................................................................................. 5 Research Design ............................................................................................................................... 5 Sampling and Recruitment ............................................................................................................... 6 Data Collection Procedures .............................................................................................................. 8 Data Analysis ................................................................................................................................. 11 Results and Discussion .......................................................................................................... 12 Consensus Achievement ................................................................................................................ 12 Tripartite Model and Full Consensus Items .................................................................................... 13 Issues of Debate Among Panelists .................................................................................................. 14 Thematic Analysis of Round Three Open Comments ...................................................................... 16 Limitations ..................................................................................................................................... 23 Practical Implications ..................................................................................................................... 24 Conclusion ............................................................................................................................ 24 References ............................................................................................................................ 26 Figures and Tables ................................................................................................................ 32 iv Appendix A – Extended Results ............................................................................................. 38 Research Question #3 .................................................................................................................... 38 Appendix B - Extended Tables and Figures ............................................................................ 42 Appendix C – Extended Review of Literature ......................................................................... 46 Sport Psychology and Culture: A Story of Two Developmental Stages ............................................ 47 Developmental Stage #1: Cultural Awareness ................................................................................ 47 Professional Accreditation, Certification, and Multicultural Competencies .................................... 56 Developmental Stage #2: From Definitions and Research to Cultural Praxis ................................... 59 Cultural Competence ..................................................................................................................... 60 Consequences of Cultural Incompetence ........................................................................................ 64 Culturally Competent Sport Psychology Applied Practice ............................................................... 67 Cultural Competency Development ............................................................................................... 73 Cultural Competency Education and Training ................................................................................. 75 Multicultural Competency Education Outcomes ............................................................................ 80 Measurement of Cultural Competency ........................................................................................... 82 Issues of Measurement and Evaluation .......................................................................................... 88 Critiques of Cultural Competency ................................................................................................... 90 Summary and Future Research ...................................................................................................... 90 Extended Review of Literature References ............................................................................ 92 v Appendix D - American Psychological Association Multicultural Guidelines (APA, 2017) ..... 105 Appendix E – Round One Survey ......................................................................................... 107 Appendix F – Round Two Survey ......................................................................................... 109 Appendix G – Round Three Personalized Survey Example .................................................... 113 Appendix H – Debriefing Round Survey ............................................................................... 125 Acknowledgements vi First and foremost, I would like to thank the chair of this dissertation and my advisor through the program, Dr. Zizzi. Numerous times throughout this process I did things on my own time and probably in a much less conventional way than you would have hoped. I appreciated your patience and guidance the entire time and there is no way this gets done without you. To the members of my dissertation committee… Dr. Shigeno, Dr. Watson, and Dr. Wyant, I likewise appreciate your patience and commitment to helping me finish the job I started years ago. Your insight and guidance have been so invaluable in making this happen. To the members of the Delphi panel… I was humbled by your depth of engagement throughout the lengthy Delphi method. You have truly set the example for me about what it means to be a selfless professional in our field. Thank you so much for being the most integral piece of this whole project. To Dr. Etzel… you invited me into this program six years ago to the month of the date of the defense of this document. Without you taking me on, I would have literally never have gotten the chance to make any of this happen. Thank you so much for getting it all started! To my dear friends in the SEP program… each of you helped keep me afloat in one way or another throughout this process. I treasured your friendship and support the whole way through and am so glad that our paths crossed when they did. To Ari… thank you so much for your help along the way during the multiple rounds of data analysis. Your feedback and perspective contributed so much richness to the data and I am forever appreciative of your willingness to help! To Sofia… there isn’t enough space to properly thank you for all you have done over the last six years. You’ve somehow always known how to push my buttons just the right way and, while it irritated me to the end of my wits at times, I’ve appreciated that so much. While you vii may have beaten me to the finish line on this by a couple years, we tied the race to the counseling masters, and I will hear nothing of it! To Erika… you have been my opposite since I met you. Through the significant differences in our personalities and thoughts about life, I can honestly say that your perspective has deeply widened mine. Thank you for that and for your ever continuing support! To Bobby… you were absolutely the perfect mentor to help get me through this program. You were there every time I needed you, even up until the submission of this document nearly a full six years after first taking me on. I appreciate you man. To Dr. Butryn and Dr. Semerjian, you both saw in me this possibility way before I even could even remotely see it for myself. Your belief and support started this process and at many times you both helped me see it through to the end. Thank you so much. To Zach, Kaylyn, Mike, and Lori… I can’t even begin to say how enormously lucky I am to have you in my life, to have experienced the love of your family, and to watch you spread that love to my son. I love you all so much. To Ken and Cindy… you’ve been part of my family for more than half my life and at some points there I think I may have accounted for more than half of your grocery bills! Thank you for your unending support as I whisked your daughter across the country, back, and then back again across the country to chase down this dream. I love you both so much. To my Mom and Dad… there isn’t enough space here to even remotely come close to expressing how much I love you both and how important your support has been throughout the entirety of my schooling. It would be an outright lie to say I was good student with any sense of direction student until way later in my life. Even so, you both pushed me and stood by me as I made one frustrating decision after another. Mom, it wasn’t until you pointed out to me that I viii could study and make a career out of sports that life started to finally make a little bit of sense. From there the rest, as they say, was history. To my loving wife Jordan… writing this is hard because I’m not even sure where to start. You’ve been my biggest cheerleader in the moments that I have been my biggest critic; my grounding point when my confidence has on occasion floated towards arrogance; and the anchor to our young family while I have been off on various adventures. You’ve done this so willingly and with so little resistance when you probably had every reason to along the way. Nevertheless, you have stood by my side from the beginning and have been my rock through it all. I would have never dreamed that this would have been our life path when I caught you staring at me in sophomore high school English all those years ago and I can’t wait to see what life brings us next. I love you. Lastly, to my son Max… I hope one day I can support you the same way these dear people above have supported me and hope you too find your team of people who will help you reach a goal you never thought possible. If there is anything I have learned from this process of school that I would like for you know, it is this… Life may not always make sense and sometimes internal sense of direction may be hard to come by; but if you focus on bringing your fullest self to the things that matter to you and march to a beat that maybe only you hear, things just seem to shake out in the end. And oftentimes in ways that you didn’t even know were possible. I never even remotely thought sport psychology would have any part of my life; and yet at this point in my life it is somehow it is exactly where I am supposed to be. I dedicate this dissertation to you. Introduction 1 Western foundations of psychological theory have a history of being rooted in European, ethnocentric assumptions (Parham, 2005). The various mental health disciplines, including sport and exercise psychology (SEP), have been critiqued and modified over the past few decades to better meet the needs of an increasingly diverse population. To address this, professionals from a variety of mental health disciplines are investing time and resources towards researching how culturally salient factors may influence clinical relationships and outcomes. One of the critical issues related to service delivery that has been demonstrated is the difference in client retention rates when the cultural background of the client and clinician differ from each other. Overall, about one out of five clients will terminate too early, regardless of identity and culturally salient factors (Swift & Greenburg, 2012). There is evidence, however, that clients identifying as Black, Indigenous, or People of Color (BIPOC) tend to terminate after the first session significantly more than white clients (Cooper & Conklin, 2015; Kilmer et al., 2019). A potential explanation for this discrepancy is that culturally incompetent mental health practitioners unknowingly micro-aggress during their sessions (Capodilupo, 2019). Further, an incomplete understanding of multicultural issues could lead clinicians to oversimplify cultural differences and make mistakes such as “sensitive stereotyping” (Kantos & Breland-Noble, 2002, p. 299) or “ethnic gloss” (Trimble & Bhadra, 2013, p. 500). Both terms refer to when a clinician or researcher falsely make a homogenous assumption about a racial and/or ethnic group. The professional discipline of psychology made significant strides in ratifying the importance of multicultural competency (MCC) by publishing multicultural guidelines three decades ago (APA, 1993). The design of these guidelines was significantly influenced by the work of Sue and his colleagues and their theoretical conceptualization of MCC (Sue et al., 1992). The American Psychological Association (APA) has revised their multicultural guidelines twice 2 more since 1993 to keep current with the latest multicultural research (APA, 2003, 2017). In general, contemporary MCC frameworks across the spectrum of mental health disciplines are informed by the tripartite model (Sue et al., 1992), which states that MCC is influenced by three factors: awareness, knowledge, and skills. In brief, culturally competent awareness is helping someone understand their own cultural identity and how it influences their interactions with the world, while culturally competent knowledge involves gaining an understanding of the rich variety of cultures and the ways in which those cultural worldviews influence peoples’ lives. Culturally competent skills refer to an individual’s capability to identify the appropriateness of interventions and adapt them to better meet the needs of those with relevant culturally salient factors (Sue et al., 2019). While the majority of professionals continue to use the tripartite model to define what is needed to become multiculturally competent, recently, researchers have suggested that the tripartite model can be supplemented with the development of a multicultural orientation, which includes the concepts of cultural humility (a lifelong commitment to the openness and willingness to reflect upon the cultural nature of ourselves and others), cultural comfort (a sense of non-defensive ease in discussing cultural conversations), and cultural opportunities (a willingness to discuss cultural conversations as they arise in session; Hook et al., 2013; Watkins et al., 2019). Recently, some scholars have begun questioning if cultural humility should supplant cultural competency as the aim of multicultural education in SEP (Curvey et al., 2022; Quartiroli et al., 2021). There is a historical pattern documenting a lack of consideration of culturally salient factors in SEP research (Duda & Allison, 1990; Ram et al., 2004) and in presentations at the annual conference of North America’s flagship sport psychology organization (Bejar et al., 2021; Kamphoff et al., 2010), the Association for Applied Sport Psychology (AASP). In response to 3 this recognition, a specialized sub-discipline of Cultural Sport Psychology (CSP) was formalized, and two critical texts were published (Ryba et al., 2010; Schinke & Hanrahan, 2009). These CSP scholars, in addition to the many others who contributed to the development of CSP, through their research and advocacy efforts—created the momentum needed to help the field move towards formally adopting cultural considerations into credentialling requirements. Unfortunately, there appears to be a subset of sport psychology professionals who report a general attitude of hesitancy regarding the integration of CSP’s findings into applied practice (Hacker & Mann, 2017; Quartiroli et al., 2021). Lack of pressure from the leading organizations had been speculated as a potential cause for the sub-standard priority of MCC in SEP (Lee, 2015). Partially in response to the criticism, AASP required a diversity/cultural competency course to have been completed at the graduate level in their updated certification standards in 2017. Furthermore, individuals looking to renew their certification are required to complete at least six continuing education credit hours every five years in diversity. Internationally, similar measures have been taken with organizations such as the International Society for Sport Psychology (ISSP) and European Federation of Sport Psychology (FEPSAC) by including cultural competency in their respective requirements for practice credentials. Since AASP and the international sport psychology community is beginning to formally ratify the importance of cultural competency proficiency in its certification programs, the attention now needs to be turned to examining the quality of the MCC education being provided. There has been research in the sister disciplines of SEP (e.g., psychology, counseling), showing ways in which those disciplines have approached the matter of training and education of MCC. In general, MCC educated through one or more of the following ways: taking and/or teaching 4 courses, attending and/or presenting at conferences, attending workshops, reading texts, and publishing manuscripts (Gillem et al., 2016). In the development of the Multicultural Counseling and Psychotherapy Test (MCPT), researchers suggested that all of these methods except for multicultural courses are correlated with the development of MCC (Gillem et al., 2016). The authors suggested that this exception may be due to the fact that all other options for training represent personal choices as opposed to requirements not necessarily borne of personal interest. Another possible explanation may reflect quality. The lack of congruence between multicultural courses and the development of MCC may be because the practice of multicultural pedagogy seems to emphasize only two-thirds of the tripartite model in practice. More specifically, researchers suggest a majority of faculty who teach about MCC tend to focus on multicultural awareness and knowledge but seem to under-emphasize multicultural skill development (Reynolds, 2011). This finding is of particular concern in SEP since the primary requirement for initial certification as a CMPC is a single course in the diversity domain. Findings from reviews of the effectiveness of MCC training and education have been mixed. One systematic review of the available psychology MCC training literature reinforces Reynolds’ (2011) findings, stating that MCC education and training only reliably increases multicultural knowledge (Benuto et al., 2018). Another more recent review found significant improvement across all facets of the tripartite model in the 37 studies it analyzed (Chu et al., 2022). Research conducted in these disciplines has relied on the application of several different self-report surveys such as the Multicultural Counseling Inventory (MCI; Sodowsky et al., 1994). For a full list of these types of instruments, see the extended review of literature in 5 Appendix C. It is not uncommon to see these self-reports also being used to assess MCC training effectiveness (Chu et al., 2022) in the clinical and counseling psychological fields. At the moment, however, it seems that graduate SEP programs are reticent to evaluate the development of MCC at all (Lee, 2015). For the few programs that do assess for development, evaluation took place through one-on-one meetings with the mentor and mentee, and/or through comprehensive exams. While there is a wealth of information about cultural competency in other fields and MCC momentum building in SEP, there is still a reported lag in SEP in MCC education when compared to psychology and counseling (Curvey et al., 2022). Given all the aforementioned factors and considerations, the purpose of the present study was to determine how a single course in MCC can be optimized, while the field as a whole continues its slow march towards the more favored integrated model whereby cultural considerations are more purposefully emphasized in each course of a program (Martens et al., 2000). Research Questions 1. What are the discrete learning outcomes that SEP educators should design this course around? 2. How can SEP educators assess the development of cultural competencies in this course? 3. How can multicultural skill development be more emphasized in this course? (See extended results) Research Design Methods The current study used the Delphi method to secure consensus among a group of experts by “structuring a group communication process” (Lindstone & Turoff, 2002, p. 3). When this 6 method was originally developed, Delphi “exercises” were conducted by hand in vivo. However, given the advent and widespread use of modern technology, the Delphi method is often conducted digitally through the internet. The Delphi method can be especially helpful when trying to secure consensus about a topic that is highly complex and/or assured to involve some level of disagreement that might hinder the communication process (Lindstone & Turoff, 2002) such as can be predicted in discussing multicultural competencies and education. Delphi studies have already been used in the past to address questions of multicultural competencies in other fields including, but not limited to, nursing (e.g., Jirwe et al., 2009), mental health (e.g., Baima & Sude, 2019), education (e.g., Sprott, 2014), and physical education (e.g. Wyant et al., 2020). Sampling and Recruitment Participants were purposely targeted through two main approaches. First, published articles were searched based on the terms “cultural competency”, “culture”, “cultur[sic]”, and “cultural sport psychology” in the title. These searches targeted publications that dealt exclusively with exploring general cultural competency in sport psychology applied practice. All published authors’ names were added to a database. Second, conference abstracts from major sport psychology conferences over the past five years were searched for presentations, sessions, symposia, workshops, etc. that focused on cultural competency in sport psychology applied practice. In addition, those who conducted more specific cultural competency work (e.g., papers related to a specific dimension of identity) were also noted. These presenters were then added to the database. Within the database, the professionals were scored based on their repeated appearances in the published literature and conference abstracts. Authors publishing or presenting directly on cultural competency education were scored with a two, whereas authors publishing or presenting on a culturally salient variable were scored with a one. The scoring produced a list of 316 authors and/or presenters with at least one entry. The 26 top scoring 7 authors/presenters were sent invitations to participate in the study as well as an additional seven authors/presenters scoring in the top 50 who the author recognized as having significant expertise which was not adequately reflected through the scoring system. From these 33 invitations, 14 responded with interest in participating. All but one of the 14 completed the informed consent and demographics collection survey, thus leaving the formal expert panel with a starting membership of 13. Participant Personal and Professional Demographics The personal demographics of the panel are presented here in a collective format to ensure panel member confidentiality. Panel member age ranged from someone in their mid 30’s to a panel member who identified their age as “65+”. The panel was comprised of five cisgender women, four cisgender men, one panel member who identified as genderqueer, and one panel member who identified as nonbinary. Racially, the panel was comprised of eight members who identified as white, one who identified as Black, one who identified as Asian, and one who identified as biracial. Ethnic identification of the panel members has been withheld for purposes of confidentiality. Panel member sexual orientations were composed of five who identified as gay/lesbian, four who identified as straight/heterosexual, one who identified as queer, and one who declined to respond to that question. The majority of the panel identified as either primarily sport and exercise psychology educators (n = 5) or as researchers (n = 3). The remaining three panel members identified as either an even combination of educator and researcher (n = 2) or applied sport psychology professional (n = 1). As a collective, the average professional experience spent researching cultural competency/diverse experiences in sport psychology was 15.09 years (SD = 9.08; range = 5 years – 31 years) and the average time teaching about cultural competency/diverse 8 experiences in sport psychology was 12.64 years (SD = 11.49; range = 0 years – 35 years). Lastly, three of the panel members reported ever having had the opportunity to teach a graduate course specifically with the purpose of enhancing cultural competency in sport psychology students, several reported having taught a continuing education course in this area (n = 6), and most had led at least one presentation at a conference in this area (n = 9). Data Collection Procedures The Delphi method often occurs in three rounds of data collection and data analysis. In this version of a Delphi study, a modified framework was adopted by using both Qualtrics and Word documents to gather responses from the expert panel asynchronously. Each data collection interval (i.e., round) was three weeks long followed by two weeks of data analysis in preparation for the next round. To prompt the completion of the surveys, members of the expert panel were emailed at regular intervals during each round. The present study finished with an attrition rate of 15.3% by having 11 out of 13 panelists finish. This rate compares favorably with previously published Delphi studies in this area which have ranged from 15-25% attrition through three rounds (Baima & Sude, 2019; Wyant et al., 2020). Round One In the first round of the Delphi process, the finalized panel of experts were provided with two open-ended questions and asked to provide up to 15 responses to each question. 1. In a graduate sport psychology course designed specifically to develop the cultural competency of its students, what learning outcomes would you choose to primarily design the course around? 2. In a graduate sport psychology course designed specifically to develop the cultural 9 competency of its students, what assessment types or strategies would you choose to measure the students for their learning progress in the course? Once responses from all 13 panel members were submitted, they were processed through a limited editing process with the assistance of a second researcher as demonstrated in Wyant et al. (2020). The following editing occurred: compound responses were broken into their component pieces, duplicate or near duplicate responses were removed, select words or phrases were edited to enhance clarity, erroneous defining information was removed, and a select few responses were recategorized as a learning outcome or assessment. At the end of the editing process, 70 learning outcomes and 32 learning assessments were generated. Round Two In round two of the Delphi process, the statements (referred hereto as items) were returned to the 13-member panel. The panel was asked to rate each item on two separate 7-point Likert-type scales from strongly disagree to strongly agree. The results from the Likert-type answers were the primary factor in determining consensus. Baima and Sude (2019) and Wyant et al. (2020) determined group consensus to have been obtained if the item reached an average greater than or equal to 6 on a 7-point Likert-type scale. In the present study, any item averaging a rating of 6 or above was considered to have reached consensus; any items that did not meet this benchmark were not considered to have met consensus. At the conclusion of this round, panelists were given an opportunity to add or revise items that may have been missed. In the present study, only two items were added at the end of round two; bringing the final total of learning outcomes to 71 and learning assessments to 33. Consensus in Delphi studies can take on different meanings in different studies. Often, 10 consensus will simply mean a rating of agreement between the participants (e.g. Jirwe et al., 2009). In the present study, participants rated each item relative to both impact (i.e., the capacity for this recommendation to make a positive change relative to the question) and feasibility (i.e., the likelihood that this recommendation could be effectively delivered and taught to sport psychology students within the constraints of a single course). Consensus was considered to be reached only if both ratings for impact and feasibility averaged above a 6 out of a possible 7. Items meeting consensus in only one dimension were considered to have met partial consensus and were tabulated as such in the results. Round Three In the third round, all learning outcomes and assessments were returned to the panelists alongside their personal ratings and the group rating for each item. The panelists were encouraged to reflect on the difference between their scores and the group cumulative score and from that reflective process, they were allowed to re-evaluate and re-rate these statements. Panelists were also encouraged to provide rationale into why their scores may have differed from that of the group’s. Panelists were provided the opportunity to add rationale to any item, but were specifically encouraged to add this rationale for any items where their score deviated from the group’s by more than 1.5 points. Of the 204 opportunities to re-rate an item, panel members averaged 7.18 re-rated items (range = 0-18). Lastly, panel members were asked to provide Likert-type scores for the two new items constructed in round two. Debriefing Round This Delphi study also included a structured debriefing round for the participants. After the conclusion of round three, final scores for all recommendations were calculated and the final 11 lists were organized. These final results were sent back to all participants along with a message of gratitude for their participation in the study. From there, participants were asked to complete an open-ended survey containing a few questions designed to illicit their thoughts about the results (see Appendix H). Because this fourth round was an organized debrief and not part of the active Delphi process, this round was not counted in the attrition rate for the Delphi study. However, some of the qualitative data generated from the debriefing round was used to illustrate the findings in the results. Nine of the final 11 members completed the debriefing survey. Data Analysis Quantitative data analysis was ongoing throughout the iterative process of completing the Delphi method by calculating average scores for both impact and feasibility. The final list of learning outcomes and assessments are organized in tables by the amount of consensus they reached (i.e., full, impact-only, feasibility-only, or none). Qualitative data collected on the third round of the survey from the panel about their justification for not ratifying one of the statements was descriptively coded and then inductively arranged into themes (Saldaña, 2016). The coding strategy of the qualitative data was designed to describe the panel’s more nuanced thoughts about MCC education in SEP and was not necessarily organized by the individual item that the participant was commenting on. The qualitative data corpus included 110 open-ended comments. These comments were parsed into 171 meaning units, refined into 111 distinguishable codes, then organized into 19 sub-themes, five themes, and lastly into two final super-ordinate themes. The entire process of the qualitative data analysis was conducted with a co-researcher over the course of five meetings. Results and Discussion 12 Consensus Achievement Learning outcomes and assessments were sorted based on whether they achieved full consensus, consensus in impact only, consensus in feasibility only, or no consensus at all. Eleven learning outcomes met full consensus (Table 1), 25 met consensus for impact only (Table 2), eight met consensus for feasibility only (Table 3), and 27 did not meet any consensus (see Table 1 in Appendix B). Of the 33 learning assessments: three met full consensus, one met consensus for impact only, 16 (Table 4) met consensus for feasibility only, and 13 (see Table 2 in Appendix B) did not meet any consensus. The three assessments that met full consensus were: Role play exercises that allow students to confront and challenge others using oppressive languages or actions (M-I: 6.38; SD-I: 0.77; M-F: 6.54; SD-F: 0.78), Develop interview guides/intake forms that are inclusive and gather cultural information about clients (M-I: 6.15; SD-I: 1.21; M-F: 6.15; SD-F: 1.07), and Complete a reflexive diary of own values, beliefs, and practices (M-I: 6.08; SD-I: 0.86; M-F: 6.23; SD-F: 0.73). The single assessment that met impact consensus only read: Shadow a professional working in a setting with students/clients that is different from student’s background and experience (M-I: 6.08; SD-I: 0.64; M-F: 4.92; SD-F: 1.04). The data show a notable pattern whereby the primary barriers in learning outcomes and assessments are opposite to each other. For learning outcomes, the primary barrier for an item to meet consensus was being considered a feasible option, whereas impactful learning assessments were much harder to come by. The primary barrier to feasibility for the learning outcomes is the time constraint imposed by a single course (discussed below). Findings related to the impact barriers associated with the assessments was much less clear. Input from the debriefing round of the survey was split between panel fatigue (given the length of the survey and multiple rounds) and the generally challenging nature of quality assessment relative to designing learning 13 outcomes. Tripartite Model and Full Consensus Items The text of the 11 consensus achieving learning outcome statements lean heavily towards the attitudes and knowledge subscales of the tripartite model (Sue et al., 1992). Notably missing are any learning outcomes directly representative of the skills subscale. Possible reasoning for the lack of skills is described later. However, an argument can be made that the fourth (“Apply learned concepts to various real-life scenarios”) and eleventh (“Articulate ways they can become more culturally competent practitioners”) consensus achieving learning outcomes can include portions of skill development depending on the ways learning outcomes are designed to be met in the course. Interestingly, the three consensus achieving learning assessments were equitably distributed across the tripartite model. The development of an interview guide can be considered an exercise in developing knowledge, the completion of a reflexive diary can be considered an exercise in developing attitudes, and role play of confronting others can be considered an exercise in developing skills. Commentary provided in the debriefing round helped illuminate the reasons for why multicultural competency skills seems to be largely absent from the consensus achieving learning outcomes. Reports from the panel indicated that multicultural competency skills are not aimed at or considered to be feasible due to a lack of time given to multicultural development with respect to the entire program. If the prevailing assumption is that a student comes into the course without stable footing in multicultural competency knowledge and multicultural competency awareness, then those must be addressed first since multicultural competency skills requires a foundation in the former two. This hierarchical approach to MCC development has been described in the 14 literature before. Wells (2000) described a six-stage developmental process ranging from cultural incompetence to cultural proficiency. The author’s stages reflect that knowledge and awareness necessarily come before culturally competent skills and the present study’s results seem to corroborate that. The present study indicated that multicultural competency skills outcomes are perceived to be extremely impactful, however, not feasible in a single course. For example, a review of the 25 learning outcomes that met impact consensus only (Table 2) shows several potential learning outcomes that are skill-based or somewhat skill-based in their aim. This criticism of time constraints of the current education model for MCC development in SEP will be revisited in the qualitative analysis below. Additionally, this uneven attention of the constructs of the tripartite model in education and training has been documented in sister disciplines (e.g., Reynolds, 2011) and is not necessarily a specific criticism of SEP curricula. Issues of Debate Among Panelists Standard deviations were calculated for all items (impact and feasibility individually) as a measure of how contested an item was among the expert panel. A selection of the highest standard deviation of each (learning outcome – impact; learning outcome – feasibility; learning assessment – impact; and learning assessment – feasibility) as well as the lowest rated item for each are presented here to illustrate some of the disagreement among the panel. The item with the highest standard deviation for learning outcomes for impact scores was: Describe the philosophical underpinnings of knowledge (M-I: 4.62; SD-I: 2.10). This same item was also the lowest rated item for impact overall and the highest standard deviation for feasibility (SD-F = 1.75). The lowest item rated for feasibility was “Demonstrate effective skills to appropriately handle situations involving cultural differences” (M-F: 4.08). 15 Some members of the panel questioned the placement of the learning outcome (“Describe the philosophical underpinnings of knowledge”) within the scope of this course, and hoped that these concepts would be, “initiated, addressed, or reinforced in other courses as well, such as qualitative methodologies or philosophy courses.” However, several other of the panel urged educators to consider how having a fundamental grasp of the philosophy of knowledge necessarily impacts the way in which we interact with our clients. One member wrote: I think it is paramount to be able to have a clear understanding of the ontological and epistemological framework leading our work. Such knowledge helps us to be aware of how we engage with our client. For example, do we see multiple realities as coexisting? Do we believe in one reality that can be experienced in different ways? Do we believe in one reality and in one way to understand it? All these approaches impact the work we do. This disagreement will be further highlighted in the thematic analysis that follows. Other items that generated significant open-ended input and debate were “Engage in exploration and commitment to one’s cultural background” and “Be able to work with people of different cultures”, both of which solicited the voluntary input of five of the 11 members. The learning assessment item with the highest standard deviation for impact was “Participate in a cultural activity that is different from the learner’s cultural identities” (M-I = 5.00; SD-I = 1.91). The lowest rated item for impact overall was “Show an understanding of cultural competency issues via exam questions” (M-I = 3.69). The learning assessment item with the highest standard deviation for feasibility was “Complete quizzes on language and concepts associated with cultural competency” (M-F = 6.15; SD-I = 1.77). The lowest rated item for feasibility was “Do sport psychology work with a population that is largely different from student’s background; write a scholarly and culturally informed reflection paper about the 16 experience” (M-F: 4.31). Thematic Analysis of Round Three Open Comments The open-ended comments from the panel in round three were qualitatively analyzed and organized into two superordinate themes, five themes, and 19 subthemes. The full thematic map is presented in Table 5. A large proportion of the commentary was dedicated to critiquing the single course approach to MCC education in SEP; this commentary is reflected in the first two themes presented below. Additionally, a significant portion of the comments were directed at reflecting upon MCC education overall which are reflected in the final three themes. Single Course Critiques One of the most frequently communicated comments directed throughout the whole process of the study was that the panel wanted to ensure that they were heard that the single course model of MCC education was simply not enough to make any significant and lasting progress in developing MCC in SEP students. This opinion is not overwhelmingly surprising given that the single course model was identified as a sub-optimal strategy over two decades ago (Martens et al., 2000). Specifically, the panel felt as if three areas could not be adequately addressed in a single course. First, the panel voiced their opinion that several broad topics (e.g., developing the capability to create inclusive spaces; identifying the differences in norms, beliefs, values, and perceptions between cultures; and understanding the nature of structural discrimination in sport and education) could simply not be done justice in such a short amount of time. The natural consequence of this is that SEP students could be exposed to MCC education that is not adequately deep enough or substantially biases some topics in MCC education over others. Indeed, there is evidence in the MCC training literature that suggests there is already a bias towards training about race/ethnicity, sexual orientation, and more general multicultural 17 identity information and a dearth of trainings that adequately discuss gender, religion, ability, and socioeconomic status (Chu et al., 2022). Further, the bias towards discussing and/or assessing the knowledge and attitudes components over the skills component has likewise been documented (Benuto et al., 2019; Reynolds, 2011). Second, the panel also noted that MCC skill development could not occur in a single semester course either, with several of the panel members explaining later in the debriefing round that skill development requires a strong foundation of MCC knowledge and awareness. One panel member expressed: Skill development requires more than a semester. If programs are only allotting one course to develop multicultural competency, which most programs seem to be, then the focus will remain on knowledge and awareness. This is why it is important to have the development of cultural competency imbedded in the full program so that these skills can be developed throughout a degree program. As mentioned before, this hierarchical theorization of cultural competency development has been previously described (Wells, 2000). To that end, it is possible the uneven application of the tripartite model in MCC education and training may be less a reflection of instructor or curriculum deficiencies, and more a factor of limited time to work through the hierarchy as needed. Lastly, the panel emphasized the importance of “personal” or “reflective” work to develop MCC. This type of work was also something that the panel felt was limited in the span of only one semester. Single Course Opportunities 18 The main purpose of this study was to identify the ways in which the effectiveness of a single course of MCC development in SEP could be maximized. While the prevailing opinion of the panel was that a single course is insufficient in MCC development, the reality is that few programs exceed this model (Lee, 2015) and fewer still reach the preferred integrated model proposed by Martens and colleagues (2000). With that in mind, the panel highlighted several critical opportunities available in a single-course model. First, the panel noted that a single course could be a dedicated platform for which a student could begin their personal journey into MCC. The panel felt that even though a single course was generally insufficient, the dedicated course represented an opportunity to build the foundation to begin the process of MCC development. In support of this point, the idea of a single course serving as a starting point was consistent throughout many of the comments made in both round three and the debriefing round. Second, the panel shared that a single MCC course could help students make reasonable progress towards developing the knowledge and awareness components of the tripartite model. Lastly, a couple of the panel members reported that a possible objective that could be met is the development of learning skills to continue self directed MCC learning and development throughout their careers. The single course as a standalone approach is clearly insufficient. However, the desire for such a course by SEP students, especially early in the graduate program, has been documented in the literature (Curvey et al., 2022). From this insight of the panel, it is clear that a goal of this course must be to help the student understand that this is a process that lasts well beyond a semester and to teach the tools necessary to do the on-going learning required. Previous SEP scholars have advocated that, “sport psychology instructors should aim to instill values related to lifelong learning, multiculturalism, and social justice” (Curvey et al., 2022, p. 14) which is 19 echoed in these findings. Points of Emphasis for MCC Education in SEP In addition to providing input pertaining to a single multicultural competency course, the panel also provided a significant amount of insight into the nature of MCC education in sport and exercise psychology. These insights were broken into three categories: (1) points of emphasis, (2) challenges, and (3) points of uncertainty. In the first category, the panel centered their commentary on five different things to emphasize while teaching MCC in SEP. First, the panel directed a good portion of their focus on the importance of transformational learning while teaching MCC over memorization-based learning. To that end, members of the panel suggested that active, more applied learning could be effective in creating more lasting MCC changes in students. A limited investigation of different styles of teaching activities in MCC education has been explored in a review, but the effectiveness of one activity over another is unclear with the limited evidence available to be reviewed (Benuto et al., 2018). Second, members of the panel stressed that learning outcomes and assessments need to be clearly defined and explained. At times, some panel members seemed unsure of what another panel member had suggested as a learning outcome or assessment. To that end, making sure that learning goals and the language used to discuss MCC topics are made clear is imperative. Third, the panel stressed that MCC education needs to focus on not only being a space to begin personal work and reflection, but to create a space where personal work and reflection are lasting outcomes. The importance of reflectivity and reflexivity have been discussed in the literature previously for its importance (Curvey, 2022; Schinke et al., 2012) and has been theorized into a SEP specific model (Terry, 2009) which makes this recommendation well suited to emphasize 20 throughout the course of MCC education in SEP. Fourth, members of the panel emphasized that critical pedagogy—as it pertains to the practice of sport and exercise psychology—must be central to the learning of MCC. Examples of this included nuanced discussions of power, oppression, and privilege, as well as interrogations of psychology’s western foundation of practice. Lastly, members of the panel stressed that an aim of MCC education should be inspiring life-long learning, development, and assessment of oneself. The panel was abundantly clear that a single course would never be fully sufficient to develop MCC, however, if the course could inspire students to continue their own learning after completing the course, then the course could be seen as more successful in meeting its primary goal. Challenges in MCC Education in SEP Given the panel’s many collective years of expertise, they also detailed a series of challenges they have recognized and/or encountered in the education of MCC in SEP students. First, the panel pointed to a series of constraints of the present educational model that limits the ability to fully educate an SEP student about MCC. One of these limits is the perceived emphasis on momentarily retaining rote knowledge for the purposes of passing an exam and, thereby, the course. This issue can set the stage for performative MCC practices from the student for purposes of passing the course, but not necessarily retaining the skillset to be used later. One panel member pointed out that MCC is “not a check box” and cannot be treated as such. Panel members suggested that lasting MCC development can be more readily achieved if abundant time was dedicated to it in additional courses and practicum or internship programs; or, better yet, lasting MCC development could be integrated across the entire scope of the program as described in Martens et al. (2000). Second, panel members spoke to the inherent complexity of 21 MCC education and spoke truthfully about the difficulty of not only teaching this area, but for students to meaningfully engage with the personal work required to start becoming more MCC. One panel member spoke about this, and the further inherent difficulties of shifting from theory to practice when discussing one of the learning outcomes: To implement these strategies, the practitioners must have first engaged in personal and professional work leading them to understand that the lack of inclusion and adversity toward diversity actually exist and that they play a role in it. This is not a simple journey. While I wish this was something easily implementable, the reality [is] that once we practitioners are asked to make the switch between theory and practice, we do struggle… This difficulty in actively engaging with MCC education has been described previously. Sue et al. (2019) wrote extensively about the wide range of expected cognitive, emotional, and behavioral resistance that a new student might experience when first coming across MCC education. The authors likewise noted that exploration of this resistance is part of the education process as well. Third, panel members reported that a primary challenge they have faced is that there is simply not enough time in the current model of MCC education to provide the requisite amount of practice necessary to become MCC. Some of the panel members spoke about MCC with taxonomical language, suggesting that there are a series of steps required to becoming more MCC. If students are coming into graduate programs with limited MCC knowledge and awareness, then the emphasis of the education has to be placed there. However, as mentioned earlier, MCC skills can only be developed once there is a stable foundation of knowledge and awareness, leaving no time to learn or practice MCC skills. Lastly, a few of the panel members 22 reported a challenge of there simply not being enough SEP professionals or mentors with MCC expertise to deliver quality learning experiences at the graduate level. The mentorship component is particularly concerning given that quality of the similar process of supervision in clinical psychology has been closely connected to overall student satisfaction of their cultural competency training (Benuto et al., 2019). Work investigating MCC development through SEP mentorship is substantially limited and the findings are not promising as results seem to indicate that SEP trainees are largely dissatisfied with the MCC component of the mentorship they receive (Foltz et al., 2015) and that it is largely absent from the process (Fogaca et al., 2018). Points of Uncertainty Lastly, the panel itself presented a variety of MCC opinions that either stood alone or were debated amongst the members of the panel throughout the Delphi process. These deliberations were organized into three subthemes. First, there were general, individual perspectives of MCC education. A few of these comments were emblematic of recent shifts in culturally competent practices. For example, one member pointed out that “safe spaces” were being phased out in favor of the more realistic “brave spaces” (see Arao & Clemens, 2013) for more on that reconceptualization) within the context of one of the proposed learning outcomes. However, several of these standalone comments raised critical questions that could use further introspection in future studies. An example of two of these comments included questions about the critical role of foundational counseling skills in MCC, and cultural variability in what is and is not considered effective assessment. Second was the argument surrounding the role of philosophy of knowledge in the course. As mentioned earlier, this single outcome generated substantial debate among the panel members. In no certain order, panel members in favor of integrating the philosophy of knowledge into the course stated that if someone comes to better understand knowledge, they 23 will also: better understand privilege and oppression, feel an influence in their applied work and client engagement, recognize what is considered “truth”, and better understand how something becomes the status quo. Indeed, this complexity of MCC founded more deeply in these philosophical tenets of CSP has been forwarded as a possible explanation of the resistance to incorporating CSP more widely (Hacker & Mann, 2017). Nevertheless, understanding the basics of the philosophy of knowledge opens up opportunity to discuss more nuanced concerns such as how to rectify the tensions between evidence-based practice in mental health care and cultural competency (Kirmayer, 2012). Lastly, there was a subset of responses throughout the open-responses that cautioned educators about the potential risks of traditional cultural exposure projects, cautioning others that these types of projects can be, “…harmful and dehumanizing to the exposed “cultural other.” This theme included a powerful comment that stated, “Traditionally marginalized communities do not exist to serve as educational material.” Limitations Every study has its limitations. A limitation of this study, and all studies using the Delphi method, is that the final results are only reflective of the panel sitting on the study. It is not only possible, but likely that a different group of people would have ranked these items differently. However, it is unlikely that another sample would have exceeded the total quantity and quality of experience of this group of professionals. Further, a different panel may have created similar items using different language or different items entirely. Another limitation of this study was in its attempt to focus on two separate—but connected—topics in learning outcomes and assessments combined. This factor, paired with the lengthy nature of a Delphi study, and the depth of responses provided panel members may have led to fatigue, specifically towards 24 questions about assessment which were always the second portion of the survey. Similar studies in the future should either split the topics into separate studies or counter-balance the design of the Delphi surveys. Practical Implications The primary implications of this study are threefold. First, it remains clear that opportunities for full-scale graduate education in this area remains few as even a paucity of the panel members reported ever having done that. For sport psychology educators on the fence about deploying such a course, the learning outcomes in Table 1 and assessments in Table 4 can provide a vetted roadmap to start the design process of the course. Second, for those who are not yet able to deploy a full course, they are invited to pick one or two of the learning outcomes or assessments to integrate into their existing courses. And third, it is hoped that the findings of this study can help continue a conversation about cultural competency education in SEP among our graduate students. Specifically, a discussion about the ways in which we can continue to advance towards the integrated model proposed by Martens and colleagues (2000) must continue. A critical theme of these panel findings and discussions was the need for time to develop MCC and the lack of time that is presently provided for it. Addressing this logistical shortcoming remains a key consideration for all SEP graduate program administrators and faculty to take under advisement. Conclusion The purpose of this study was to secure consensus about how to optimize an MCC course in SEP. Through the reflections of 11 expert professionals, a series of agreed upon learning outcomes, learning assessments, and a subset of reflections about how to enhance MCC education have been forwarded. Patterns in the results indicate that time allotted for a single 25 course may not be enough to develop robust MCC. However, careful design of this course can promote a lifelong pattern of learning that can help a SEP student continue quality self-directed learning. It is hoped that these results will both develop the quality of multicultural competency education provided at the graduate level as well as continue a conversation about how to better strengthen multicultural competency education overall in graduate programming. References 26 American Psychological Association (1993). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. American Psychologist, 48, 45 48. American Psychological Association (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377-402. https://doi.org/10.1037/0003-066X.58.5.377 American Psychological Association (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. Retrieved from: http://www.apa.org/about/policy/multicultural-guidelines.pdf Arao, B., & Clemens, K. (2013). From safe spaces to brave spaces: A new way to frame dialogue around diversity and social justice. In L. Landreman (Ed.), The art of effective facilitation (pp. 135-150). Stylus Publishing. Baima, T., & Sude, M. S. (2019). What White mental health professionals need to understand about whiteness. A Delphi study. Journal of Martial and Family Therapy, 46, 62-80. https://www.doi.org/10.1111/jmft.12385 Bejar, M. P., Shigeno, T. C., Larsen, L. K., & Lee, S. (2021). The state of diversity in the Association for Applied Sport Psychology: Gaining momentum or still swimming upstream? Journal of Applied Sport Psychology. 1-15. https://www.doi.org/10.1080/10413200.2021.1913452. Benuto, L. T., Casas, J., & O’Donohue, W. (2018). Training culturally competent psychologists: A systematic review of the training outcome literature. Training and Education in Professional Psychology, 12(3), 125-134. https://doi.org/10.1037/tep0000190. 27 Benuto, L. T., Singer, J., Newlands, R. T., & Casas, J. B. (2019). Training culturally competent psychologists: Where are we and where do we need to go? Training and Education in Professional Psychology, 13(1), 56-63. http://dx.doi.org/10.1037/tep0000214. Capodilupo, C. M. (2019). Microaggressions in counseling and psychotherapy. In D. W. Sue, D. Su

How do college student-athletes’ understanding and expectations of mindfulness and self-compassion change through an intervention? How do college student-athletes’ understanding and expectations of mindfulness and self-compassion change through an intervention? of mindfulness and self-compassion change through an intervention? Blake Costalupes West Virginia University, bc0104@mix.wvu.edu Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Cognitive Psychology Commons, and the Sports Studies Commons Recommended Citation Costalupes, Blake, "How do college student-athletes’ understanding and expectations of mindfulness and self-compassion change through an intervention?" (2023). Graduate Theses, Dissertations, and Problem Reports. 11748. https://researchrepository.wvu.edu/etd/11748 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. How do college student-athletes’ understanding and expectations of mindfulness and self compassion change through an intervention? Blake Costalupes, M.A. Dissertation submitted to the College of Applied Human Sciences at West Virginia University School of Sport Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Sam Zizzi, Ed.D., Chair Dana K. Voelker, Ph.D. Monica Leppma, Ph.D. Melissa Sherfinski, Ph.D. School of Sport Sciences Morgantown, West Virginia 2023 Keywords: mindfulness, self-compassion, qualitative research Copyright 2023 Blake Costalupes Abstract How do college student-athletes’ understanding and expectations of mindfulness and self compassion change through an intervention? Blake Costalupes In the last two decades, mindfulness has permeated sport, exercise, and performance psychology (SEPP). Mindfulness research in SEPP primarily focuses on the efficacy of manualized protocols on various outcomes related to performance and wellbeing; how athletes understand this complex construct, though, is largely unexplored in the literature. Additionally, some researchers suggest that the potentially paradoxical adoption of mindfulness in Western psychology may be contributing to limited outcomes, low engagement in, and poor adherence to mindfulness-based interventions (MBIs). In addition, the exploration of self-compassion as a mechanism for change through mindfulness practice has increased in recent years, making it an important component to consider. The purpose of the present study was to investigate what college student-athletes (SAs) expect to gain from participating in a MBI, how they understand the concepts of mindfulness and self-compassion, and how these expectations and understandings change from beginning to end of an intervention. Intervention supported shifts in understanding were viewed through a constructivist-interpretivist lens. Individual interviews (n = 42) were conducted with all SAs on an NCAA DII swim team at the beginning and end of a 7 week MBI. Reflexive thematic analysis revealed multiple levels of change across members of the team, indicating that expectations may be tied to outcomes, and understanding may be a limiting factor for perceived outcomes. Results provide some evidence that SA expectations and understanding of mindfulness and self-compassion may be related to ambiguity caused by the blending of traditional Eastern mindfulness with Western psychological interventions. Keywords mindfulness, self-compassion, qualitative research, understanding, expectations, intervention MINDFULNESS AND SELF-COMPASSION iii Acknowledgements I have many individuals for whom I am extremely grateful for their unconditional support through the process of this doctoral degree. First, I would like to thank Dr. Zizzi – your sustained guidance and ability to hold perspective, positive regard, and see both sides of the fence have been, and will always be, incredibly important to me. Thank you for your mentorship, and the lasting impact you have made in my life. It is, in fact, the best day of the year. Thank you to my wonderful cohort. To Tommy – thank you for allowing me to be of witness to your unparalleled persistence, work ethic, and acceptance toward others. I would absolutely not have completed this journey when I did without your help. To Luna – thank you for your friendship and for being a voice of comfort and reason when I needed it most. I will be forever grateful. Thank you to all my friends, colleagues, and mentors in the SEPP program at West Virginia University. The culture of this program got me in the door, it fueled me the last four years, and it will be something I miss and cherish forever. Programs such as this are only as good as the people that make it, and I can only hope that others get to keep experiencing this as well. Lastly, thank you to my family. To Audrey – thank you for your unconditional love and support, for picking me up when I fall down, and enduring my struggles at every step of the way. To mom and dad – thank you for your continued support and allowing me to persist in my dreams. To Brock – thank you for testing the way, making me feel that I had a place in higher education, and lighting the fuse for what I thought possible for myself. MINDFULNESS AND SELF-COMPASSION iv Table of Contents How do college student-athletes’ understanding and expectations of mindfulness and self compassion change through an intervention? ................................................................................. 1 Methods........................................................................................................................................... 7 Design.......................................................................................................................................... 7 Paradigm...................................................................................................................................... 7 Research Team Positionality ....................................................................................................... 9 Participants and Recruitment .................................................................................................... 10 Data Collection Instruments ...................................................................................................... 12 Demographics and Expectations ........................................................................................... 12 Interviews .............................................................................................................................. 13 Mindfulness Intervention ....................................................................................................... 14 Pilot Intervention ................................................................................................................... 15 Procedure ................................................................................................................................... 16 Data Analysis ............................................................................................................................ 18 Trustworthiness ......................................................................................................................... 20 Results and Discussion ................................................................................................................. 20 Change in Expectations ............................................................................................................. 21 Change in Mindfulness.............................................................................................................. 25 Change in Self-Compassion ...................................................................................................... 28 Limitations and Future Directions ................................................................................................ 32 Summary and Conclusion ............................................................................................................. 33 Literature Review.......................................................................................................................... 35 Mindfulness ............................................................................................................................... 35 Mindfulness - What is it? Where did it come from, and how did it get here? ....................... 35 Mindfulness-Based Interventions outside sport .................................................................... 38 Mindfulness-Based Interventions for Sport ........................................................................... 41 Self-Compassion ....................................................................................................................... 47 Self-Compassion in Sport ...................................................................................................... 50 Combining Mindfulness and Self Compassion ..................................................................... 54 Expectations and Experiences of MBIs .................................................................................... 57 References ..................................................................................................................................... 61 MINDFULNESS AND SELF-COMPASSION v Tables ............................................................................................................................................ 74 Demographics and Expectations Questionnaire ........................................................................ 77 Part 1. Tell us a little bit about yourself and your sport experiences .................................... 77 Interview Guide (T1) ................................................................................................................. 79 Interview Guide (T2) ................................................................................................................. 81 Extended Methods ..................................................................................................................... 84 Researcher Positionality ........................................................................................................ 84 Extended Results ....................................................................................................................... 87 Time 1: Beginning of Intervention ........................................................................................ 87 Time 2: End of intervention................................................................................................. 102 MINDFULNESS AND SELF-COMPASSION 1 How do college student-athletes’ understanding and expectations of mindfulness and self compassion change through an intervention? In recent decades, the concept of mindfulness has been increasingly adopted by Western psychology. As a concept and practice, mindfulness dates back thousands of years and is rooted in Eastern (e.g., Hindu and Buddhist) philosophical teachings. This migration of mindfulness from east to west is due, in part, to Jon Kabat-Zinn and Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1982), which was designed to mitigate human suffering through an eight week manualized training. MBSR demonstrates efficacy in improving wellbeing in a variety of settings with diverse populations (Haller et. al., 2021; Kabat-Zinn et. al., 1985; Zhang et al., 2019; Zou et al., 2020;). Researchers in the field of sport and exercise psychology (SEP) have similarly adopted mindfulness for use in enhancing wellbeing and performance among sport participants. For example, Noetel et al. (2019) conducted a systematic review of mindfulness based interventions (MBIs) in SEP and found that such approaches can promote flow states and anxiety reduction. Moreover, Wang and colleagues (2023) meta-analyzed existing randomized trials including MBIs, with the most compelling evidence suggesting that MBIs can promote aspects of mindfulness, flow states, and psychological flexibility—though only 32 studies were included and little research exists suggesting practicing mindfulness directly improves sport performance. Although promising results have been found regarding MBIs in sport, some critiques should be noted. Current reviews and commentaries have questioned the rigor of MBI research in SEP (McAlarnen & Longhshore, 2017). Specifically, much of the mindfulness literature in SEP, and in general psychology, consists of small sample sizes with varied effects, inconsistent outcomes, few randomized controlled trials, lack of replicability, and ambiguous language MINDFULNESS AND SELF-COMPASSION 2 surrounding terms like mindfulness and meditation (Noetel et al., 2019; Van Dam et al., 2018). Additionally, some authors suggest that engaging in mindfulness practices can lead to adverse effects (AEs) for some individuals (Farias et al., 2020). Additionally, some studies show that athletes completing an MBI report difficulties with lack of immediate results and feeling uncomfortable during meditation practices (Cote et al., 2019), or show decreases in performance (Zadkhosh et al., 2018). and a more realistic, less dogmatic interpretation of potential benefits of the practice is needed particularly given what extant literature communicates (Britton et al., 2019; Van Dam et al., 2018). In addition to inconsistent research quality, possible AEs, and lack of research suggesting MBIs directly increase performance, some have suggested that the very nature of mindfulness in in SEP may be “paradoxical” in that it is being integrated into a cultural paradigm that is focused on controlling specific outcomes—like sport performance (Andersen, 2020). Further, Roychowdhury et al. (2021, p. 2) discussed the “transnational migration” of mindfulness from ancient Indian Hinduism and Buddhism to the modern Western view. The authors suggested that traditional aspects of mindfulness teachings that may result in greater benefits could have been lost as a result of the reappropriation of mindfulness in the modern, outcome-focused conceptualization. These traditional teachings of mindfulness include letting go of ego, embracing impermanence, practicing nonjudgement of thoughts and feelings, and acceptance and compassion towards self and others, which may contrast with how mindfulness may be marketed in the West (Andersen, 2020). Although both Eastern and Western conceptualizations of mindfulness are aimed at easing human suffering, the mechanisms for achieving this may be distinctly different and perhaps even conflicting. Further, current framing of mindfulness in Western-based interventions may limit the benefits participants could gain from a fuller MINDFULNESS AND SELF-COMPASSION 3 understanding of traditional mindfulness (Andersen, 2020; Khong 2009, 2021; Roychowdhury et al., 2021; Segall, 2021). To fully discern the effects of these two distinct conceptualizations of mindfulness, it may first be important to assess what concepts are most salient to those practicing with little to no formal experience or understanding. Becoming aware of ones’ baseline conceptual understanding, and how it changes through practice, may be foundational in determining how mindfulness ‘gains’ are realized and implemented in various life domains. Although experts in SEP and related fields are integrating mindfulness consistently, little research has investigated what conceptual components of the practice actually mediate or moderate changes related to wellbeing and performance. Some promising descriptive research, however, may provide insights into how mindfulness connects with outcomes related to performance and wellbeing. For example, self-compassion has been noted in the literature as one of the core concepts of, not separate from, mindfulness (Khong, 2021). Mosewich et al. (2013) observed significant improvements, with moderate-to-strong effects, in rumination, concern with mistakes, and self-criticism among female athletes who engaged in a self-compassion intervention compared to controls. Additionally, Lyon and Plisco (2020) explored cross-sectional associations between self-compassion, mindfulness, dispositional flow, and sport anxiety among elite athletes. Results indicated that self-compassion significantly predicted athletes’ levels of flow beyond the predictive value of mindfulness. The combined effect of mindfulness and self compassion accounted for 27% of the variance in participants' flow state experience. These studies indicate that self-compassion may play a role in enhancing the sport experience by decreasing disruptors of performance and wellbeing. Specifically, self-compassion may interrupt negative thinking by helping individuals to practice mindful awareness and self-kindness rather than self-criticism or mechanisms for stopping or controlling thoughts. Of note, MBI research in MINDFULNESS AND SELF-COMPASSION 4 SEP with prominent programs such as Mindfulness, Acceptance, and Commitment (MAC; Gardner & Moore, 2004) and Mindfulness Sport Performance Enhancement (MSPE; Kaufman et al., 2009) have not explored self-compassion as a moderator of MBI effectiveness (with the exception of Pineau, 2014). Although self-compassion may be a crucial element of Eastern mindfulness, it is often excluded from MBI research in sport and treated as a distinct construct. However, the research investigating the relationship between mindfulness and self compassion in SEP is emerging, and it presents an argument for its important role in wellbeing and performance outcomes. The construct of self-compassion has been defined in Western psychology by Neff (2003) as, “being touched by and open to one’s own suffering, not avoiding or disconnected from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness” (p. 87). Further, Neff’s conceptualization of self-compassion includes three main components, namely, self-kindness (employing a warm and nonjudgmental nature to self), common humanity (normalizing adversity and perceived failures as part of the human condition), and mindful awareness (being open and accepting to thoughts and feelings that arise). Further, this conceptualization of self-compassion has been investigated as an attitude that can be developed over time (Ingstrup et al., 2017; Doorely et al., 2022; Mosewhich et al., 2013; Reis et al., 2015; Voelker et al., 2019). Although some interventions outside of sport exist to teach self-compassion (Neff & Germer, 2013), there is only one sport MBI that highlights compassion as a key theme. The Mindfulness Meditation Training for Sport 2.0 program (MMTS; Baltzell & Summers, 2018) was developed to promote mindfulness and self-compassion among sport participants. Most research investigating this program has been qualitative in nature, and explored experiences of student-athletes (SAs) after having completed the MMTS 2.0 program—with a specific focus on MINDFULNESS AND SELF-COMPASSION 5 self-compassion (e.g., Cote et al., 2019; Baltzell et al., 2014; Baltzell, 2015). Overall, participants across MMTS 2.0 studies noted that the program was enjoyable and helped them learn emotion regulation strategies. However, the results also showed that the athletes struggled with meditation at times, had low fidelity to engagement outside of sessions, and felt confused about the application of meditation to sport performance (Cote et al., 2019; Baltzell et al., 2014). One study investigating coaches’ experience in the intervention noted that they viewed the program as a useful means of mental training but were unable to attribute any positive changes in their athletes directly to the intervention (Baltzell et al., 2015). No qualitative research has explored the changing conceptual understanding, and how perceptions differ from pre- to post intervention. Although investigating the experience of athletes completing MBIs is important, mindfulness literature in sport has been focused predominantly on outcomes and program evaluations. Although important, this focus on outcome studies may be limiting the full understanding of for whom, and why, mindfulness is effective or ineffective. A few recent studies, however, have investigated participants’ expectations and understanding of mindfulness. For example, Mistretta et al. (2017) asked 45 college SAs to state their top three expectations before completing the MSPE program. The athletes indicated that they expected to gain benefits related to mental toughness, self-regulation of mood, stress, and anxiety, and overall increases in sport performance. Similarly, Tifft et al. 2022 conducted a cross-sectional study with college students (n = 98) and gathered information related to their expectations for mindfulness practice. Although outside of sport, they found that those who were interested in outcomes related to self regulation and control, such as getting rid of or reducing anxiety, achieved less effective results and reported greater negative affect, depression, and anxiety than those seeking to learn about MINDFULNESS AND SELF-COMPASSION 6 things like acceptance and nonjudgment (Tifft et al., 2022). These studies highlight that expectations among participants for mindfulness practice may affect outcomes. Specifically, it is possible that expectations about control over thoughts and feelings may conflict with mechanisms of change in mindfulness practice surrounding acceptance and letting go. It may be important for practitioners, then, to seek to assess for participants’ understanding of mindfulness and the mechanisms that may be involved in positive change through practice. Although few studies exist investigating participant understanding of mindfulness, Goisbault et al. (2022) conducted a study with 40 elite French female basketball players (M = 16.33 years old) after completing a 15-week MBI. Post-MBI participant interviews revealed that the athletes’ understanding of concepts like acceptance, stress, and satisfaction were related to positive improvements in those areas and changed during the intervention. Additional research that explores the connection between athletes’ understanding of mindfulness and intervention outcomes is necessary to document these potential moderating effects. In sum, the post-intervention experiences of athletes participating in MBIs has been studied with some frequency. What is missing from the literature is an understanding of how participants’ understanding of mindfulness changes over time; specifically, no studies have jointly explored what athletes expect to gain from MBIs, how athletes understand mindfulness and self-compassion conceptually, and how these connect to their changing understanding of these concepts. The connection between expectations and understanding of mindfulness and self compassion may be foundational to understanding how and why MBIs are effective or ineffective. It may also help practitioners learn how to best frame and implement mindfulness and self-compassion practices with athletes relative to the outcomes they are looking to achieve. MINDFULNESS AND SELF-COMPASSION 7 To address these gaps, the primary purpose of the present study was to investigate college SAs’ expectations and understandings of mindfulness and self-compassion before and after a MBI. The MBI, adapted from MMTS 2.0 and combined with other MBI protocols in sport, was implemented as part of a larger study investigating the connection between mindfulness and thriving. The research questions in the present study were: (1) What do SAs expect to gain from completing a mindfulness and self-compassion intervention? (2) How do SAs understand mindfulness and self-compassion? (3) How do expectations and understandings of mindfulness and self-compassion change as a result of participating in a MBI, if at all? Methods Design This study was conceptualized as a qualitative examination of an intervention supporting shifts in participants’ expectations and understandings of mindfulness and self-compassion. Grossman and Van Dam (2011) discuss the significance of using individual interviews to understand the complexities of mindfulness that may not be gathered in brief self-report measures, which have garnered criticism (Van Dam et al., 2018). Semi-structured interviews were thus the primary source of data collection. This approach to interviewing allowed for enough structure to make comparisons in themes across time, while creating the flexibility to ask probing and follow-up questions to capture participants’ unique understandings. Further, this approach allowed results to be grounded in participant explanations, rather than coming to any objective “truth” about their experiences. Paradigm Ontologically, this study was viewed through the lens of relativism, such that multiple meanings can be made from the same observable phenomenon, and none are more or less valid MINDFULNESS AND SELF-COMPASSION 8 (Harper, 2011). For example, the research team remained open to the notion that participants would most likely experience change from the intervention on a spectrum. This spectrum may range from no change at all to some change, to significant. Further, a constructivism interpretivism epistemology framed the qualitative inquiry in this study. Ponterottro (2005) posits that in constructivism, the nature of reality is created cognitively through participants’ own experience rather than a single truth that is produced outside the individual’s perception. This position also asserts the idea that reflection by the participant is essential to uncover the lived reality of their experience. Further, this reflection can be sparked by the interaction between the researcher and the participant. This framework guided the research team by keeping the focus on the participants and their subjective experiences with the intervention, without a focus on uncovering any objective reality that is the same for each individual. Patterns of data were created through analysis solely to highlight changes that occurred for each individual from beginning to end of the intervention. Because this inquiry was focused on each participant's unique expectations and understandings of the intervention across time, a constructivist paradigm was most appropriate. Constructivism stems from the original idea of Kant (1966), in that the perceptions of humans are characterized by both the senses, and cognitions and perceptions of those senses. Therefore, claims about reality can only be understood through the cognitions of others. The intervention protocol was the same for each participant; however, the complexities of their understanding of the concepts taught through this program was unique to the individual. Additionally, it should be noted that the participants’ experience of the intervention, and meanings derived, were impacted, in part, by the levels of society in which they operate. The application of constructivism in this study, therefore, also includes interpretivism, or the idea that the reality of each individual’s understanding is situated historically, at one moment in time, and MINDFULNESS AND SELF-COMPASSION 9 culturally. Specifically, the experiences for each individual were shaped by their sport culture, university, family structure, and the ideals inherent within Western society and/or that of which they have experienced personally. Although the present study did not analyze the data solely as a derivative of social construction, contextual realities of each participant were noted, and it is important to highlight that these influences were likely in effect to some degree for each participant, respectively. Research Team Positionality The current study was conducted by a research team consisting of the primary author, four faculty members, a doctoral candidate engaging in data analysis coding, two additional doctoral students conducting interviews, and an undergraduate research assistant (for a full positionality statement for the primary author and research team, see Appendix D). In conducting a qualitative study such as this, it is important to fully situate the research team, as they are positioned within the study, including the subject to be investigated, the research participants, and the methods used. It is important to understand that each member of the research team carries with them their own identities, world views, and preconceived notions towards the current study, its participants, and the methods of data collection and analysis. For example, the primary author and additional doctoral candidate engaged in data analysis have a prior affinity towards mindfulness and self-compassion in their work, including past research projects, SEP consulting, and psychotherapy. In addition, both researchers were engaged in the world of sport culture through athletics participation and coaching. Researcher reflexivity was important through the process of this project to mitigate potential influences of these experiences in the data analysis process. For example, each researcher kept their own written notes on potential biases and pre-conceived notions throughout their exposure to the data. When the researchers MINDFULNESS AND SELF-COMPASSION 10 met to discuss progress through the analysis process, collaborative dialogue on reflexivity was present. Participants and Recruitment Braun and Clarke (2019) suggest that meaning through qualitative exploration, specifically Thematic Analysis (TA), is created through interpretation rather than extracted from the data, and therefore knowing when enough data is collected before the analysis process can prove difficult. Therefore, in determining the appropriate sample size for a study using TA, it may be most appropriate to use the information power concept (Malterud et al., 2016). Information power suggests that the more information the sample contains, the lower the amount of participants necessary. In this approach, appropriate sample size is determined by the scope or purpose of the study, theoretical framework, specificity, quality and depth of data, and implementation methods for analysis (Malterud et al., 2016). Because the present study included one college athletic team, the methods used for this study was aimed at capturing all voices of its members. This study attempted to gain insight into the understanding of concepts that may have been new to participants, and included interviews at both at the beginning and post-intervention. Therefore, the research team expected the depth of responses in the first interview related to understanding of mindfulness and self-compassion and the role it currently plays in their life, to be quite low in power. For this reason, it became important to ensure that the data reflected the majority of voices on the team. To ensure most voices were captured, the interviews were framed as part of the intervention itself. At post-intervention, it was hypothesized that participants would have more to say having gone through the MBI, and therefore typical attrition that may occur in this kind of study could still yield high information power due to increase depth of responses. Additionally, many previous qualitative studies of MBI’s (Baltzell et al., 2014, 2015; Worthen & MINDFULNESS AND SELF-COMPASSION 11 Luiselli, 2016) have primarily included individuals who volunteered to complete interviews. This method may have led to biased results, missing accounts from others that had neutral or negative experiences. The intention in the present study was to advertise the interviews to participants as a reflective activity embedded in the program to garner a more diverse set of experiences and the greatest number of responses. However, participants did have the choice whether to engage in interviews, and completion, or lack thereof did not exclude them from participation in the intervention itself. Convenience and purposive sampling were used to recruit one mixed-sex NCAA Division II college varsity athletic team in the Mid-Atlantic region of the United States. This team was chosen based on availability of schedule and proximity to the research team. Larger teams, including those with both male and female members were given primary consideration due to more diversity in the sample and potential for generalizability of the data. Although the entire team participated in the intervention, each individual on the team was considered a distinct case in the present study and asked to complete both interviews. Of the total sample that completed the intervention (n = 31), 28 completed at least one interview and were included in the study. A total of 26 completed the T1 pre-intervention interviews (83.8% completion rate), and 16 completed the T2 post-intervention interviews (51.6%). The total number of participants that completed both interviews was 14. The total sample (n = 28) was composed of 16 females and 12 males, age ranged between 17 and 22 (

A Grounded Theory Investigation of Basic Psychological NeedsA Grounded Theory Investigation of Basic Psychological Needs Theory as a F y as a Framework for E amework for Effective Mental Health Ref e Mental Health Referrals in Collegiate Sport Luna Ugrenović West Virginia University Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Other Psychology Commons Recommended Citation Ugrenović, Luna, "A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport" (2024). Graduate Theses, Dissertations, and Problem Reports. 12694. https://researchrepository.wvu.edu/etd/12694 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport Luna Ugrenović, M.S., M.A. Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Dana K. Voelker, Ph.D., Chair Ashley Coker-Cranney, Ph.D. Johannes Raabe, Ph.D. Monica Leppma, Ph.D. School of Sport Sciences Morgantown, West Virginia 2024 Keywords: interpersonal behaviors, need supporting, need thwarting, sport support personnel, teammates, student-athletes Copyright 2024 Luna Ugrenović ABSTRACT A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport Luna Ugrenović Using a grounded theory approach, this study explored collegiate athletes’ mental health referral experiences and identified mechanisms explaining those experiences based upon perceptions of psychological need fulfillment and thwarting according to Basic Psychological Needs Theory (BPNT). Interviews were conducted with a purposive, maximum variation sample of 14 current and former collegiate athletes who were referred to mental health services by support personnel or other athletes. Analyses yielded three overarching theoretical categories/properties: prereferral factors, proactive and reactive referral conversations, and referral outcomes. Referral is often understood as an isolated conversation in which athletes are provided mental health resources in response to a crisis. Challenging this notion, the present study showed that proactive referral as a preventative approach, as well as intentional understanding athletes’ pre-referral experiences, were central to supporting athletes’ relationship with their mental health. Generally, referral experiences that resulted in helping athletes disconnect their mental health concerns from understandings of their self-worth, and ultimately pursue mental health services with hope for recovery, were linked to psychological need satisfaction throughout the referral process (e.g., autonomously choosing mental health services, relating to the referrer through a similar experience, mastering skills for pursuing therapy). Yet, in cases of positive referral experiences, some athletes re-internalized mental health stigma upon re-engaging with unsupportive sport and familial environments. Need thwarting amid the referral conversation was generally associated with poorer outcomes, in addition to cultural environments that deterred help-seeking. Together, the data suggest BPNT is a promising framework for effective referral guidance, though psychological needs are met uniquely for each athlete based upon their characteristics and context. MENTAL HEALTH REFERRALS IN SPORT iii Acknowledgments I cannot thank enough everyone from both sides of the ocean who have supported me on this journey. I would like to express my deepest gratitude to Dr. Dana K. Voelker, my advisor and committee chair, for her invaluable patience, guidance, and support. Her passion for the field and dedication to the highest excellence has pushed me to reach my potential. This endeavor also would not have been possible without my committee, who generously provided their knowledge and expertise. I thank Dr. Ashley Coker-Cranney for her methodological expertise and guidance that made this ambitious study possible. I thank Dr. Johannes Raabe for challenging me to reach the highest research standards and offering his theoretical expertise. I thank Dr. Monica Leppma for reminding me to trust my intuition and to practice self-compassion. I would also like to deeply thank my research assistant, Verena Zaisberger, for her dedication and perspective during each phase of the study – her curiosity and hard work were pivotal in creating the final product of this project. I am also so grateful for my colleagues and friends who read drafts, offered feedback, and were my moral support. Without them, my journey would not have been nearly as meaningful and fulfilling. I will be forever grateful to Dr. Tommy Minkler, Dr. Blake Costalupes, Dr. Sofía España Pérez, Dr. Zenzi Huysmans, Dr. Karly Casanave Phillips, Dr. Andrew Chip Augustus, Kim Tolentino, Jaxson Judkins, Kayla Hussey, Hannah Miller, Sarah Sadler, Hannah SilvaBreen, and Lindsey Leatherman. I thank my family, especially my parents, Maja and Vladan, and my sister, Mia. Their belief in me has kept my spirits and motivation high, while their unconditional love has offered me a sanctuary when I needed it. Lastly, I want to express special thanks to my husband, Salman, whose tireless support, love, and selflessness helped me overcome each and every obstacle along the way. Our shared passion for the topic and many long late-night discussions about the grounded theory have inspired me and reminded me of the opportunity to impact others with my research. I thank him for sharing this journey with me every step of the way. MENTAL HEALTH REFERRALS IN SPORT iv Table of Contents Introduction and Literature Review…………..…………………………………………….……..1 Basic Psychological Needs Theory………………………………………………………..4 Methods and Materials…………………………………………………………………………….7 Research Approach and Philosophical Assumptions..…...…………………...…….……..8 Methodological Approach………………………………..….………….………...………9 Participants………………………………………………………………………..……...10 Materials…………………………………………………………………………………11 Demographic Survey…………………………………………………………….11 Interviews………………………………………………………………………...11 Procedures………………………………………………………………………………..12 Data Analysis…………………………………………………………………………….14 Methodological Rigor……………………………………………………………………18 Results……………………………………………………………………………………………19 Pre-Referral Factors….…………………………………...……………………………...20 Participants’ Identities and Culture……………………………………………....20 Participants’ Family Environments………………………………………………22 Participants’ Sport Environments……………………...………………………...23 Reactive and Proactive Referral Conversations………………...…………………....…..25 Psychological Need Satisfaction and Thwarting………...………………………26 Autonomy Satisfaction and Thwarting…………...……………………...26 Relatedness Satisfaction and Thwarting………..….…………………….28 Competence Satisfaction and Thwarting…………….…..………………30 Referral Outcomes……………………………………………………………………….30 Perceptions of Self as Context……………………………………...….……...…31 Perceptions of Self as Content…………………………...……………………....32 Discussion………………………………………………………………………………………..36 Practical Implications…………………………………………………………………….42 Limitations and Future Directions………………………………………...……………..44 Conclusion……………………………………………………………………………….46 References………………………………………………………………………………………..48 MENTAL HEALTH REFERRALS IN SPORT v Appendix A: Extended Literature Review…………………………………………….……...….59 Collegiate Athlete Mental Health……………………………………………...……...…60 Mental Health Referrals………………………………………………………………….64 Mental Health Referrals in Sport………………………….……………...……...70 Rates of Mental Health Referrals in Collegiate Sport…..…………...…..72 Possible Barriers to Successful Mental Health Referrals in Sport……….74 Mental Health Referrals in Sport – Best Practices……………………….78 Basic Psychological Needs Theory………………………………………………………84 Basic Psychological Needs Theory and Collegiate Athletes…………………….87 Basic Psychological Needs Theory, Well-Being, and Mental Health….....……..90 References………………………………………………………………………………..92 Appendix B: Extended Methods and Materials………………………………………….…......106 Researcher’s Positionality and Background……………………………………………106 Appendix C: Recruitment Flyer………………………………………………………………...109 Appendix D: Cover Letter………………….………………………...………………....……...110 Appendix E: Demographic Survey……………………………………………..………………112 Appendix F: The Final Version of The Interview Guide…………………………….…………115 MENTAL HEALTH REFERRALS IN SPORT 1 Introduction Mental health concerns are rising among collegiate athletes (Brown et al., 2021). Data suggest the prevalence of stress, anxiety, sadness, mental exhaustion, anger, and sleep difficulties are 1.5 to 2 times higher than pre-2021 reports (National Collegiate Athletic Association [NCAA], 2022). Collegiate athletes experience signs and symptoms of various mental health concerns (e.g., Brown et al., 2021; Gavrilova & Donohue, 2018) at greater frequencies than their same-age, non-athlete peers (e.g., Donohue et al., 2018; Li et al., 2017). Despite collegiate athletes’ reported frequency of mental health concerns, research suggests most do not pursue mental health services. For example, the NCAA Well-Being Study (2022) found that less than half of the collegiate athletes surveyed reported feeling comfortable seeking help from an oncampus mental health professional. There are various barriers to collegiate athletes’ willingness and ability to pursue mental health services, such as stigma, limited knowledge of the supports and resources available, negative help-seeking beliefs, concerns about confidentiality, and perceived lack of time (e.g., Cox et al., 2017; Hilliard et al., 2020; Moore, 2016). To address this problem, understanding how best to connect collegiate athletes with mental health services, in ways they feel comfortable and motivated to pursue those services, is gravely needed. An important step in the mental health help-seeking process, and that can be investigated to address collegiate athletes’ growing mental health concerns, is referral. Defined as the process of directing others to appropriate supports and resources to address their mental health needs (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015), referral is often made by peers or support personnel in collegiate athletes’ immediate performance environments, such as academic advisors, strength and conditioning coaches, sport coaches, sport dieticians, mental performance consultants, physiotherapists, physiologists, and athletic MENTAL HEALTH REFERRALS IN SPORT 2 trainers (Cormier, 2014; Daltry et al., 2021; Neal et al., 2013; 2015; Sebbens et al., 2016; Van Raalte et al., 2015). Unfortunately, support personnel report they are neither comfortable nor confident in their ability to communicate with, refer, and support athletes experiencing mental health concerns (Gayman & Crossman, 2006; McArdle et al., 2018; Moreland et al., 2018; Sandgren et al., 2022). In a qualitative study, support personnel reported feeling anxious, frustrated, underprepared, and unskilled to refer athletes, citing a critical need for guidance on what and how to communicate with athletes experiencing mental health difficulties (McArdle et al., 2016). Gayman and Crossman’s (2006) qualitative study found mental performance consultants rarely discussed the possibility of referrals to mental health services during intakes, did not maintain an updated referral list of available providers, and did not follow-up with the athlete clients if a referral was made. Unsurprisingly, this discomfort with mental health conversations is compounded by collegiate athletes also feeling the effects of this uncertainty (Arthur-Cameselle et al., 2012). For example, Cutler and Dwyer’s (2020) study of 158 collegiate athletes found that only half believed their coaching staff could offer support in an emotional crisis. Clearly, a lack of preparedness and comfort with mental health has led to the avoidance of referral-related behaviors among support personnel and is also impacting athletes. Collectively, these data suggest that although support personnel can play a key role in referrals given their proximity to and rapport with collegiate athletes (e.g., Daltry et al., 2021; Neal et al., 2015; Sebbens et al., 2016), barriers to effective communication with athletes around mental health concerns may impede the referral process, perpetuate negative help-seeking attitudes and stigma, and in turn make it exceedingly difficult for collegiate athletes to seek appropriate and timely help when needed. These communication barriers are not just limited to the exchange between support personnel and athletes, as many athletic departments also do not MENTAL HEALTH REFERRALS IN SPORT 3 sufficiently discuss the referral process, suggesting structural difficulties that some coaches have described as “broken” and “dismantled” (Eckenrod et al., 2023, p. 7). Accordingly, support personnel must be better equipped to support collegiate athletes through the development and implementation of referral guidelines that ease and facilitate communication while empowering athletes to pursue mental health supports and resources. This need extends to athlete peers, as some literature suggests that, with adequate training, college student peers generally, and athlete peers specifically, can act as helpful sources of mental health referrals (e.g., Kalkbrenner et al., 2019; Van Raalte et al., 2015). Yet, extant referral guidelines designed for athletes are limited. Vella at al.’s (2021) systematic review and meta-synthesis of mental health position statements in sport found the overall quality of the guidelines to be low. Specifically, although many policy statements discuss the importance of referrals, they lack clear referral guidelines, such as when, how, and to whom to refer. Guidelines solely focused on policy and procedure (i.e., what to do) but not process (i.e., how to do it) are limited in their effectiveness (Tod & Anderson, 2014) as they fail to support the application and implementation of their referral policies and procedures to specific contexts. This not only refers to the sport environment context but also to collegiate athletes’ identities and cultural backgrounds, as collegiate athletes working with support personnel reportedly value when their identities beyond sport are acknowledged and honored (Bejar et al., 2019). Further, as culture influences the likelihood of engaging with mental health care in unique ways (Abdullah & Brown, 2011), athletes’ identities and cultural contexts may also impact referral outcomes. More recently, the NCAA (2024) released a mental health best practices consensus document, yet their recommendations are also on referral pathways and not processes. Although such efforts MENTAL HEALTH REFERRALS IN SPORT 4 are timely and important, there remains a need to delineate specific steps and actions that support personnel and other athletes can utilize when engaging in the mental health referral conversation. Recommendations that do explicate process are largely based on accounts of experienced practitioners and include: (a) building rapport with athletes and communicating care for their well-being; (b) facilitating a team approach to athlete care; (c) preparing athletes for referrals; (d) showing support and normalizing mental health concerns; (e) referring in (i.e., inviting therapists to meetings with athletes and support personnel); (f) explaining reasons for referrals; (g) describing what working with therapists entails; (h) following up with athletes; and (i) being prepared to offer alternative coping options and to revisiting referral after giving athletes time to consider the recommendations (Andersen et al., 1994; Neal et al., 2013; 2015; Tod & Andersen, 2014; Van Raalte & Andersen, 2014). Such practitioner-informed guidelines can be further strengthened by centering athletes’ voices on effective and ineffective referral experiences, considering athletes’ identities and unique needs, and studying the interpersonal components with referrers that may affect athletes’ willingness and ability to pursue mental health recommendations. Further, using well-established conceptual frameworks to explore and explain the referral process would provide additional structure to future research in this area, particularly with respect to predicting athletes’ willingness to engage in the recommendations they are provided, while providing clarity and focus to key targets of intervention that would improve the referral experience. Basic Psychological Needs Theory A promising framework for understanding how to facilitate effective referrals for collegiate athletes, is basic psychological needs theory (BPNT; Ryan & Deci, 2017), a wellresearched theoretical guide for successful interpersonal interactions toward future behavior. MENTAL HEALTH REFERRALS IN SPORT 5 BPNT may be especially helpful in this context as it has been widely used in sport research to explore the impact of interpersonal behaviors on motivation (e.g., Raabe & Zakrajsek, 2017). Specifically, as one of the mini theories within the larger framework of self-determination theory (SDT; Ryan & Deci, 2017), BPNT has helped explain antecedents to initiating and maintaining behaviors in sport (e.g., Raabe et al., 2016), work (e.g., Parfyonova et al., 2019), health care (e.g., Ryan at al., 2008), and other settings. According to BPNT, an individual’s innate and basic psychological needs are autonomy, competence, and relatedness, all three of which are influenced through social interactions and are considered essential for psychological growth (Ryan & Deci, 2017). Autonomy refers to perceptions of self-governance and volition and the degree to which one values these behaviors. While autonomy support involves conveying value of one’s perspective and encouraging selfdirectedness over one’s decisions, autonomy controlling behaviors involve the use of external controls, like rewards and punishments, that promote need thwarting and undermine motivation. Competence refers to perceptions of self-mastery in one’s interactions with their environment. Supporting another’s need to feel competent involves providing education, guidance, feedback, and structure to assist in the development of mastery and efficacy. Conversely, thwarting another’s need to feel competent involves highlighting faults and lack of abilities, demonstrating doubt in the ability to improve, and discouraging engagement in difficult tasks. Finally, relatedness pertains to a sense of belonging in which one feels connected to, and valued by, others. With respect to relatedness, need support constitutes genuine interest, care, acceptance, and companionship from others, whereas need thwarting constitutes treatment from others that is distant, emotionally unavailable, exclusionary, and characterized by a failure to listen. As others’ behaviors influence the extent to which one perceives these needs to be satisfied, or thwarted, MENTAL HEALTH REFERRALS IN SPORT 6 this in turn determines the likelihood of initiating and maintaining a behavior and informs wellbeing. Although specific ways basic needs are satisfied or frustrated differ based on context, culture, and social setting, they are considered to universally apply to all humans (Ryan & Deci, 2017). In a recent meta-analysis (Slemp et al., 2024), perceived need satisfaction, coupled with interpersonal support, was associated with optimal motivation, wellbeing, and performance. Conversely, negative interpersonal behaviors informed perceptions of need thwarting that, in turn, were associated with ill-being, poorer performance, and diminished motivation. Researchers have used BPNT to understand the wellbeing and mental health of diverse groups of young adults (e.g., Akbag et al., 2017; Campbell et al., 2018; Cantarero et al., 2021), including athletes. For instance, in a sample of over a thousand collegiate students from four countries (i.e., Belgium, China, USA, and Peru), Chen at al. (2015) found need-satisfaction predicted well-being, and need-thwarting predicted ill-being, irrespective of students’ nationality, their reported importance of each need, and their willingness to satisfy them. This evidence highlights the utility of a BPNT framework in understanding mechanisms for supporting mental health among college students. BPNT has been also used in collegiate sport to explore athletes’ fulfilment and frustration of the three basic psychological needs in both academic and athletic settings (e.g., Raabe at al., 2022; Raabe & Readdy, 2016), and coaches’ and teammates’ impact on collegiate athletes’ need-satisfaction (e.g., Raabe & Zakrajsek, 2017). Some studies have specifically examined the role of support personnel (e.g., coaches and athletic trainers) in injured athletes’ need satisfaction and thwarting during their recovery and return to sport. Bejar et al.’s (2019) study of NCAA Division I collegiate athletes with an injury found greater motivation during injury rehabilitation when they perceived their athletic trainers supported their needs for autonomy, competence, and relatedness (Bejar et al., 2019). MENTAL HEALTH REFERRALS IN SPORT 7 Specifically, participants reported that athletic trainers facilitated their motivation to engage in rehabilitation recommendations when they provided (a) information, clear expectations and goals, encouragement, and reassurance (facilitating their competence); (b) scheduling availability and flexibility, focus on both health and performance goals, receptivity to feedback, and choice in treatment (facilitating their autonomy); and (c) approachability, rapport-building, and curiosity about athletes’ lives beyond sport (facilitating relatedness; Bejar et al., 2019). The findings of this study suggest BPNT may be a useful framework for investigating the role of support personnel in collegiate athletes’ motivations to pursue recommendations around their care. Specifically, behaviors of support personnel and athlete peers may similarly influence collegiate athletes’ motivation to follow-through on referral recommendations by interacting with their psychological needs and, in turn, impacting their wellbeing. Situated within their identities and cultural contexts, this study explored (a) collegiate athletes’ experiences receiving mental health referrals from support personnel and their athlete peers, and (b) the mechanisms, informed by perceptions of psychological need supporting and/or thwarting, that explained the experiences and their associated outcomes. The findings are used to inform theoretically-grounded, data-driven, and athlete-centered recommendations for referral in collegiate sport environments. Methods and Materials Research Approach and Philosophical Assumptions The researchers adopted a multiparadigm approach integrating constructivist and critical realist research paradigms (Bogna et al., 2020; Voelker et al., 2024) to fully achieve the research aims. As proposed by Bogna et al. (2020), a constructivist paradigm allowed the researchers to explore the domain of the empirical, as guided by (a) relativist ontology whereby researchers MENTAL HEALTH REFERRALS IN SPORT 8 assumed there were multiple and socially constructed realities (Sale et al., 2002); (b) subjective epistemology in that meaning was believed to be socially- and culturally-informed through interactions with one’s environment (Moon & Blackman 2014), and (c) the axiological aim was to understand and communicate co-constructed realities between the researchers and the participants (Biedenbach & Jacobsson, 2016). Toward the first study aim, a constructivist paradigm was used to first give voice to participants themselves, and in that way, understand their mental health referral experiences and meaning. Specifically, participants’ referral beliefs and experiences were perceived as products shaped by social and cultural contexts associated with their unique identities and collegiate sport environments and were considered as multiple and individual truths. A critical realist paradigm allowed the researchers to explore the domain of the real (Bogna et al., 2020), as guided by (a) realist ontology that assumed an objective reality existed independent of one’s perception of it (Wynn & Williams, 2012); (b) interpretivist epistemology or the assumption that relationships, ideas, and knowledge interacted to shape causal mechanisms, events, and experiences that resulted in specific tendencies (Peters et al., 2013); and (c) the axiological goal to understand mechanisms and causal regularities (Bogna et al., 2020). Toward the second study aim, the researchers explored structures, mechanisms, and conditions associated with a well-established and empirically supported theoretical framework, BPNT, that shaped these experiences using a critical realist paradigm. The two paradigms were merged to explore the domain of the actual, where mutually constructed meanings and associated occurrences and events were shaped by structures, mechanisms, and conditions, and therefore, allowed a more complete and deeper understanding of the studied phenomenon (Bogna et al., 2020; i.e., referral experiences). In other words, the MENTAL HEALTH REFERRALS IN SPORT 9 multiparadigm approach allowed exploration of the what, using constructivism, and the how, using critical realism, regarding mental health referrals in collegiate sport. Methodological Approach Consistent with a multiparadigm approach that aimed to explore the domain of the actual (Bhaskar, 1978), a constructivist grounded theory methodology (Charmaz, 2000; 2006, 2014) was integrated with a critical realist, or retroductive, grounded theory methodology (Looker et al., 2021), both of which share eight common elements (Weed, 2009). According to Charmaz (2014), a constructivist grounded theory methodology acknowledges “subjectivity and the researcher’s involvement in the construction and interpretation of the data” (p. 14). Hence, this methodology allowed for exploration of what are the referral experiences and what are the realities of collegiate athletes within relevant culture and context, while considering the researchers’ role, including experiences, privileges, and biases, in the construction of that knowledge. Rooted in classical grounded theory (Glaser and Strauss, 1967), retroductive grounded theory aims to develop understanding of mechanisms, or causal powers, that produce the studied phenomenon (Hoddy, 2019; Kempster & Parry, 2011; Looker et al., 2021). According to Kempster and Parry (2011), because the critical realism paradigm suggests knowledge is valueladen, retroductive grounded theory is a context-rich, versus context-free, approach to studying phenomena. Unique from other grounded theory approaches, drawing upon existing theories while analyzing the data is encouraged with a retroductive approach (Kempster & Perry, 2011). Hence, this retroductive methodology was used to explore the role of BPNT in clarifying the possible mechanisms that affected mental health referral in sport; or in other words, the how behind collegiate athletes’ referral experiences. Together, constructivist and retroductive MENTAL HEALTH REFERRALS IN SPORT 10 grounded theory methodology captured the lived experiences and meanings of collegiate athletes who were referred to mental health services, and mechanisms that shaped these experiences. Participants Participants were 14 current (n = 8) and former (n = 6) collegiate athletes aged 18 to 25 years (M = 21.28, SD = 2.23). Participants were referred one to three times within the past four years by athletic trainers (n = 8), coaches (n = 7), collegiate athlete peers (n = 5), nutritionists (n = 2), mental performance consultants (n = 2), and physicians (n = 1). Table 1 provides sample demographics. Table 1 Participants’ Self-Identified Demographic Characteristics Characteristic n % Sex and Gender Cisgender Woman 10 71.4 Cisgender Man 4 28.6 Race and Ethnicity *White 12 85.7 Latina 1 7.1 White and Asian 1 7.1 Nationality American 11 78.6 English 1 7.1 German 1 7.1 Mexican 1 7.1 Annual Family Income $25,000-$50,000 3 21.4 $50,000-$75,000 3 21.4 $75,000-$100,000 2 14.3 $100,000 or more 5 35.8 Did not know 1 7.1 Religion and Spirituality Nondenominational Christian 3 21.4 Catholic Christian 3 21.4 Spiritual but not religious 2 14.3 Agnostic 1 7.1 Atheist 1 7.1 Easter Orthodox Christian 1 7.1 MENTAL HEALTH REFERRALS IN SPORT 11 Characteristic n % Methodist Christian 1 7.1 Pentecostal/Assembly of God Christian 1 7.1 Protestant Christian 1 7.1 Sport Rifle 2 14.3 Soccer 2 14.3 Swimming 2 14.3 Triathlon 2 14.3 Diving 1 7.1 Lightweight rowing 1 7.1 Rowing 1 7.1 Track and Field; Softball 1 7.1 Competitive Level NCAA DI 10 71.4 NCAA DII 1 7.1 NCAA DIII 3 21.4 Note. NCAA = National Collegiate Athletic Association; DI/DII/DIII = Divisions I, II, and III *5 participants who identified as white American also reported identifying as: Bulgarian, German/Polish/Irish/Italian, Irish/German, Irish/Wales, and Polish. Materials Demographic Survey. A demographic survey (see Appendix E) was administered via Qualtrics software and asked when participants were referred to mental health services and who referred them, as well as their age, sex, gender identity, sexual orientation, race, ethnicity, nationality, SES (socioeconomic status), religion, collegiate sport organization, division, and sport(s). Interviews. Individual in-depth, semi-structured, online, video-recorded interviews started with rapport-building, followed by open-ended and follow-up questions to generate conversation as recommended by Charmaz (2014) and Hoddy (2019). The first author, who conducted the interviews, continuously engaged in self-reflexivity according to guidelines established by Tracy (2010), to examine her assumptions about referrals in collegiate sport and communicate, both verbally and via open body language, a willingness to learn and understand MENTAL HEALTH REFERRALS IN SPORT 12 participants’ lives from their perspective. These experiences were processed with a critical friend with each subsequent interview to also deepen reflexivity. The first version of the interview guide was developed based on previous literature on mental health referrals in sport (e.g., Sebbens et al., 2016; Van Raalte et al., 2015), BPNT (e.g., Ryan & Deci, 2017), prior experiences interviewing collegiate athletes about mental health concerns (e.g., Coker-Cranney et al., 2018), as well as guidance on constructing questions aligned with both constructivist (Charmaz, 2014) and critical realist aims (Brönnimann, 2022). Broadly, questions explored collegiate athletes’ experiences being referred to mental health services with intentional exploration of their identities and culture in connection with those experiences. Participants were then provided a cursory overview of the three psychological needs and asked their perceptions of needs satisfaction and thwarting amid their referral experiences. Consistent with Glaser and Strauss (1967), the interview guide evolved as data were collected to support the process of theoretical sampling and consequent development of grounded theory (see Appendix F for the final version). Initial interviews ranged from 55 to 105 minutes in duration (M = 86 minutes). Procedures After receiving IRB approval (Protocol #2302727613), participants were purposively sampled according to the eligibility criteria (i.e., at least 18 years of age, current or former collegiate athlete, was referred to mental health services in the past four years by support personnel or other athletes). Maximum variation sampling was used to garner the widest range of experiences, to the extent possible, with respect to several key factors found to play a role in collegiate athletes’ mental health concerns and/or help seeking behaviors (e.g., Ballesteros & Tran, 2020; Brown et al., 2021; NCAA, 2022; Li et al., 2017); these variables included sex, MENTAL HEALTH REFERRALS IN SPORT 13 gender identity, sexual orientation, race and ethnicity, and SES. Further maximum variation was sought with respect referral experience (i.e., positive and negative) and referral source (e.g., mental performance consultant, athletic trainer, sport dietician, academic advisor, strength and conditioning coach, sport coach, or athlete peer). Nationality, sport, year in college, collegiate sport organization, division, and religion were also considered. As suggested by Charmaz (2014) and Hoddy (2019), interviews were transcribed and evaluated as they were completed to support a theoretical sampling process that informed the type of data sought in subsequent interviews as a theory emerged, such as revising interview guide questions (e.g., re-ordering questions about basic psychological needs) and/or recruiting participants with certain experiences (e.g., perceiving to have a lack of choice during referral experience) or attributes (e.g., man-identified collegiate athletes) to explore a gap in the developing theory. Recruitment, then, was an iterative process continuously informed by the purposive, maximum variation, and theoretical sampling processes to obtain a sample with rich and wide-ranging experiences that meaningfully informed a substantive grounded theory. Recruitment approaches included multiple flyer (see Appendix C) distributions via social media outlets (e.g., LinkedIn) and email to colleagues, sport support personnel (e.g., mental performance consultants, athletic trainers), and or collegiate sport teams. Interested participants who voluntarily contacted the first author were provided additional information about the study outlined in a cover letter (see Appendix D), including the purpose of the study, what participation would entail, the possible benefits and risks of participation, and participation incentives, and then screened for inclusion criteria. Eligible participants were offered an opportunity to read the cover letter, ask questions, and then complete a demographic survey. The first author conducted initial interviews and invited the participant for a member reflection on a MENTAL HEALTH REFERRALS IN SPORT 14 second date following the initial coding of the participant’s first interview. Although each member reflection was unique, they broadly included a summary of main takeaways, followed by a discussion of participant’s impressions and conclusions from the initial interview, and new understandings and experiences since the initial interview. Thirteen participants completed the follow-up, lasting between 10 and 29 minutes (M = 19.7). Participants who completed the study received a $50 Amazon gift card in modest appreciation of their time. To protect participants’ confidentiality, all interviews were de-identified, and participants were assigned pseudonyms. Data Analysis Data analysis was guided by both constructivist (Charmaz, 2014) and retroductive grounded theory approaches (Looker et al., 2021). Prior to and during data collection and analysis, a two-person data analysis team continuously explored theoretical sensitivity – examining the studied phenomenon with an open mind to explore and compare different perspectives as well as evolve original ideas (Glaser, 1978). Theoretical sensitivity allowed the data analysis team to explore the participants’ perspectives about referrals in novel and original ways. To support this process, the data analysis team consulted with a larger research team, comprised of applied practitioners and academic researchers in sport psychology and clinical mental health, during bi-weekly hourly meetings for several months. According to Glaser and Strauss (1967), grounded theory methodology involves an iterative process of engaging in data collection and analysis simultaneously. Accordingly, analysis started, and continued, as each new interview was conducted and transcribed. Analysis of each interview began with the data analysis team reading each transcript and then verbally processing their insights with one another. The first author then conducted the initial coding (constructivist grounded theory) using a line-by-line coding approach to define the phenomenon MENTAL HEALTH REFERRALS IN SPORT 15 and allow the data to speak (Charmaz, 2014). The goal of the initial coding was to remain open and curious to all possible theoretical directions suggested by participants’ perceptions of the referral process. Charmaz suggested focusing on exploration of the actions and processes that define the phenomenon (i.e., collegiate athletes’ experience being referred to mental health services) was crucial at the beginning stages of the data analysis because it helped provide evidence of fit (i.e., capturing the essence of the participants’ experiences via codes and categories) and relevance (i.e., creating a framework that captures what was happening and relationships between implicit and explicit processes) of the emerging theory. Then, the first author conducted focused coding (constructivist grounded theory), also called open coding (retroductive grounded theory) – a process through which the goal was to conceptualize the phenomenon by choosing the most significant and or frequent initial codes that categorized the data inclusively and completely, and then comparing them to additional data (Charmaz, 2014; Looker et al., 2021). During focused/open coding, the first author moved across interviews to compare participants’ referral experiences, actions, and meanings (the dolman of empirical) to synthesize the main themes across large amounts of data while also exploring the structures and mechanisms that may have underscored these experiences and meanings (the domain of real). Theoretical categories (constructivist grounded theory) or emergent properties (retroductive grounded theory; i.e., core elements in a theory) emerged during focused/open coding and memo writing as well as constant comparison between the data (Charmaz, 2014; Looker et al., 2021). This process was not linear; later interviews made some processes clearer and incited reanalysis of earlier interviews. Following focused/open coding, the first author engaged in theoretical coding – a process that hypothesized possible relationships among MENTAL HEALTH REFERRALS IN SPORT 16 theoretical categories/emergent properties (constructivist grounded theory; Charmaz, 2014), with retroductive coding that explored generative and context-specific causal mechanisms that helped explain those relationships (retroductive grounded theory; Looker et al., 2021). Consistent with constructivist and retroductive grounded theory, this phase involved constant comparison between the new data, memos, and codes as well as possible reanalysis (Charmaz, 2014; Looker et al., 2021) toward exploration of the domain of the actual. To support the process of describing and conceptualizing the phenomenon, the first author engaged in consistent memo writing described as an analytic process in both constructivist and retroductive grounded theory (Charmaz, 2014; Looker et al., 2021). Broadly, memo writing allowed the first author to generate ideas, develop and connect theoretical categories/emergent properties, gain insights early in the research process, and explore the possible causal mechanisms that explain the relationships between theoretical categories/emergent properties (Charmaz, 2006; 2014; Looker et al., 2021). Memo writing supported iterative data analysis as it allowed the first author to explore and discover ideas freely and spontaneously (Weed, 2009). When needed, memos were discussed with the research team to support the exploration of the phenomenon. An important part of memo writing was raising focused/open codes to theoretical categories/emergent properties (Charmaz, 2014; Hoddy, 2019). This was done by choosing focused/open codes that best capture what was happening in the data and why it was happening though comparison between the data, incidents, contexts, and other categories/properties. Via memo writing, the first author defined and explored characteristics of tentative theoretical categories/emergent properties, explored their relationships with other theoretical categories/emergent properties, and possible causal mechanisms that explained these MENTAL HEALTH REFERRALS IN SPORT 17 relationships (Charmaz, 2014; Looker et al., 2021). In advanced memos, the first author traced and categorized data to achieve the purpose of the study, describe how theoretical categories/emergent properties and possible causal mechanisms emerge and change, identify the beliefs and assumptions that supported them, explore various perspectives of the memo topic, and engage in constant comparisons. Throughout each phase of the study, the first author conducted constant comparison iteratively between data and data, data and codes, codes and theoretical categories/emergent properties, and theoretical categories/emergent properties and BPNT literature. The first author started theoretical sampling once there were preliminary theoretical categories/emergent properties from which to collect subsequent data that expanded and improved theoretical categories/emergent properties and related causal mechanisms informing the emerging theory (Weed, 2009). Theoretical sampling was facilitated by memo writing that helped identify incomplete theoretical categories/emergent properties and causal mechanisms, and gaps in the analysis. Weed (2009) argued theoretical sampling, based on tentative theoretical categories/emergent properties, continued until no new characteristics of theoretical categories/emergent properties and no new causal mechanisms emerged from new data (i.e., theoretical saturation; Charmaz, 2014; Hoddy, 2019). Based on what emerged from the existing data, theoretical sampling involved recruiting new participants with specific experiences, or collecting follow-up data collection from the existing participants (Charmaz, 2014; Hoddy, 2019). The first author regularly consulted with the research team about decisions regarding the specific approaches to theoretical sampling. To deepen the analysis and construction of the emerging theory, the first author engaged in theoretical sorting, comparing/diagramming, and integrating memos (Charmaz, 2014). This MENTAL HEALTH REFERRALS IN SPORT 18 involved comparing memos and exploring how the order and logic of memos capture the referral experiences of collegiate athletes. Additionally, drawing diagrams assisted in establishing and solidifying theoretical categories/emergent properties, their relationships, and causal mechanisms that explain them. Together, these strategies provided insight toward an emerging theoretical framework on referring collegiate athletes to mental health services. To support the process of theory development, the first author met with expert consultants regularly during each phase of the analysis regarding the quality and rigor of the analysis and relevance to the BPNT framework. Follow up member reflections and the research team interpretations were transcribed and analyzed with the rest of the data to refine the theoretical categories/emergent properties and emerging theory (Albas & Albas, 1988; 1993; Charmaz, 2014; Looker et al., 2021). Methodological Rigor To support the process of investigating, interrogating, and deepening different interpretations of the data (Harper, 2011), the research team included individuals with a variety of experiences in the collegiate sport and mental health fields. Some of the shared experiences of the research team involved completing post-secondary education in either sport psychology, mental health counseling, or both. Additional commonalities among the research team included being an athlete, a coach, a mental performance consultant, and a mental health counselor in various sport and clinical settings in the United States and Europe. Some of the unique experiences of the research team included identifying with different nationalities (i.e., American, German, Austrian, and Serbian) and gender identities (i.e., woman- and man-identified), competing and working for different sports and sport levels (i.e., high school and collegiate), and interacting with collegiate athletes in different capacities (e.g., as a therapist, a professor, a mental performance consultant, a supervisor, a former collegiate athlete). Additionally, the MENTAL HEALTH REFERRALS IN SPORT 19 research team had diverse experiences, expertise, and formal training regarding conducting qualitative research in sport psychology and counseling, BPNT, and making and receiving collegiate athletes’ mental health referrals. The approaches used to support data trustworthiness, credibility, and confirmability were engaging in self-reflexivity both in written (i.e., memo writing) and verbal (i.e., discussions with the critical friend) forms as well as regular consultations with the research team experts regarding conceptual and methodological decisions, and conducting member reflections, as previously discussed. Additionally, Carcary (2020) recommendations for audit trail best practices were followed (i.e., documenting the research process in all phases of the study, including key methodological decisions, and tracing how researchers’ thinking evolved during each phase). Results Data analysis resulted in a substantive grounded theory (Figure 1) that described and explained participants’ experiences of being referred to mental health services by support personnel and other athletes. Three overarching theoretical categories/properties emerged: (a) pre-referral factors (i.e., conditions and dynamics prior to referrals informing referral conversations); (b) referral conversations (i.e., interactions in which referrers recommended athletes seek appropriate mental health resources); and (c) referral outcomes (i.e., consequences of referral conversations). Figure 1 illustrates subcategories identified within each category, and the relationships between them, that together described participants’ experiences and mechanisms explaining those experiences. Figure 1 A Substantive Grounded Theory of Referring Collegiate Athletes to Mental Health Services MENTAL HEALTH REFERRALS IN SPORT 20 Note. White boxes represent experiences, and gray boxes represent mechanisms. Pre-Referral Factors Prior to the initiation of referrals, pre-referral factors shaped how referral conversations unfolded and, ultimately, the referral outcomes. These factors included aspects of participants’ identities and cultures and interactions with their family and sport environments. Although basic psychological needs were not explicitly explored with participants at this stage of the interview, pre-referral factors clearly also influenced autonomy, competence, and relatedness when shaping participants’ relationships with, and attitudes toward, mental health and, ultimately, the referral. Participants’ Identities and Culture Participants described how aspects of their identities and culture, such as their nationality, race, ethnicity, SES, religion, and gender identity, influenced their perceptions of mental health concerns and help-seeking behaviors that, in turn, informed their willingness to pursue referral MENTAL HEALTH REFERRALS IN SPORT 21 recommendations. For example, Fin referenced that “in Germany, we are…more private, very distant people” which is “probably also one of the reasons why I never really looked at [therapy] before.” Mia, on a different note, commented on SES status: “Growing up, the money aspect was hard. So, that’s why I never went [to therapy].” Other participants described how binary gender norms, informed by their upbringing and traditional sport culture, influenced their help-seeking attitudes. Gia reported that “girls are seen as weaker…guys [are] trying to be the strongest” and that “coaches would see you as weaker” for seeking mental health resources. Tom described how a lack of representation contributed to his mental health concerns and deterred him from seeking help: “I think not only is it hard to be a queer person [in the] outside world, but also being a queer person inside of athletics is incredibly difficult.” Further, some participants cited their religious background and spirituality as both a barrier and facilitator to seeking mental health services. Bri explained, “[My religious community is] very supportive…It gave me an opportunity…to talk about [my mental health] more.” Zoe similarly discussed how “the guiding principles of religion” encouraged her to “find the healthiest version of myself, mentally and physically.” Ana stated why she went to therapy: I realized there was a spiritual element to this… The enemy was telling me, ‘You’re a failure.’ And I was believing it… I need to get my faith back in order. This is a lie… This is not who God says I am… That faith…was HUGE because that was the catalyst that started changing things. Other participants believed religion sufficed as therapy and, accordingly, avoided facing their difficulties as a way to cope (i.e., spiritual bypassing). Mia reported, “I always just thought I could just pray it off…Why isn’t praying enough for me? I didn’t want it to feel like I couldn’t do it on my own with just God.” MENTAL HEALTH REFERRALS IN SPORT 22 Some participants reported ways their intersecting identities shaped their views on helpseeking. Ana described her “quite emotionally unavailable” English culture and “the culture of being an athlete” as making her “incredibly reluctant” to seek help. Others explained that support personnel failed to honor their intersecting identities, exacerbating their mental health concerns and unwillingness to seek help. Tom explained that, in his sport environment, the term “athlete” was used to generalize “a group of people that can be incredibly diverse.” He noted, “As someone who has been athletic since I was five years old, I just took onto that [athlete] title and didn’t allow other things in my life to define who I was.” He added, “[Sport personnel] don’t really talk too much about sexuality…It was never really a topic of conversation.” For the participants who recognized having privileged identities, representation in mental health settings was often not a concern. Ana stated, “I’m heterosexual, [that is] why I don’t feel there [were] any barriers in terms of those parts of my identity.” Ana also acknowledged her teammates may have had a different experience: “We had a couple of lesbians on the team. I could see how they wouldn’t want to go to a Christian counselor for fear that they would be judged.” For some participants who belonged to minoritized groups, representation was key to their willingness to seek mental health services. As a member of “the international community,” Lea reported noticing “more of a need for cross-cultural specialists… Our counseling center… has been staffed by older white people.” Lea suggested “having…knowledge of various backgrounds and…cultures…helps with the referral process” as professionals may “understand your experience and you feel represented in them.” Participants’ diverse identities and culture had strong effects on their help-seeking attitudes and behaviors, and, consequently, their openness to referral recommendations. Participants’ Family Environments MENTAL HEALTH REFERRALS IN SPORT 23 Participants in family environments that encouraged help-seeking were more likely to have positive attitudes toward help-seeking themselves. Max stated, “I’ve never thought [seeking therapy] was a bad thing… I’ve always been told…if you’re struggling mentally, there’s nothing wrong with talking to [psychotherapists].” Ana noted, “My parents didn’t see seeking counseling as a sign of weakness… I know my dad had gone…and…it was helpful for him… If anything, it encouraged me… They’re not gonna judge me…” Contrarily, negative attitudes toward help seeking in their immediate family deterred other participants from wanting to seek mental health services. Mia mentioned, “My parents are very against being mentally weak… [My extended family] don’t believe in therapy at all… I would never say [to them]…that I’m in therapy.” Some participants also said that help-seeking attitudes were passed down generationally, making it harder to shift their own attitudes. Lea reported, “[My mother] moved from [another country]… With my grandparents it very much was like, ‘You don’t need anything. It’ll be fine’…The cultural mindset travels with you.” Among these participants, some discussed slow but important shifts in intergenerational help-seeking attitudes. Gia reported that her “transition generation” is growing up in a time when they are “actually…listened to” instead of being told to just “toughen up,” and that younger generations will benefit from further shifts in this direction. Family members’ attitudes towards mental health help-seeking, whether positive or negative, strongly influenced participants’ own attitudes yet were noted as malleable. Participants’ Sport Environments Many participants similarly described their sport environments as supportive or unsupportive of mental health help. These participants were more likely to have positive attitudes toward help-seeking when athletic department cultures encouraged it. Joy felt “really good” about seeking services after noticing that “no one looked twice” when her teammate disclosed MENTAL HEALTH REFERRALS IN SPORT 24 pursuing therapy. Gia did not originally value mental health services, but because her head coach “wants to talk about mental health…it’s not uncomfortable.” Gia also described several benefits of mental health services being accessible and frequently promoted in her sport environment. Per Gia, coaches pointed to “posters with [the psychotherapist’s] contact information,” and athletic trainers frequently offered to “help you set up an appointment.” These participants also discussed having better access to services when mental health providers were integrated into sport. For Max, “the fact that [the psychotherapist in athletics] is around us and really looks out for us…definitely helped. Max noted, “I don’t know if it was some random person if I would have [sought therapy].” Conversely, some participants noted several barriers when athletic department cultures failed to promote mental health. Ana’s teammate “didn’t believe what was going on with me was a big deal… It made me feel like, ‘Oh, maybe she’s right. Maybe there’s nothing wrong with me. Maybe I’m just being dramatic,’ which was very painful.” Ana further noted, “Before that conversation [about referrals] even happens, …there’s more that can be done with the culture around [mental health],” explaining that requiring a referring athletic trainer to “deal with this” is “unfair…when there is not a culture already in place that makes those conversations accessible and comfortable.” Fin “wasn’t really aware of [existing therapy resources for athletes]… that wasn’t really too public that I would have the option to talk to [psychotherapists]…. That message never really came from the main coaches.” Ella had “never heard someone who goes to [the psychotherapist in athletics] and has a good experience… She’s trained…just…not very good.” Contrarily, some participants indicated that an overemphasis on mental health was also an issue. Ella described this as an “overcorrection,” as her coach’s efforts to normalize mental health made the coach “too emotionally involved”, thus “hindering…[team] performance.” Ella MENTAL HEALTH REFERRALS IN SPORT 25 also felt that some of her teammates were “too annoying and loud about mental health.” As with family environments, participants’ sport environments, including cultural messaging about mental health, impacted their pre-referral attitudes and intentions toward help-seeking. Reactive and Proactive Referral Conversations Participants’ identities, cultural backgrounds, and family and sport environments informed the help-seeking attitudes they, figuratively, brought with them to their referral conversations with support personnel and other collegiate athletes. In these referral conversations, referrers broached their concerns with participants and recommended mental health resources or services. Many participants described these conversations as having occurred reactively (i.e., in response to an experienced mental health crisis) or proactively (i.e., with the aim to prevent concerns from beginning or worsening). Participants further discussed ways they perceived their basic psychological needs to be supported or thwarted amid these interpersonal exchanges. Most participants reported being referred reactively, as a result of “hitting rock bottom” (Tom) or in response to crisis, such as sexual assault, suicidality, and panic. Referrals following a crisis that were experienced positively involved the referrers who promptly provided support, information, and choices to help them feel safer and more in control. Liz stated it “was helpful to know what I was walking into.” She further explained, “[The athletic trainer] said, ‘[The boyfriend]…can sit in [the session] with you…,’ prepared me it was going to be a guy [the psychotherapist],” and gave “me the basics of what I was going to experience.” In rare cases, some participants were referred proactively as a preventive measure to help them cope with upcoming stressors. Gia, who “had never done triathlon before”, explained that her head coach referred her “to make sure that you’re not feeling you’re in over your head.” Being referred MENTAL HEALTH REFERRALS IN SPORT 26 proactively increased some participants’ openness to services and reduced mental health stigma. For Gia, this approach showed her that “anyone can be referred… [Therapy] can be helpful for anybody” and “preventative.” Lea described being referred proactively as “a welcome little push to get me to take care of myself and prioritize wellbeing,” with others stating that it helped them overcome ambivalence or avoidance. Bri noted, “Had I not had that [referral] conversation with [the athletic trainer], I probably would have never gone to see anybody.” Such examples exemplified the importance of approaching each referral differently based on an athlete’s unique needs. Psychological Need Satisfaction and Thwarting In addition to the proactive/reactive nature of referral conversations, participants discussed ways in which the interpersonal exchanges with referrers supported, or thwarted, their basic psychological needs. These included participants’ autonomy (i.e., sense of selfgovernance), relatedness (i.e., sense of connection), and competence (i.e., sense of mastery). Autonomy Satisfaction and Thwarting. Many participants explained that common hierarchical power structures influenced their referral conversations and, subsequently, their decisions to pursue mental health services. When asked about what it was like to be referred by their teammates, two participants voluntarily compared it to referrals by coaches, stating it felt “more like my own decision… Athlete to coach is more a sense of authority” (Eva). Mia echoed, “If [the coach] were to suggest [therapy]… I would not have a comfortable conversation” and “would just go…feel I had no choice” and “be doing it for him.” For Ari, “Having [the athletic trainer and the coach]…reach out to [the psychotherapist] before I even gave consent…or approval…was upsetting. So, I didn’t feel I had the autonomy because it was not brought forward to me.” In contrast, a few participants discussed how financial privilege was another MENTAL HEALTH REFERRALS IN SPORT 27 form of power that supported autonomy during and following the referral. Bri reported she “went out and found [a psychotherapist] on my own… It’s privileged to be able to afford that… Privilege does create autonomy.” Many participants reported feeling autonomous when their referrers asked them for their thoughts and preferences and provided control around referral outcomes, including the opportunity to contemplate and choose whether to pursue services. Bri stated, “it was my choice” because the athletic trainer informed her about resources and said “It’s completely up to you. We’re not going to force you into it or judge you if you decide not to.” Fin reported, “[Therapy] was…brought up…[as] an option. And I was like, ‘Okay, I’m gonna give it a thought…’ It was never the end of the conversation and then a fixed, ‘Yeah, I’m gonna…[seek therapy].’” Fin further explained, “After a week… based on my own evaluation… [and] taking into consideration… what [the r

Living Your Best Life: The Mindful Pursuit of Student-Athlete Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving Andrew Augustus West Virginia University, ana00006@mix.wvu.edu Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Health Psychology Commons, Other Psychology Commons, and the School Psychology Commons Recommended Citation Augustus, Andrew, "Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving" (2023). Graduate Theses, Dissertations, and Problem Reports. 11689. https://researchrepository.wvu.edu/etd/11689 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving Andrew N. Augustus, MEd. Dissertation submitted to the College of Applied Human Sciences at West Virginia University School of Sport Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Sam Zizzi, Ed.D., Chair Dana Voelker, PhD. Scott Barnicle, PhD. Vanessa Shannon, PhD. School of Sport Sciences Morgantown, West Virginia 2023 Keywords: Mindfulness, Well-Being, Performance, Self-Compassion, Thriving Copyright 2023 Andrew Augustus Abstract Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving Andrew N. Augustus, MEd. Thriving, or the concurrent experience of healthy well-being and high-level performance, may serve as a valuable construct when studying the optimal student-athlete experience and mindfulness-based interventions (MBIs) have been shown to positively impact well-being and performance. The purpose of the present study began to examine the impact of an MBI for improving student-athlete experiences of thriving via a quasi-experimental longitudinal design. NCAA Division II student-athletes (n = 55) from three sports were randomly assigned to either a control or a 7-session MBI. While comprehensive measures of thriving did not yield significant change for those in the MBI relative to the control, multiple thriving characteristics and outcomes were improved. MBI participants reported quantitative significant improvement for subjective performance satisfaction, mindful awareness, and the use of mindfulness to regulate emotions. Exploratory analysis revealed those in the MBI, relative to the control, experienced improvements of optimism and a sense of meaning and purpose. Within the program evaluation, student-athletes qualitatively reported sport and life benefits related to thriving (e.g., self regulation, focus, awareness, vitality, intentional actions) while also suggesting improving MBIs with systematic reminders to meditate, more meditation opportunities within the sport environment, and autonomy-supportive instruction. These preliminary data support the use of MBIs to facilitate characteristics and outcomes of thriving, while also offering suggestions for practical improvements when implementing MBIs with student-athletes. Acknowledgements iii I am grateful for the support and guidance I have received throughout this process. Thank you to my committee for your critical feedback and invaluable perspectives. Each of you have tremendously impacted this dissertation from conceptualization to submission. Thank you to my family, friends, and classmates for encouraging, listening, and empowering me throughout this journey. Most of all, thank you to my parents for your endless love and support. “There is a road, no simple highway. Between the dawn and the dark of night. And if you go, no one may follow. That path is for your steps alone.” – Robert Hunter iv Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving ............................. 1 Method ........................................................................................................................................... 6 Research Design .......................................................................................................................... 6 Participants .................................................................................................................................. 6 Instruments .................................................................................................................................. 6 Background and Demographic Information ............................................................................ 6 Thriving ................................................................................................................................... 7 Subjective Performance ........................................................................................................... 8 Mindfulness ............................................................................................................................. 8 Program evaluation ................................................................................................................ 10 Procedures ................................................................................................................................. 10 Pilot Intervention ................................................................................................................... 11 Intervention Details ............................................................................................................... 12 Data Analysis ............................................................................................................................ 14 Results .......................................................................................................................................... 15 Descriptive Statistics and Baseline Characteristics ............................................................... 15 Intervention Engagement and Effects: Manipulation Check ................................................. 16 Impact on Thriving: Between-Groups Differences ............................................................... 17 Program Evaluation Feedback ............................................................................................... 18 Discussion..................................................................................................................................... 19 Sport Performance Satisfaction via Mindful Awareness and Self-Regulation...................... 20 Impact on Thriving: Optimism and Purpose for Sport and Beyond ...................................... 21 Practical Implications ............................................................................................................ 24 Limitations and Future Considerations.................................................................................. 26 Conclusion ................................................................................................................................. 28 References .................................................................................................................................... 30 Tables ........................................................................................................................................... 42 Table 1: Overview and Intervention Details for Sport-Adapted MBI ................................... 43 Table 2: Baseline Descriptives, T-Tests, and Chi-Squares (Time 1) .................................... 44 Table 3: Manipulation Check: Between-groups RM ANOVA Interaction Results and Estimated Marginal Means (Times 1-2) ................................................................................ 47 Table 4: Between-groups RM-MANOVA and RM-ANOVA Results and Estimated Marginal Means (Times 1-3) ................................................................................................. 48 Mindfulness and Thriving v Table 5: Exploratory Analysis of CIT Subcomponents- RM-ANOVA Results and Estimated Marginal Means (Times 1-3) ................................................................................................. 49 Table 6: Summary of Program Evaluation Open Response Answers ................................... 51 Appendix A: Extended Literature Review ............................................................................... 52 Thriving ..................................................................................................................................... 53 Facilitators of Thriving .......................................................................................................... 54 Thriving Interventions ........................................................................................................... 58 Measures of Thriving ................................................................................................................ 60 Mindfulness ............................................................................................................................... 62 Features and Historical Influences ........................................................................................ 62 Benefits for Mental Health and Well-Being .......................................................................... 63 Dosage. .................................................................................................................................. 65 Formal and Informal Approaches .......................................................................................... 66 Mindfulness Interventions for Sport ...................................................................................... 68 Connections Between Mindfulness and Thriving ..................................................................... 70 Accomplishments and Performance ...................................................................................... 71 Vitality, Meaning, and Eudaimonistic Enlightenment .......................................................... 75 Learning ................................................................................................................................. 76 Flow and Engagement ........................................................................................................... 78 Self-Efficacy, Self-Regulation, and Self-Compassion .......................................................... 80 Mental Toughness, Psychological Flexibility, and Performing through Pressure ................ 82 Optimism ............................................................................................................................... 83 Autonomy .............................................................................................................................. 83 Relatedness and Cohesion ..................................................................................................... 84 Subjective Well-Being ........................................................................................................... 84 Figure 1. ................................................................................................................................. 87 Measures of Mindfulness .......................................................................................................... 88 Appendix B: Overview and Intervention Details for Sport-Adapted MBI ........................... 90 Module 1: Introduction to Mindfulness; Values and Committed Actions ............................ 91 Module 2: Acceptance and Self-Compassion ........................................................................ 92 Module 3: Mind-Body Connection and Sport ....................................................................... 93 Module 4: Lifelong Mindfulness to Thrive ........................................................................... 94 Appendix C – Intervention Materials ....................................................................................... 95 Module 1: Introduction to Mindfulness; Values and Committed Actions ............................ 95 Module 2: Acceptance and Self-Compassion ...................................................................... 101 Mindfulness and Thriving vi Module 3: Mind-Body Connection and Sport ..................................................................... 103 Module 4: Lifelong Mindfulness ......................................................................................... 108 Session 7-- Continuing to Build Towards Poise and Psychological Flexibility .................. 108 Appendix D: Assessment Battery ............................................................................................ 113 Mindfulness At-Home Practice Log and Mental Health Referral........................................... 128 References ............................................................................................................................... 129 Mindfulness and Thriving 1 Living Your Best Life: The Mindful Pursuit of Student-Athlete Thriving The performance and well-being of athletes are foundationally important goals, and the ultimate aims of sport, exercise, and performance psychology (SEPP) practitioners. Mental health can be understood across a continuum that spans from mental illness (i.e., diagnosable symptoms that impede normal functioning) to mental well-being (i.e., positive mental functioning); well-being is comprised of social (e.g., relationships), psychological (e.g., optimism, eudaimonia), and subjective (e.g., happiness) components (Keyes, 2002). Recently, public disclosures from elite athletes like Simone Biles and Michael Phelps have illuminated athlete experiences along this continuum. Phelps shared at the Kennedy Mental Health Forum: “We’re supposed to be this big, macho, physically strong human being, but this is not a weakness. We are seeking and reaching for help” (Prizont-Cardo, 2018). Biles noted the connections between mental health, well-being, and performance: “Put mental health first because if you don’t, then you’re not going to enjoy your sport, and you’re not going to succeed as much as you want to” (Nardino, 2021). Coinciding with these anecdotal accounts, researchers have found that a high level of performance success does not occur without personal and sport-related experiences of adversity (Sarkar et al., 2015). Although adversity does not cause mental illness, stressors from the high pressure environment may magnify athlete mental health symptoms. In addition to the mental illnesses of the general population (e.g., depression, anxiety), athletes may experience sport specific stress related to overtraining, injury, athletic identity, transition from sport, disordered eating, substance misuse, sleep disorders, and more (Chang et al., 2020). As athletes transition from high school to college, they are near the developmental age when mental illness first arises in young adults (McGorry et al., 2011), Furthermore, collegiate student-athletes report academic Mindfulness and Thriving 2 and performance stress and pressure from coaches, teammates, and family unique from non student-athletes (Brown et al., 2014). With the student-athletes facing a variety of stressors related to sport and beyond,it is not a surprise that researchers have prioritized well-being and performance in their approaches with this population (Gross et al., 2018). Researchers from a variety of fields ranging from industrial organizational psychology to positive youth development are investigating the intersection of well-being and performance through the construct of thriving (Brown et al., 2021; Lerner et al., 2011; Sarkar & Fletcher, 2014; Spreitzer et al., 2005). Although definitions slightly vary across fields, thriving is the joint experience of consistent high-level performance and healthy development and well-being (Brown et al., 2018). People experiencing this adaptive state often believe they are learning, growing, and progressing towards goals or values with a sense of passion and vitality (Spreitzer et al., 2005). Brown and colleagues (2018) qualitatively examined thriving according to the perspectives of athletes, coaches, and sport psychology practitioners (n = 15) and identified facilitators (e.g., training environment, self-regulation), characteristics (e.g., focused, sense of belonging), and outcomes (e.g., optimal performance, personal development) of thriving. A key characteristic of thriving is basic psychological needs satisfaction (BPNS), which accounts for the necessity of humans to experience relatedness, competence, and autonomy (Deci & Ryan, 2012). Researchers have reported a strong, positive relationship between BPNS and thriving among both adult and youth athlete samples (Brown et al., 2021; Kinoshita et al., 2021). Athletes emphasize that strong supportive social connections, collective team goals, and autonomy-focused coaching facilitate thriving (Brown & Arnold, 2019; McHenry et al., 2020). These contextual factors may foster an environment that is conducive to learning, growing, performing through pressure, and building a strong sense of competence (Brown et al., 2021). Mindfulness and Thriving 3 Beyond contextual facilitators (e.g., motivational climate) that might influence both BPNS and thriving, several personal factors also play a role. Goal setting, mental toughness, self regulation, self-awareness, concentration, and mindfulness have all been identified as possible facilitators of thriving (Brown et al., 2018; Gucciardi et al., 2017; Özcan & Vural, 2020). Athletes, coaches, and sport psychology practitioners also reported an optimistic mindset as a key characteristic of thriving (Brown et al., 2018). Other personal characteristics of thriving, like vitality, meaning, and purpose, may support thriving outcomes like holistic development and eudaimonia (Spreitzer et al., 2005; Su et al., 2014). Interventions aimed to improve these personal factors may help facilitate thriving. For example, positive youth development programs have been successful in improving thriving outcomes (e.g., holistic development) by focusing on the intentional application of life skills for young people who have experienced adversity (Pearson et al., 2021). Positive psychology interventions that guide female university students towards pursuing intrinsically valued goals have helped increase thriving (Heekerens & Heinitz, 2019). Additionally, researchers have begun to investigate how mindfulness-based interventions (MBIs) may improve thriving with university students (Özcan & Şahin, 2021). Mindfulness is defined as an intentional state of accepting, compassionate, and nonjudgmental awareness within the present moment (Kabat-Zinn, 2003). Mindfulness appears to influence or have significant associations with several characteristics and outcomes of thriving, such as relatedness and cohesion (e.g., Baltzell et al., 2014), engagement and flow (e.g., Moore et al., 2013), learning (e.g., Zhang et al., 2016), self-efficacy and competence (e.g., Blecharz et al., 2014), vitality (e.g., Chang et al., 2022), optimism and mental toughness (e.g., Wang et al., 2021). Figure 1 illustrates some of the established and emerging connections between mindfulness and thriving. In a randomized controlled trial (RCT), Özcan and Şahin’s Mindfulness and Thriving 4 (2021) sample of female-identified university students (n = 19) reported significant improvements in thriving, as measured by the Multidimensional Thriving at Work Scale [MTWS; Porath et al., 2012], following a 6-session MBI. Seppälä et al. 's (2020) RCT with university students (n = 131) found that exercises focused on emotional intelligence, self compassion, gratitude, and self-regulation with breath-based meditations effectively improved psychological thriving, as measured by a variety of well-being scales, after an 8-week intervention. Though these studies show promising results, they used different measures of thriving, did not include follow-up data to examine long-term outcomes, and were not with student-athletes. Specific to student-athletes, researchers have identified that MBIs may support the two key outcomes of thriving: well-being and performance (Gross et al., 2018; Evers et al., 2021). Gross et al. (2018) compared a 7-week Mindfulness-Acceptance-Commitment (MAC) intervention group to an active control group who experienced traditional Psychological Skills Training (PST) with 22 Division III women basketball players. The MAC intervention utilized psychoeducation and experiential components (e.g., centering exercises, meditations) to teach mindfulness, cognitive defusion, commitment to values, acceptance, and poise. Relative to the PST, the MAC intervention was significantly more effective at reducing psychological distress and generalized anxiety while improving psychological flexibility, emotion regulation, and performance satisfaction. Using an extended (15-week) yet similar MAC-influenced intervention, researchers explored the effects with elite female basketball players (n = 40, age M = 16.3) via a mixed-methods design (Goisbault et al., 2022). Following the intervention, athletes qualitatively reported benefits related to awareness, attention, and vitality (e.g., commitment towards values and goals) in addition to significant quantitative improvements with moderate Mindfulness and Thriving 5 effect sizes for non-judgment, acceptance, interpretations of stress, and performance satisfaction. Mindfulness might support sport performance indirectly in several ways, including self regulation and optimism (Wang et al., 2021). Following an 8-week MAC intervention, participants (n = 60, age M = 19.54) reported significantly higher levels of mental toughness, endurance, and optimism in relation to running an 800-meter race. Furthermore, when considering the thriving outcome of holistic development, student-athlete academic performance is also important and MBIs have also been shown to have positive academic benefits such as self-regulation and focus (Phan et al., 2022). Although thriving was not measured directly, these findings suggest MBIs may be useful in supporting characteristics and outcomes of thriving in student-athlete populations. Student athletes have reported many qualitative (e.g., vitality, engagement) and quantitative (e.g., performance satisfaction) improvements related to thriving, but using instruments specifically designed to measure thriving (e.g., Comprehensive Inventory of Thriving, Su et al., 2014) could provide a more comprehensive analysis of these connections. With an emphasis on both performance success and well-being, the construct of thriving may be a valuable lens through which to explore optimal athlete experiences in a comprehensive way. The purpose of this research was to (a) examine the efficacy of a MBI in improving thriving and subjective performance in collegiate student-athletes as compared to a control and (b) explore the components of the MBI perceived by collegiate student-athletes to be the most helpful, beneficial, or challenging. It was hypothesized that participants in the intervention group, relative to those in the control group, will experience greater improvements in thriving and subjective performance. Mindfulness and Thriving 6 Method Research Design A quasi-experimental, longitudinal design was used to gather quantitative and qualitative data over the course of a 7-week sport-adapted MBI (with five-week follow-up data) to assess the efficacy of improving student-athlete thriving and mindfulness. Participants Participants were recruited from Division II and III colleges and universities in the Midwestern and Eastern sections of the US. With the guidance and introductions from a committee member, the researcher emailed coaches in the region to recruit potential teams. To be included in this study, participants were at least 18 years of age and current student-athletes on teams with coaches that agreed to participate in the intervention. Participants or teams that had previously completed a MBI were excluded. A total of 55 student-athletes from three teams at two different universities were successfully recruited for the intervention, with a total of 49 participants completing time 2 data collection, and 44 completing time 3 data collection. Instruments Background and Demographic Information Items asked participants to report age, race, sex, sport, years of sport participation, and current hours per week spent practicing sport. Previous exposure and practice of mindfulness was also recorded through an item on experiences with mindfulness. Mindfulness and Thriving 7 Thriving The Comprehensive Inventory of Thriving (CIT; Su et al., 2014) was used to assess thriving. Corresponding with Keyes’ (2002) view of well-being, the 54-item CIT contains 18 subcomponents based on the seven factors of well-being: relationships, engagement, mastery, autonomy, meaning, optimism and subjective well-being. Participants answered items via a 5 point likert scale (1, Strongly Disagree, to 5, Strongly Agree). Item scores were added for a total score of positive scales and negative scales, as well as subcomponent scores. Higher scores indicate greater levels of thriving for positive scales and lower scores indicate better levels of thriving for negative scales. All subscales of the CIT have shown solid internal consistency across five validation samples (α ranged from 0.71 - 0.96) and test-retest reliability (0.54 - 0.83). Internal consistency with the current sample ranged from α = .56 to .87 for subcomponents and was α = .67 for negative scales and α = .90 for positive scales. One of the validation samples (n = 490, age M = 19.5) was exclusively university students. Convergent and discriminant validity testing of the CIT shows moderate to strong relationships with several established measures of well-being and negative correlations with measures of ill-being (Su et al., 2014). Although most thriving characteristics and outcomes are represented by the CIT, to our knowledge, this is the first time it has been used to measure thriving within a sport population. The Multidimensional Thriving at Work Scale (MTWS; Porath et al., 2012) was used to assess thriving through the participants experiences of learning and vitality in their sport and academic environment. The MTWS is a 10-item, 5-point Likert scale (1, Strongly Disagree, to 5, Strongly Agree) inventory in which scores are summed to yield a total score and learning and vitality subscales, with higher scores indicating higher levels of thriving in the sport or academic domain. Porath et al.’s (2012) thriving scale has commonly been used in many fields, including Mindfulness and Thriving 8 sport (Gucciardi et al., 2017). The construct validity of the MTWS has been supported by convergent data showing a significant relationship with positive affect (r = .49), learning goal orientation (r = .37), proactive personality (r = .56), job satisfaction (r = .72), organizational commitment (r = .41), career initiative (r = .40), and performance (r = .29). Discriminant data shows a significant inverse relationship between the MTWS and negative affect (r = -.31) and burnout (r = -.74). Additionally, the MTWS had excellent internal consistency across validation samples (α ranged from 0.90 - 0.94). Internal consistency with the current sample ranged from α = .73 to .91 for subscales and composite scales for both academic and sport-adapted versions. Subjective Performance Subjective athletic and academic performance were reported on a 1-10 sliding scale in which participants were asked to “Mark your level of satisfaction with your sport (or academic) performance over the past month, from 0 (not at all satisfied) to 10 (highly satisfied)”. Additionally, participants were asked to share two to three factors contributing to their rating. The 1-10 subjective performance ratings scale has been used by other thriving and sport researchers (Brown et al., 2017; Arnold et al., 2017; Levy et al., 2011) as an outcome variable in their interventions. Mindfulness The Athlete Mindfulness Questionnaire (AMQ; Zhang et al., 2017) was used to assess levels of dispositional mindfulness. The AMQ has 16 items that measure three factors; sport specific present-moment attention, awareness, and acceptance on a 5-point likert scale (1, Never True, to 5, Always True). Scores are added to yield a total score and subscale scores, with higher scores indicating greater levels of sport-specific mindfulness. Each of the three factors has been Mindfulness and Thriving 9 shown to be internally reliable (αs = 0.64 to 0.75) and to have convergent (rs = 0.21 to 0.46) and divergent (rs = -0.23 to -0.40) validity with four samples (n = 1302, age Ms = 19.6 to 21.6) of Chinese athletes (Zhang et al., 2017). Additionally, reliability (αs = 0.75 to 0.77) and validation with discriminant data (rs = -0.14 to -0.42) of the AMQ has also been supported with US college athletes (Van Dyke et al., 2021). Internal consistency with the current sample ranged from α = .77 to .79 for subcscales and was α = .89 for the composite scale. The Applied Mindfulness Process Scale (AMPS; Li et al., 2016) was used to assess how participants incorporate mindfulness practices within their lives. The AMPS has 15 items that measure three factors; negative emotion regulation, positive emotion regulation, and decentering on a 5-point likert scale (0, Never, to 4, Almost Always). Scores are added to yield a total score and subscale scores, with higher scores indicating higher application of mindfulness skills. Each of the three factors has been shown to be internally reliable (α = 0.91) and to have convergent (r = 0.29 – 0.52) and divergent (r = - 0.48) validity with a large sample of mindfulness practitioners (Li et al., 2016). Internal consistency with the current sample ranged from α = .74 to .87 for subcscales and was α = .92 for the composite scale. The Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011) was used to measure psychological flexibility, which shares common features with components of thriving (Sarkar & Fletcher, 2014). The AAQ-II assesses levels of psychological inflexibility versus flexibility and experiential avoidance versus acceptance. The AAQ-II contains 7 items that are rated on a Likert scale (1, Never True, to 7, Always True) and added to create a composite score, with lower scores indicating higher levels of psychological flexibility. Bond et al’s (2011) validation study (n = 2816) included 6 samples from a range of backgrounds (e.g., college students, financial industry workers, rehabilitation patients). The researchers found the AAQ-II Mindfulness and Thriving 10 to have high test-retest reliability (rs = 0.79 to 0.81) and good predictive (d = 1.12) and discriminant validity (rs = 0.49 to 0.71). Internal consistency for the current sample was α = .88. Program evaluation Sixteen items were used to assess participants’ satisfaction with the sport-adapted MBI, perceived benefits, perceived challenges or obstacles, likelihood of continuing a daily mindfulness practice, and likelihood of recommending the program to peers. Nine items were on a Likert scale (1, Strongly Disagree to 5, Strongly Agree) while seven items prompted open answer responses. The program evaluation items (e.g., challenges, obstacles) also captured negative or adverse experiences of the program, which is an important facet of mindfulness research (Van Dam et al., 2018). At the start of sessions 2-7 and at data collection 3, participants were asked how many minutes per day they practiced mindfulness on their own to evaluate between session practice fidelity and transfer of interventions skills into daily life. Procedures During the summer of 2022, the primary researcher conducted a pilot version of the sport-adapted MBI. This allowed the primary researcher to plan, administer, and evaluate session content, timing, and mode of delivery. Additionally, administration of the assessment battery helped evaluate item wording, timing, and explore effect sizes for variables to inform power analysis for sample size. After the pilot, the researchers attained Institutional Review Board approval for the study. Convenience sampling was used to gain access to potential sport team participants. Sports with spring championships were favored to ensure an offseason or early season intervention, limiting extraneous variables and improving feasibility due to increased availability of practice time. After recruitment, three Division II teams agreed to participate in the study: a swim team (n = 33) that was randomly assigned to the intervention group and a golf Mindfulness and Thriving 11 team (n = 10) and tennis team (n = 12) that were randomly assigned to the control group. Due to the smaller rosters of tennis and golf, they were combined for random assignment as an attempt to balance sample size between intervention and controls. Student-athletes were informed of the potential benefits (e.g., improvements of well-being, performance) and risks (e.g., adverse reactions to meditation, loss of time) of the intervention and given the choice to participate prior to the first data collection by a secondary researcher. Data collection occurred at three timepoints: pre-intervention (T1), nine weeks later at post-intervention (T2), and a five-week follow-up (T3). Data were collected in-person through an assessment battery administered in person at the team’s facility by secondary researchers. Pilot Intervention Pilot participants were recruited from a team the first researcher had previously provided consultation. Although the original intervention was planned for eight weeks, due to scheduling feasibility, modules 3 and 4 were reduced to one week each and the total intervention to six weeks. Initially, six participants signed up for the pilot intervention. Five participants completed the first survey and majority of the intervention, while four participants completed both surveys (survey took between 13 to 18 minutes to complete). There was a 93% adherence rate for the five who participated, and sessions took on average 54 minutes. Outcome data from RM-ANOVAs indicated large effect sizes for the AMQ-16 (ηp2 = .43), AAQ-II (ηp2 = .41), AMPS (ηp2 = .27), CIT (ηp2 = .25), and MTWS (ηp2 = .25). A power analysis using the effect sizes for mindfulness and thriving from the pilot study (ηp2 = .25 to .43) suggested 42 total participants as adequate for statistical analysis with these larger effect sizes. Feedback from the participants informed the research team of considerations regarding survey items (e.g., rewording CIT community items to be sport-specific), mindfulness exercises (e.g., participants thought box breathing was the least Mindfulness and Thriving 12 useful while awareness of breath was the most useful), and modes of delivery (e.g., all preferred handouts to write on versus slides or prompt questions with open journaling). While participants reported practicing formal mindfulness on their own for an average of 28 minutes per week (participants were encouraged to practice 35 minutes per week), they shared that introducing more informal methods early on and a weekly check-in could have helped reinforce daily practice. After the pilot it was determined that the intervention could be adequately experienced in seven sessions; the researchers decided to keep modules 1-3 at two sessions each, and to reduce the final module to one session. Sport-related language (e.g., team, teammates) was added to items 4, 5, 6, 8, 16 on the CIT to help participants clarify item meaning. Pilot participant feedback also informed changes to modes of delivery and mindfulness exercises provided for between-session practice. Aligning with their preferences, prepared handouts were used for each session and awareness of breath exercises was practiced within sessions and encouraged for between-session practice more frequently than box breathing. Intervention Details The intervention was led by the first author. He has ten years of experience coaching swimming, applied counseling experience through his MEd., and six years of mental performance consulting experience. His theoretical orientation integrates acceptance and commitment therapy, cognitive behavioral therapy, and positive psychology. First introduced to mindfulness in 2016, the first author has progressively embedded mindfulness into his personal practice and professional work. With the support of the second author, who has over two decades of mindfulness practice, the first author has instructed college courses on mindfulness. Mindfulness and Thriving 13 The protocol for the intervention group was influenced by sport-adapted MBIs including MAC (Gardner & Moore, 2007), Mindful Sport Performance Enhancement (MSPE; Kaufman et al., 2018), and especially Mindfulness Meditation Training for Sport (MMTS; Baltzell & Summers, 2017). Specific components from each program align well with conceptual and correlational connections to thriving and therefore were emphasized. This adaption allowed for purposeful selection of mindfulness concepts and exercises that may promote thriving. Participants completed seven sessions within four modules over the course of nine weeks. Session length will varied from 50-60 minutes and included psychoeducation, didactic discussions, reflection journal prompts, group and partner reflections, and mindful meditation exercises with an emphasis on application to performance and well-being in sport and daily life. Across the course of the four modules, participants were introduced to mindfulness and acceptance concepts (e.g., present-moment awareness, attention, self-compassion, defusion, anchoring) and asked to do 5-10 minutes of mindfulness at home each day. The researchers considered feasibility as well as the previous research highlighting frequency and the potential impact of brief meditations when deciding dosage recommendations (Karing & Beelmann, 2021; Edwards et al., 2017). The researchers provided between-session mindful journaling prompts and meditation resources to support participant at-home practice. An emphasis of the program was to enhance mindfulness and increase value-driven behaviors by guiding participants towards intentionally applying skills and concepts towards training, performance, and daily life. Further details related to intervention design, justifications, and decision-making regarding the intervention can be found in appendix B. A comprehensive outline of each module is provided in Table 1. Mindfulness and Thriving Data Analysis 14 Data was analyzed via SPSS. Descriptive analysis via independent sample t-tests and chi squared analysis was conducted to determine the equivalence of groups at baseline. As an intervention manipulation check, 2 x 2 ANOVAs were used to assess changes in mindfulness and psychological flexibility. A series of MANOVAs and ANOVAs was conducted to answer the first research question and its subsequent parts, while a pragmatic approach with basic thematic analysis was be used for the second research question (Chen, 2016). Two 2 x 3 group by time MANOVAs were used to answer examine if those in the MBI group improved comprehensive thriving (via the CIT), compared to a control group. MANOVAs allow for a sufficient analysis of complex constructs and questions, making this approach necessary for the comprehensive definition and measurement of thriving. A 2 x 3 MANOVA was used for all the positive subcomponents of the CIT and one was used for the negative subcomponents of the CIT. For each 2 x 3 MANOVA, the researchers tested for multivariate normality and homogeneity of covariance matrices. Additionally, the researchers conducted 2 x 3 RM-ANOVAs for the subcomponents of the CIT as an exploratory analysis. A series of 2 x 3 group by time RM-ANOVAs were used to assess change for the MBI group relative to the control, in academic and sport thriving (via the MTWS), as well as subjective performance satisfaction. For each 2 x 3 RM-ANOVA, the researchers first tested for normality and sphericity. Post hoc comparisons were made to analyze differences between groups over time. The second research question focused on participants’ experiences within the intervention and was analyzed with a pragmatic program evaluation (Chen, 2016). This approach is designed for the evaluation of real-world programs and incorporates simple quantitative and qualitative elements to capture participants perceptions and experiences. The 5-point Likert scale items were Mindfulness and Thriving 15 averaged across participants so that means and standard deviations could be compared with similar MBI program evaluations (Worthen & Luiselli, 2016). A post-positivist approach was used for the program evaluation open response data analysis. With an understanding that while the true objective reality of the study cannot be fully captured, it is important to allow the participant’s words to determine themes (Ponterotto, 2005). In alignment with a post-positivist approach, content analysis was used to determine themes from the open answer items (Wood & Bloor, 2006). This approach allowed for the efficacy of the intervention to be analyzed directly from participant perceptions. Consistent with previous researchers, a hybrid approach to coding was used with questions categorized deductively (e.g., benefits, challenges), and patterns of responses coded inductively (Fereday & Muir-Cochrane, 2006). Researchers one and three became acquainted with the data by compiling responses into one source and reading over the data multiple times. Once familiar with the data, the researchers independently inductively coded responses to support the rigor and integrity of the analysis. The researchers then met to identify, debate, and rectify patterns and themes found within the data. Once themes were identified, the second researcher audited the themes. Results Descriptive Statistics and Baseline Characteristics Independent samples t-tests and chi-squared analysis were conducted at baseline (N = 55) to examine potential differences between the control and intervention group on DVs. The intervention group was significantly higher in sport experience (p < .001) and hours per week in sport (p < .001), but lower in comprehensive positive thriving (p = .02), sport vitality (p = .02), and sport-specific mindful awareness (p = .02). See Table 2 for full descriptive baseline data. Mindfulness and Thriving 16 Intervention Engagement and Effects: Manipulation Check Attendance for each session was as follows: session one (93.5%), session two (93.5%) session three (83.8%), session four (90.3%), session five (83.8%), session six (77.4%), and session seven (96.7%) for an average of 88.4%. Over the course of the program, participants reported practicing formal mindfulness for 31.95 (SD = 24.89) minutes per week which accounts for 71% of what was prescribed. At follow-up, participant practice had dropped an additional 20.7% to an average of 25.35 (SD = 21.79) minutes per week, which accounts for 56.3% of what was prescribed. To test program fidelity, a manipulation check was conducted via 2 x 2 RM-ANOVAs (n = 49) for each mindfulness scale and subscale, as well as psychological flexibility, comparing the means for these variables from pre-program to post-program of the intervention group relative to the control. From this manipulation check, several significant medium to large effects were found. There were statistically significant interactions of group and time on the AMPS subscale of negative emotion regulation (ηp2 = 0.17, p = .01), the AMPS (ηp2 = 0.15, p = .007), the AMQ subscale of awareness (ηp2 = 0.14, p = .008), AMPS subscale of decentering (ηp2 = 0.13, p = .01), and the AMPS subscale of positive emotion regulation (ηp2 = 0.09, p = .04). As was intended, the intervention appears to have led to moderate effects on several mindful process variables. Although medium effects were found, there was no significant interaction of time and group on AMQ scores between T1 and T2 for the intervention group relative to the control (ηp2 = 0.06, p = .08). Similarly, there were no significant differences in the AMQ subscale of acceptance (ηp2 = 0.03, p = .27), AAQ scores (ηp2 = 0.02, p = .39), or the AMQ subscale of attention (ηp2 = 0.0, p = .99). Though these patterns of data were encouraging, except for mindful awareness which did have a medium effect, the intended effects of the intervention on self Mindfulness and Thriving 17 reported mindfulness and psychological flexibility were not observed. See Table 3 for full results from the manipulation check. Impact on Thriving: Between-Groups Differences Two 2 x 3 RM-MANOVAs were used to analyze changes in comprehensive thriving for the positive and negative scales. Although effects were seen in the hypothesized directions, there were no significant condition-by-time effects for either positive (ηp2 = .03) or negative thriving (ηp2 = .02). Due to a lack of power (Range: 0.25 - 0.49), analysis of the MANOVA results was limited. To gain a better understanding of the changes in comprehensive thriving, a series of 2 x 3 exploratory RM-ANOVAs were used to examine effect sizes for the subscales of comprehensive thriving. Medium effects were found for optimism (ηp2 = .09) and meaning and purpose (ηp2 = .08). Specifically, the intervention group showed improvement of scores, compared to the control group, on these two variables – providing some support for the intervention effects. A series of 2 x 3 RM-ANOVAs were used to assess changes in sport thriving, academic thriving, subjective sport performance, and subjective academic performance across the course of the intervention. Subjective sport performance was found to show significant group-by-time effects with medium magnitude (ηp2 = 0.12). This moderate effect shows that the intervention group reported greater improvements in sport performance satisfaction compared to the control group. No significant interaction effects were found for sport thriving, academic thriving, nor academic performance satisfaction. Results for all thriving-related RM-MANOVAs and RM ANOVAs with estimated marginal means and notes regarding violations of assumptions can be found in Table 4. The exploratory result details can be found in Table 5. Mindfulness and Thriving 18 Program Evaluation Feedback As a result of content analysis, a variety of themes were produced related benefits, facilitators, challenges, and negative experiences within the program. Participants shared that the program was effective in providing benefits to sport (M = 4.34 out of 5, SD = .54), including improved self-regulation (20.4%), enhanced focus (15.9%), and positive changes of awareness and perspective (18.2%). Participants reported using mindfulness to channel the right mindset (“helped me be calm but competitive”) prior to performance (“helped get me into the zone”), as well as in response to adversity (“calm and collected when things get hard”). Finding a balanced perspective (“take the good things even in dark days”) and reigniting intrinsic motivation (“actually enjoying swimming for swimming”) also resonated with some participants. The program also appears to have helped participants in their daily lives outside of sport (M = 4.16 out of 5, SD = .72). Participants reported academic benefits (24.2%) such as improved engagement (“easier to pay attention in class”) and self-regulation (“nerves when test-taking”). The self-regulation benefits seen in sport also appeared to transfer to daily life (21.2%) as participants used mindfulness to help themselves “think clearer” and be “able to relax”. While 87.5% of participants reported no negative or adverse reactions to mindfulness, 6.2% of participants cited an increased awareness of negative thoughts or emotions. Although 23.5% of participants reported no challenges to learning and practicing mindfulness, maintaining focus did appear to hinder others (23.5%). The large group setting may have further contributed to challenges with focus while meditating within sessions (M = 2.59 out of 5, SD = 1.24). Participants found the applied portions of sessions (e.g., meditation; 34.5%) and the autonomy-supportive strategies (e.g., multiple meditation options; 34.5%) to be most engaging or helpful aspects of the intervention for learning mindfulness. They also reported that reminders Mindfulness and Thriving 19 (18.8%) and more meditation opportunities (e.g., pre-practice; 18.8%) may have increased their use of mindfulness between sessions. For more program evaluation data, see Table 6. Discussion The purpose of the study was to examine the efficacy of a mindfulness-based intervention in improving student-athlete thriving while also evaluating their self-reported experiences with the MBI. Due to lower than desired statistical power, findings will be discussed in order of most to least important based on effect size and novel findings. The intervention appears to have had the intended effect on some aspects of mindfulness (i.e., sport-specific awareness) and mindfulness processes (i.e., emotion regulation, decentering). Inexperienced meditators may overestimate their levels of trait mindfulness (Grossman, 2011), so the use of instruments to measure changes in mindfulness processes may further illuminate the impact of MBIs. The use of the AMPS to measure change and identify which processes may be most impacted within a sport-MBI provided novel insight into how and why athletes apply mindfulness. Participants AMPS scores corresponded with their open answers (“easier to manage big workloads”; “less anxious for school”), indicating the MBI helped increase their use of mindfulness skills (e.g., decentering, emotion regulation, self-regulation, self-compassion) to manage stressful moments, thereby reducing their suffering in their academic and performance environments. General psychology researchers have used the AMPS to measure mindfulness processes as a resilience factor and validation studies have shown moderate relationships between the AMPS and measures of well-being and mindfulness (Galvin et al., 2021; Li et al., 2016). The connections between mindfulness skills, their daily lives, and their well-being was discussed throughout the intervention and was the culminating focus of the final session. Mindfulness and Thriving 20 Sport Performance Satisfaction via Mindful Awareness and Self-Regulation Although the main hypothesis that the MBI would significantly increase thriving was not fully supported, several thriving-related findings were noteworthy. Consistent with previous literature, the MBI appears to have improved athlete subjective reports of sport performance with moderate effects (Goisbault et al., 2022). These improvements are noteworthy when considering contextual factors surrounding the intervention group. Improvements at T2 were the highest and this time point coincided with several stressors (i.e., coming off a travel meet with performance related pressure, entering final exams with academic-related pressure). Academic and sport stressors have been shown to inhibit athlete coping and negatively impact performance (Hamlin et al., 2019). Despite these stressors, participants reported improved performance as they were able to, as one athlete noted, “stay calm and collected when things get hard”. In their open-ended responses at the end of the program, athletes shared benefits such as self-regulation, poise, focus, awareness, and self-compassion that may have contributed to their self-reported improvements in sport performance. Self-regulation and poise have been linked with thriving as well as sport performance (Özcan and Vural, 2020; Perry et al., 2017; Brown et al., 2018). Noting the observed increases in mindful awareness and decentering (e.g., defusion, non-judgement), athletes may have applied these skills as methods of self-regulation. One of the meditations shared with the athletes, and commonly used by the coach for pre-practice mindfulness, focused on using the breath to ground themselves in the moment and then state a value-based intention. Athletes may have used this awareness of values to self-regulate and direct their focus and energy away from stressors and into the practice or performance. Consistent with elite basketball players from the Goisbault et al. (2022) study, being mindful of sport-specific cues appears to help improve focus, which Mindfulness and Thriving 21 indirectly helps improve performance by helping athletes invest more attention and energy in each practice session. Finally, practicing self-compassion may increase athlete resilience by helping them move beyond mistakes and refocus (Mosewich et al., 2013). Participants reported being able to “separate myself from my performance” and improving their “ability to not be so critical” which might have given them the freedom and poise to perform. Impact on Thriving: Optimism and Purpose for Sport and Beyond Although the results should be taken with caution, the exploratory analysis of changes in measures of comprehensive thriving indicated that a mindfulness intervention may increase levels of optimism. These findings support the emerging evidence that mindfulness may help reduce pessimism or increase optimism in sport (Scott-Hamilton and Schutte, 2016; Wang et al., 2021). Athletes in other studies have previously described having an optimistic outlook as a key characteristic of thriving (Brown et al., 2018). Furthermore, items related to optimism in the present study were not sport-specific but generalized to life experiences. Corresponding with these improvements, some participants reported positive changes in awareness and perspective (e.g., optimism, gratitude) in both sport and life such as the athlete that stated they learned to “take the good things even in dark days”. Student-athletes reporting these positive changes in both domains is encouraging for practitioners to note when considering mindfulness as a method to promote holistic well-being. These increases in optimism may be influenced by the intervention’s emphasis on self-compassion and empowerment (see Module 2, Table 1). It is possible that participants used self-compassion to dwell less on setbacks and reinterpret failure with a more mentally tough and optimistic perspective, which their increased AMPS emotion regulation scores would support. Mindfulness and Thriving 22 The exploratory analysis using the CIT also revealed a moderate intervention effect on participants’ sense of meaning and purpose. A key focus of the intervention was identifying and fostering commitment to values for both sport and life. Similar to previous MAC research, participants in the current study may have become more aware of, or connected and committed to, values and goals important to their sport (Goodman et al., 2014; Goisbault et al., 2022). Yet the exploratory findings reveal an improved sense of meaning and purpose in life beyond sport. The DII student-athletes in the sample may share common priorities with their generation (e.g. mental health support, holistic development), leading to an appreciation for the MBI’s emphasis on identifying values important to sport and life (Twenge et al., 2019; Gould et al., 2020). Segall (2021) implored mindfulness researchers to integrate eastern and western approaches to mindfulness; describing a similar pursuit of eudaimonia that is fostered when awareness and actions align with virtuous purposes. While some of the internal CIT scales seemed to be impacted by the MBI, relative to the control at follow-up, most of the CIT scales and other thriving measures (MTWS) were not. Interestingly, the means for all but one thriving scale moved in the hypothesized direction from T1 to T2, but most experienced drop-offs at T3. This pattern may be reflective of the time of season the swimmers in the intervention group were experiencing; while T1 and T2 were at moderate training load periods, T3 was during the heaviest training load of the season, when student-athletes were on a near empty campus during a holiday break. These contextual factors – the timing of in-season assessments – are important to note for future researchers who study thriving longitudinally with student-athletes experiencing heavy training loads. Internal factors like participant’s mood, engagement, and sense of vitality might have been impacted by the physical exhaustion that accompanies heavy training loads (Alfonso & Capdevila, 2022; Issurin, Mindfulness and Thriving 23 2019). Though the self-report instruments did not reveal significant findings, vitality-related improvements (i.e. energy, intentional action, flow) were reported by some participants at post intervention as they shared they were “less tired” and more able to “pinpoint daily goals”, “be intentional” and “get into the zone”. Ensuring less drop-off in mindfulness practice between T2 and T3 might have further supported their recovery and sense of vitality through this training period as mindfulness has been shown to aid stress-recovery balance (Holguín-Ramírez et al., 2020). While there were some self-reports of improved interpersonal skills, contrary to previous findings, specific effects on social well-being or team cohesion were not observed over time or self-reported in the current study (Piasecki et al., 2021). It is possible that athletes from a co acting sport like swimming may not prioritize social factors and team cohesion as much as athletes from co-dependent sports like soccer or volleyball (Worthen & Luiselli, 2016). The T3 contextual factors of experiencing the most intense period of training on an isolated campus may have also limited social interactions and inhibited external factors of thriving (i.e., belonging, community, trust, respect, autonomy, loneliness) that relate to team cohesion. Similarly, although the researcher witnessed anecdotal accounts of autonomy-supportive coaching between T1 and T2 (e.g., allowing the seniors to select events), athletes may have felt less autonomy from T2 to T3 due to having their holiday break involve intense training on an isolated campus. It is possible that the coach choosing the team to do the MBI, versus student-athletes signing up at their own volition, also inhibited autonomy, limited engagement, and acted as barrier to thriving at a comprehensive level. A lack of autonomy through controlling coach behaviors has been seen to prevent thriving for female netballers (Gucciardi et al., 2017). An extended MBI like Milligan et Mindfulness and Thriving 24 al.’s (2017) 20-week program may have further guided participants to make value-based decisions that promote self-autonomy and cohesion despite their circumstances. When considering the academic domain, although trending in the hypothesized directions, there were no significant changes in academic thriving or academic performance satisfaction. While reports of academic vitality did increase over time (ηp2 = .05) relative to the control group, the effect was not as large as has been seen in previous research using the same instrument (Augustus & Zizzi, 2022). Participants in the Augustus and Zizzi (2022) study watched the Headspace Guide to Meditation series (Grosso, 2021) in their health class which may have promoted transfer of skills to the academic setting. Nevertheless, in the current study program evaluation, approximately 1 in 4 responses about the daily life benefits of mindfulness highlighted academic performance. Some student-athletes reported improved focus, time management, and self-regulation of test anxiety which would correspond with previous academic research (Milligan et al., 2017; Phan et al., 2022). Practical Implications The actual practice of meditation was valued over learning mindfulness concepts as 38% of participants found the meditations to be the most engaging aspect of the MBI compared to 14% reporting psychoeducation. Facilitative factors like autonomy-supportive strategies (i.e., provided multiple options of meditations, discussion-based activities) were also appreciated by participants (34.5%) which supports research from a self-determination theory perspective (McHenry et al., 2020). Additional challenges reported included maintaining focus (35.3%), specifically for longer meditations and in the group format. Practitioners may weigh out the costs and benefits of dividing teams for MBIs to provide an environment more conducive to meditation. The use of engaging games (12%) as well as more sessions and interactions (9%) Mindfulness and Thriving 25 were suggested as possible solutions by current participants, highlighting the importance of building rapport. From an accountability standpoint, participants somewhat agreed that at-home practice was challenging (M = 2.88 out of 5) but some also reported the logs as being helpful in reminding them to practice. At-home practice adherence numbers were similar to Minkler (2023) and practice dropped-off between the end of the MBI (71% of desired dosage) and follow-up (56% of desired dosage). A central focus of the final session was to help student-athletes identify mindfulness resources and plan daily practices for after the MBI ended. Participants in the current study reported higher intentions of continuing to practice mindfulness in their sport (M = 4.34 out of 5) relative to participants in other sport-based MBIs (M = 3.89 out of 5; Worthen & Luiselli, 2016). A steeper drop-off in practice post-MBI may have been prevented by the emphasis on continued daily application. Athletes noted that reminders would have helped them increase consistency in at-home practice. Practitioners should consider, and future researchers may explore, the most acceptable and effective ways of using reminders via text, email, or physical cues in the athletes’ environment. Although the coach did implement some pre-practice meditations, athletes suggested more meditation opportunities and easier access would have increased their practice. While most (88%) of the participants reported no negative experiences while practicing mindfulness, 2 participants did state they became of aware of negative thoughts or memories. Although the research is limited regarding adverse or negative experiences with MBIs (Van Dam et al., 2018), this percentage of negative or adverse experiences (6% or 2 of 33 athletes) is consistent with estimates in previous literature (Farias et al., 2020), and reinforces the importance of having referral processes embedded in MBI protocols. While no one requested Mindfulness and Thriving 26 referral for mental health services, multiple participants responded that they already were supported by the university counselor. Even with adverse experiences being low, having a referral system in place when conducting MBIs ensures appropriate support for participants. Limitations and

A Grounded Theory Investigation of Basic Psychological NeedsA Grounded Theory Investigation of Basic Psychological Needs Theory as a F y as a Framework for E amework for Effective Mental Health Ref e Mental Health Referrals in Collegiate Sport Luna Ugrenović West Virginia University Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Other Psychology Commons Recommended Citation Ugrenović, Luna, "A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport" (2024). Graduate Theses, Dissertations, and Problem Reports. 12694. https://researchrepository.wvu.edu/etd/12694 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport Luna Ugrenović, M.S., M.A. Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Dana K. Voelker, Ph.D., Chair Ashley Coker-Cranney, Ph.D. Johannes Raabe, Ph.D. Monica Leppma, Ph.D. School of Sport Sciences Morgantown, West Virginia 2024 Keywords: interpersonal behaviors, need supporting, need thwarting, sport support personnel, teammates, student-athletes Copyright 2024 Luna Ugrenović ABSTRACT A Grounded Theory Investigation of Basic Psychological Needs Theory as a Framework for Effective Mental Health Referrals in Collegiate Sport Luna Ugrenović Using a grounded theory approach, this study explored collegiate athletes’ mental health referral experiences and identified mechanisms explaining those experiences based upon perceptions of psychological need fulfillment and thwarting according to Basic Psychological Needs Theory (BPNT). Interviews were conducted with a purposive, maximum variation sample of 14 current and former collegiate athletes who were referred to mental health services by support personnel or other athletes. Analyses yielded three overarching theoretical categories/properties: prereferral factors, proactive and reactive referral conversations, and referral outcomes. Referral is often understood as an isolated conversation in which athletes are provided mental health resources in response to a crisis. Challenging this notion, the present study showed that proactive referral as a preventative approach, as well as intentional understanding athletes’ pre-referral experiences, were central to supporting athletes’ relationship with their mental health. Generally, referral experiences that resulted in helping athletes disconnect their mental health concerns from understandings of their self-worth, and ultimately pursue mental health services with hope for recovery, were linked to psychological need satisfaction throughout the referral process (e.g., autonomously choosing mental health services, relating to the referrer through a similar experience, mastering skills for pursuing therapy). Yet, in cases of positive referral experiences, some athletes re-internalized mental health stigma upon re-engaging with unsupportive sport and familial environments. Need thwarting amid the referral conversation was generally associated with poorer outcomes, in addition to cultural environments that deterred help-seeking. Together, the data suggest BPNT is a promising framework for effective referral guidance, though psychological needs are met uniquely for each athlete based upon their characteristics and context. MENTAL HEALTH REFERRALS IN SPORT iii Acknowledgments I cannot thank enough everyone from both sides of the ocean who have supported me on this journey. I would like to express my deepest gratitude to Dr. Dana K. Voelker, my advisor and committee chair, for her invaluable patience, guidance, and support. Her passion for the field and dedication to the highest excellence has pushed me to reach my potential. This endeavor also would not have been possible without my committee, who generously provided their knowledge and expertise. I thank Dr. Ashley Coker-Cranney for her methodological expertise and guidance that made this ambitious study possible. I thank Dr. Johannes Raabe for challenging me to reach the highest research standards and offering his theoretical expertise. I thank Dr. Monica Leppma for reminding me to trust my intuition and to practice self-compassion. I would also like to deeply thank my research assistant, Verena Zaisberger, for her dedication and perspective during each phase of the study – her curiosity and hard work were pivotal in creating the final product of this project. I am also so grateful for my colleagues and friends who read drafts, offered feedback, and were my moral support. Without them, my journey would not have been nearly as meaningful and fulfilling. I will be forever grateful to Dr. Tommy Minkler, Dr. Blake Costalupes, Dr. Sofía España Pérez, Dr. Zenzi Huysmans, Dr. Karly Casanave Phillips, Dr. Andrew Chip Augustus, Kim Tolentino, Jaxson Judkins, Kayla Hussey, Hannah Miller, Sarah Sadler, Hannah SilvaBreen, and Lindsey Leatherman. I thank my family, especially my parents, Maja and Vladan, and my sister, Mia. Their belief in me has kept my spirits and motivation high, while their unconditional love has offered me a sanctuary when I needed it. Lastly, I want to express special thanks to my husband, Salman, whose tireless support, love, and selflessness helped me overcome each and every obstacle along the way. Our shared passion for the topic and many long late-night discussions about the grounded theory have inspired me and reminded me of the opportunity to impact others with my research. I thank him for sharing this journey with me every step of the way. MENTAL HEALTH REFERRALS IN SPORT iv Table of Contents Introduction and Literature Review…………..…………………………………………….……..1 Basic Psychological Needs Theory………………………………………………………..4 Methods and Materials…………………………………………………………………………….7 Research Approach and Philosophical Assumptions..…...…………………...…….……..8 Methodological Approach………………………………..….………….………...………9 Participants………………………………………………………………………..……...10 Materials…………………………………………………………………………………11 Demographic Survey…………………………………………………………….11 Interviews………………………………………………………………………...11 Procedures………………………………………………………………………………..12 Data Analysis…………………………………………………………………………….14 Methodological Rigor……………………………………………………………………18 Results……………………………………………………………………………………………19 Pre-Referral Factors….…………………………………...……………………………...20 Participants’ Identities and Culture……………………………………………....20 Participants’ Family Environments………………………………………………22 Participants’ Sport Environments……………………...………………………...23 Reactive and Proactive Referral Conversations………………...…………………....…..25 Psychological Need Satisfaction and Thwarting………...………………………26 Autonomy Satisfaction and Thwarting…………...……………………...26 Relatedness Satisfaction and Thwarting………..….…………………….28 Competence Satisfaction and Thwarting…………….…..………………30 Referral Outcomes……………………………………………………………………….30 Perceptions of Self as Context……………………………………...….……...…31 Perceptions of Self as Content…………………………...……………………....32 Discussion………………………………………………………………………………………..36 Practical Implications…………………………………………………………………….42 Limitations and Future Directions………………………………………...……………..44 Conclusion……………………………………………………………………………….46 References………………………………………………………………………………………..48 MENTAL HEALTH REFERRALS IN SPORT v Appendix A: Extended Literature Review…………………………………………….……...….59 Collegiate Athlete Mental Health……………………………………………...……...…60 Mental Health Referrals………………………………………………………………….64 Mental Health Referrals in Sport………………………….……………...……...70 Rates of Mental Health Referrals in Collegiate Sport…..…………...…..72 Possible Barriers to Successful Mental Health Referrals in Sport……….74 Mental Health Referrals in Sport – Best Practices……………………….78 Basic Psychological Needs Theory………………………………………………………84 Basic Psychological Needs Theory and Collegiate Athletes…………………….87 Basic Psychological Needs Theory, Well-Being, and Mental Health….....……..90 References………………………………………………………………………………..92 Appendix B: Extended Methods and Materials………………………………………….…......106 Researcher’s Positionality and Background……………………………………………106 Appendix C: Recruitment Flyer………………………………………………………………...109 Appendix D: Cover Letter………………….………………………...………………....……...110 Appendix E: Demographic Survey……………………………………………..………………112 Appendix F: The Final Version of The Interview Guide…………………………….…………115 MENTAL HEALTH REFERRALS IN SPORT 1 Introduction Mental health concerns are rising among collegiate athletes (Brown et al., 2021). Data suggest the prevalence of stress, anxiety, sadness, mental exhaustion, anger, and sleep difficulties are 1.5 to 2 times higher than pre-2021 reports (National Collegiate Athletic Association [NCAA], 2022). Collegiate athletes experience signs and symptoms of various mental health concerns (e.g., Brown et al., 2021; Gavrilova & Donohue, 2018) at greater frequencies than their same-age, non-athlete peers (e.g., Donohue et al., 2018; Li et al., 2017). Despite collegiate athletes’ reported frequency of mental health concerns, research suggests most do not pursue mental health services. For example, the NCAA Well-Being Study (2022) found that less than half of the collegiate athletes surveyed reported feeling comfortable seeking help from an oncampus mental health professional. There are various barriers to collegiate athletes’ willingness and ability to pursue mental health services, such as stigma, limited knowledge of the supports and resources available, negative help-seeking beliefs, concerns about confidentiality, and perceived lack of time (e.g., Cox et al., 2017; Hilliard et al., 2020; Moore, 2016). To address this problem, understanding how best to connect collegiate athletes with mental health services, in ways they feel comfortable and motivated to pursue those services, is gravely needed. An important step in the mental health help-seeking process, and that can be investigated to address collegiate athletes’ growing mental health concerns, is referral. Defined as the process of directing others to appropriate supports and resources to address their mental health needs (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015), referral is often made by peers or support personnel in collegiate athletes’ immediate performance environments, such as academic advisors, strength and conditioning coaches, sport coaches, sport dieticians, mental performance consultants, physiotherapists, physiologists, and athletic MENTAL HEALTH REFERRALS IN SPORT 2 trainers (Cormier, 2014; Daltry et al., 2021; Neal et al., 2013; 2015; Sebbens et al., 2016; Van Raalte et al., 2015). Unfortunately, support personnel report they are neither comfortable nor confident in their ability to communicate with, refer, and support athletes experiencing mental health concerns (Gayman & Crossman, 2006; McArdle et al., 2018; Moreland et al., 2018; Sandgren et al., 2022). In a qualitative study, support personnel reported feeling anxious, frustrated, underprepared, and unskilled to refer athletes, citing a critical need for guidance on what and how to communicate with athletes experiencing mental health difficulties (McArdle et al., 2016). Gayman and Crossman’s (2006) qualitative study found mental performance consultants rarely discussed the possibility of referrals to mental health services during intakes, did not maintain an updated referral list of available providers, and did not follow-up with the athlete clients if a referral was made. Unsurprisingly, this discomfort with mental health conversations is compounded by collegiate athletes also feeling the effects of this uncertainty (Arthur-Cameselle et al., 2012). For example, Cutler and Dwyer’s (2020) study of 158 collegiate athletes found that only half believed their coaching staff could offer support in an emotional crisis. Clearly, a lack of preparedness and comfort with mental health has led to the avoidance of referral-related behaviors among support personnel and is also impacting athletes. Collectively, these data suggest that although support personnel can play a key role in referrals given their proximity to and rapport with collegiate athletes (e.g., Daltry et al., 2021; Neal et al., 2015; Sebbens et al., 2016), barriers to effective communication with athletes around mental health concerns may impede the referral process, perpetuate negative help-seeking attitudes and stigma, and in turn make it exceedingly difficult for collegiate athletes to seek appropriate and timely help when needed. These communication barriers are not just limited to the exchange between support personnel and athletes, as many athletic departments also do not MENTAL HEALTH REFERRALS IN SPORT 3 sufficiently discuss the referral process, suggesting structural difficulties that some coaches have described as “broken” and “dismantled” (Eckenrod et al., 2023, p. 7). Accordingly, support personnel must be better equipped to support collegiate athletes through the development and implementation of referral guidelines that ease and facilitate communication while empowering athletes to pursue mental health supports and resources. This need extends to athlete peers, as some literature suggests that, with adequate training, college student peers generally, and athlete peers specifically, can act as helpful sources of mental health referrals (e.g., Kalkbrenner et al., 2019; Van Raalte et al., 2015). Yet, extant referral guidelines designed for athletes are limited. Vella at al.’s (2021) systematic review and meta-synthesis of mental health position statements in sport found the overall quality of the guidelines to be low. Specifically, although many policy statements discuss the importance of referrals, they lack clear referral guidelines, such as when, how, and to whom to refer. Guidelines solely focused on policy and procedure (i.e., what to do) but not process (i.e., how to do it) are limited in their effectiveness (Tod & Anderson, 2014) as they fail to support the application and implementation of their referral policies and procedures to specific contexts. This not only refers to the sport environment context but also to collegiate athletes’ identities and cultural backgrounds, as collegiate athletes working with support personnel reportedly value when their identities beyond sport are acknowledged and honored (Bejar et al., 2019). Further, as culture influences the likelihood of engaging with mental health care in unique ways (Abdullah & Brown, 2011), athletes’ identities and cultural contexts may also impact referral outcomes. More recently, the NCAA (2024) released a mental health best practices consensus document, yet their recommendations are also on referral pathways and not processes. Although such efforts MENTAL HEALTH REFERRALS IN SPORT 4 are timely and important, there remains a need to delineate specific steps and actions that support personnel and other athletes can utilize when engaging in the mental health referral conversation. Recommendations that do explicate process are largely based on accounts of experienced practitioners and include: (a) building rapport with athletes and communicating care for their well-being; (b) facilitating a team approach to athlete care; (c) preparing athletes for referrals; (d) showing support and normalizing mental health concerns; (e) referring in (i.e., inviting therapists to meetings with athletes and support personnel); (f) explaining reasons for referrals; (g) describing what working with therapists entails; (h) following up with athletes; and (i) being prepared to offer alternative coping options and to revisiting referral after giving athletes time to consider the recommendations (Andersen et al., 1994; Neal et al., 2013; 2015; Tod & Andersen, 2014; Van Raalte & Andersen, 2014). Such practitioner-informed guidelines can be further strengthened by centering athletes’ voices on effective and ineffective referral experiences, considering athletes’ identities and unique needs, and studying the interpersonal components with referrers that may affect athletes’ willingness and ability to pursue mental health recommendations. Further, using well-established conceptual frameworks to explore and explain the referral process would provide additional structure to future research in this area, particularly with respect to predicting athletes’ willingness to engage in the recommendations they are provided, while providing clarity and focus to key targets of intervention that would improve the referral experience. Basic Psychological Needs Theory A promising framework for understanding how to facilitate effective referrals for collegiate athletes, is basic psychological needs theory (BPNT; Ryan & Deci, 2017), a wellresearched theoretical guide for successful interpersonal interactions toward future behavior. MENTAL HEALTH REFERRALS IN SPORT 5 BPNT may be especially helpful in this context as it has been widely used in sport research to explore the impact of interpersonal behaviors on motivation (e.g., Raabe & Zakrajsek, 2017). Specifically, as one of the mini theories within the larger framework of self-determination theory (SDT; Ryan & Deci, 2017), BPNT has helped explain antecedents to initiating and maintaining behaviors in sport (e.g., Raabe et al., 2016), work (e.g., Parfyonova et al., 2019), health care (e.g., Ryan at al., 2008), and other settings. According to BPNT, an individual’s innate and basic psychological needs are autonomy, competence, and relatedness, all three of which are influenced through social interactions and are considered essential for psychological growth (Ryan & Deci, 2017). Autonomy refers to perceptions of self-governance and volition and the degree to which one values these behaviors. While autonomy support involves conveying value of one’s perspective and encouraging selfdirectedness over one’s decisions, autonomy controlling behaviors involve the use of external controls, like rewards and punishments, that promote need thwarting and undermine motivation. Competence refers to perceptions of self-mastery in one’s interactions with their environment. Supporting another’s need to feel competent involves providing education, guidance, feedback, and structure to assist in the development of mastery and efficacy. Conversely, thwarting another’s need to feel competent involves highlighting faults and lack of abilities, demonstrating doubt in the ability to improve, and discouraging engagement in difficult tasks. Finally, relatedness pertains to a sense of belonging in which one feels connected to, and valued by, others. With respect to relatedness, need support constitutes genuine interest, care, acceptance, and companionship from others, whereas need thwarting constitutes treatment from others that is distant, emotionally unavailable, exclusionary, and characterized by a failure to listen. As others’ behaviors influence the extent to which one perceives these needs to be satisfied, or thwarted, MENTAL HEALTH REFERRALS IN SPORT 6 this in turn determines the likelihood of initiating and maintaining a behavior and informs wellbeing. Although specific ways basic needs are satisfied or frustrated differ based on context, culture, and social setting, they are considered to universally apply to all humans (Ryan & Deci, 2017). In a recent meta-analysis (Slemp et al., 2024), perceived need satisfaction, coupled with interpersonal support, was associated with optimal motivation, wellbeing, and performance. Conversely, negative interpersonal behaviors informed perceptions of need thwarting that, in turn, were associated with ill-being, poorer performance, and diminished motivation. Researchers have used BPNT to understand the wellbeing and mental health of diverse groups of young adults (e.g., Akbag et al., 2017; Campbell et al., 2018; Cantarero et al., 2021), including athletes. For instance, in a sample of over a thousand collegiate students from four countries (i.e., Belgium, China, USA, and Peru), Chen at al. (2015) found need-satisfaction predicted well-being, and need-thwarting predicted ill-being, irrespective of students’ nationality, their reported importance of each need, and their willingness to satisfy them. This evidence highlights the utility of a BPNT framework in understanding mechanisms for supporting mental health among college students. BPNT has been also used in collegiate sport to explore athletes’ fulfilment and frustration of the three basic psychological needs in both academic and athletic settings (e.g., Raabe at al., 2022; Raabe & Readdy, 2016), and coaches’ and teammates’ impact on collegiate athletes’ need-satisfaction (e.g., Raabe & Zakrajsek, 2017). Some studies have specifically examined the role of support personnel (e.g., coaches and athletic trainers) in injured athletes’ need satisfaction and thwarting during their recovery and return to sport. Bejar et al.’s (2019) study of NCAA Division I collegiate athletes with an injury found greater motivation during injury rehabilitation when they perceived their athletic trainers supported their needs for autonomy, competence, and relatedness (Bejar et al., 2019). MENTAL HEALTH REFERRALS IN SPORT 7 Specifically, participants reported that athletic trainers facilitated their motivation to engage in rehabilitation recommendations when they provided (a) information, clear expectations and goals, encouragement, and reassurance (facilitating their competence); (b) scheduling availability and flexibility, focus on both health and performance goals, receptivity to feedback, and choice in treatment (facilitating their autonomy); and (c) approachability, rapport-building, and curiosity about athletes’ lives beyond sport (facilitating relatedness; Bejar et al., 2019). The findings of this study suggest BPNT may be a useful framework for investigating the role of support personnel in collegiate athletes’ motivations to pursue recommendations around their care. Specifically, behaviors of support personnel and athlete peers may similarly influence collegiate athletes’ motivation to follow-through on referral recommendations by interacting with their psychological needs and, in turn, impacting their wellbeing. Situated within their identities and cultural contexts, this study explored (a) collegiate athletes’ experiences receiving mental health referrals from support personnel and their athlete peers, and (b) the mechanisms, informed by perceptions of psychological need supporting and/or thwarting, that explained the experiences and their associated outcomes. The findings are used to inform theoretically-grounded, data-driven, and athlete-centered recommendations for referral in collegiate sport environments. Methods and Materials Research Approach and Philosophical Assumptions The researchers adopted a multiparadigm approach integrating constructivist and critical realist research paradigms (Bogna et al., 2020; Voelker et al., 2024) to fully achieve the research aims. As proposed by Bogna et al. (2020), a constructivist paradigm allowed the researchers to explore the domain of the empirical, as guided by (a) relativist ontology whereby researchers MENTAL HEALTH REFERRALS IN SPORT 8 assumed there were multiple and socially constructed realities (Sale et al., 2002); (b) subjective epistemology in that meaning was believed to be socially- and culturally-informed through interactions with one’s environment (Moon & Blackman 2014), and (c) the axiological aim was to understand and communicate co-constructed realities between the researchers and the participants (Biedenbach & Jacobsson, 2016). Toward the first study aim, a constructivist paradigm was used to first give voice to participants themselves, and in that way, understand their mental health referral experiences and meaning. Specifically, participants’ referral beliefs and experiences were perceived as products shaped by social and cultural contexts associated with their unique identities and collegiate sport environments and were considered as multiple and individual truths. A critical realist paradigm allowed the researchers to explore the domain of the real (Bogna et al., 2020), as guided by (a) realist ontology that assumed an objective reality existed independent of one’s perception of it (Wynn & Williams, 2012); (b) interpretivist epistemology or the assumption that relationships, ideas, and knowledge interacted to shape causal mechanisms, events, and experiences that resulted in specific tendencies (Peters et al., 2013); and (c) the axiological goal to understand mechanisms and causal regularities (Bogna et al., 2020). Toward the second study aim, the researchers explored structures, mechanisms, and conditions associated with a well-established and empirically supported theoretical framework, BPNT, that shaped these experiences using a critical realist paradigm. The two paradigms were merged to explore the domain of the actual, where mutually constructed meanings and associated occurrences and events were shaped by structures, mechanisms, and conditions, and therefore, allowed a more complete and deeper understanding of the studied phenomenon (Bogna et al., 2020; i.e., referral experiences). In other words, the MENTAL HEALTH REFERRALS IN SPORT 9 multiparadigm approach allowed exploration of the what, using constructivism, and the how, using critical realism, regarding mental health referrals in collegiate sport. Methodological Approach Consistent with a multiparadigm approach that aimed to explore the domain of the actual (Bhaskar, 1978), a constructivist grounded theory methodology (Charmaz, 2000; 2006, 2014) was integrated with a critical realist, or retroductive, grounded theory methodology (Looker et al., 2021), both of which share eight common elements (Weed, 2009). According to Charmaz (2014), a constructivist grounded theory methodology acknowledges “subjectivity and the researcher’s involvement in the construction and interpretation of the data” (p. 14). Hence, this methodology allowed for exploration of what are the referral experiences and what are the realities of collegiate athletes within relevant culture and context, while considering the researchers’ role, including experiences, privileges, and biases, in the construction of that knowledge. Rooted in classical grounded theory (Glaser and Strauss, 1967), retroductive grounded theory aims to develop understanding of mechanisms, or causal powers, that produce the studied phenomenon (Hoddy, 2019; Kempster & Parry, 2011; Looker et al., 2021). According to Kempster and Parry (2011), because the critical realism paradigm suggests knowledge is valueladen, retroductive grounded theory is a context-rich, versus context-free, approach to studying phenomena. Unique from other grounded theory approaches, drawing upon existing theories while analyzing the data is encouraged with a retroductive approach (Kempster & Perry, 2011). Hence, this retroductive methodology was used to explore the role of BPNT in clarifying the possible mechanisms that affected mental health referral in sport; or in other words, the how behind collegiate athletes’ referral experiences. Together, constructivist and retroductive MENTAL HEALTH REFERRALS IN SPORT 10 grounded theory methodology captured the lived experiences and meanings of collegiate athletes who were referred to mental health services, and mechanisms that shaped these experiences. Participants Participants were 14 current (n = 8) and former (n = 6) collegiate athletes aged 18 to 25 years (M = 21.28, SD = 2.23). Participants were referred one to three times within the past four years by athletic trainers (n = 8), coaches (n = 7), collegiate athlete peers (n = 5), nutritionists (n = 2), mental performance consultants (n = 2), and physicians (n = 1). Table 1 provides sample demographics. Table 1 Participants’ Self-Identified Demographic Characteristics Characteristic n % Sex and Gender Cisgender Woman 10 71.4 Cisgender Man 4 28.6 Race and Ethnicity *White 12 85.7 Latina 1 7.1 White and Asian 1 7.1 Nationality American 11 78.6 English 1 7.1 German 1 7.1 Mexican 1 7.1 Annual Family Income $25,000-$50,000 3 21.4 $50,000-$75,000 3 21.4 $75,000-$100,000 2 14.3 $100,000 or more 5 35.8 Did not know 1 7.1 Religion and Spirituality Nondenominational Christian 3 21.4 Catholic Christian 3 21.4 Spiritual but not religious 2 14.3 Agnostic 1 7.1 Atheist 1 7.1 Easter Orthodox Christian 1 7.1 MENTAL HEALTH REFERRALS IN SPORT 11 Characteristic n % Methodist Christian 1 7.1 Pentecostal/Assembly of God Christian 1 7.1 Protestant Christian 1 7.1 Sport Rifle 2 14.3 Soccer 2 14.3 Swimming 2 14.3 Triathlon 2 14.3 Diving 1 7.1 Lightweight rowing 1 7.1 Rowing 1 7.1 Track and Field; Softball 1 7.1 Competitive Level NCAA DI 10 71.4 NCAA DII 1 7.1 NCAA DIII 3 21.4 Note. NCAA = National Collegiate Athletic Association; DI/DII/DIII = Divisions I, II, and III *5 participants who identified as white American also reported identifying as: Bulgarian, German/Polish/Irish/Italian, Irish/German, Irish/Wales, and Polish. Materials Demographic Survey. A demographic survey (see Appendix E) was administered via Qualtrics software and asked when participants were referred to mental health services and who referred them, as well as their age, sex, gender identity, sexual orientation, race, ethnicity, nationality, SES (socioeconomic status), religion, collegiate sport organization, division, and sport(s). Interviews. Individual in-depth, semi-structured, online, video-recorded interviews started with rapport-building, followed by open-ended and follow-up questions to generate conversation as recommended by Charmaz (2014) and Hoddy (2019). The first author, who conducted the interviews, continuously engaged in self-reflexivity according to guidelines established by Tracy (2010), to examine her assumptions about referrals in collegiate sport and communicate, both verbally and via open body language, a willingness to learn and understand MENTAL HEALTH REFERRALS IN SPORT 12 participants’ lives from their perspective. These experiences were processed with a critical friend with each subsequent interview to also deepen reflexivity. The first version of the interview guide was developed based on previous literature on mental health referrals in sport (e.g., Sebbens et al., 2016; Van Raalte et al., 2015), BPNT (e.g., Ryan & Deci, 2017), prior experiences interviewing collegiate athletes about mental health concerns (e.g., Coker-Cranney et al., 2018), as well as guidance on constructing questions aligned with both constructivist (Charmaz, 2014) and critical realist aims (Brönnimann, 2022). Broadly, questions explored collegiate athletes’ experiences being referred to mental health services with intentional exploration of their identities and culture in connection with those experiences. Participants were then provided a cursory overview of the three psychological needs and asked their perceptions of needs satisfaction and thwarting amid their referral experiences. Consistent with Glaser and Strauss (1967), the interview guide evolved as data were collected to support the process of theoretical sampling and consequent development of grounded theory (see Appendix F for the final version). Initial interviews ranged from 55 to 105 minutes in duration (M = 86 minutes). Procedures After receiving IRB approval (Protocol #2302727613), participants were purposively sampled according to the eligibility criteria (i.e., at least 18 years of age, current or former collegiate athlete, was referred to mental health services in the past four years by support personnel or other athletes). Maximum variation sampling was used to garner the widest range of experiences, to the extent possible, with respect to several key factors found to play a role in collegiate athletes’ mental health concerns and/or help seeking behaviors (e.g., Ballesteros & Tran, 2020; Brown et al., 2021; NCAA, 2022; Li et al., 2017); these variables included sex, MENTAL HEALTH REFERRALS IN SPORT 13 gender identity, sexual orientation, race and ethnicity, and SES. Further maximum variation was sought with respect referral experience (i.e., positive and negative) and referral source (e.g., mental performance consultant, athletic trainer, sport dietician, academic advisor, strength and conditioning coach, sport coach, or athlete peer). Nationality, sport, year in college, collegiate sport organization, division, and religion were also considered. As suggested by Charmaz (2014) and Hoddy (2019), interviews were transcribed and evaluated as they were completed to support a theoretical sampling process that informed the type of data sought in subsequent interviews as a theory emerged, such as revising interview guide questions (e.g., re-ordering questions about basic psychological needs) and/or recruiting participants with certain experiences (e.g., perceiving to have a lack of choice during referral experience) or attributes (e.g., man-identified collegiate athletes) to explore a gap in the developing theory. Recruitment, then, was an iterative process continuously informed by the purposive, maximum variation, and theoretical sampling processes to obtain a sample with rich and wide-ranging experiences that meaningfully informed a substantive grounded theory. Recruitment approaches included multiple flyer (see Appendix C) distributions via social media outlets (e.g., LinkedIn) and email to colleagues, sport support personnel (e.g., mental performance consultants, athletic trainers), and or collegiate sport teams. Interested participants who voluntarily contacted the first author were provided additional information about the study outlined in a cover letter (see Appendix D), including the purpose of the study, what participation would entail, the possible benefits and risks of participation, and participation incentives, and then screened for inclusion criteria. Eligible participants were offered an opportunity to read the cover letter, ask questions, and then complete a demographic survey. The first author conducted initial interviews and invited the participant for a member reflection on a MENTAL HEALTH REFERRALS IN SPORT 14 second date following the initial coding of the participant’s first interview. Although each member reflection was unique, they broadly included a summary of main takeaways, followed by a discussion of participant’s impressions and conclusions from the initial interview, and new understandings and experiences since the initial interview. Thirteen participants completed the follow-up, lasting between 10 and 29 minutes (M = 19.7). Participants who completed the study received a $50 Amazon gift card in modest appreciation of their time. To protect participants’ confidentiality, all interviews were de-identified, and participants were assigned pseudonyms. Data Analysis Data analysis was guided by both constructivist (Charmaz, 2014) and retroductive grounded theory approaches (Looker et al., 2021). Prior to and during data collection and analysis, a two-person data analysis team continuously explored theoretical sensitivity – examining the studied phenomenon with an open mind to explore and compare different perspectives as well as evolve original ideas (Glaser, 1978). Theoretical sensitivity allowed the data analysis team to explore the participants’ perspectives about referrals in novel and original ways. To support this process, the data analysis team consulted with a larger research team, comprised of applied practitioners and academic researchers in sport psychology and clinical mental health, during bi-weekly hourly meetings for several months. According to Glaser and Strauss (1967), grounded theory methodology involves an iterative process of engaging in data collection and analysis simultaneously. Accordingly, analysis started, and continued, as each new interview was conducted and transcribed. Analysis of each interview began with the data analysis team reading each transcript and then verbally processing their insights with one another. The first author then conducted the initial coding (constructivist grounded theory) using a line-by-line coding approach to define the phenomenon MENTAL HEALTH REFERRALS IN SPORT 15 and allow the data to speak (Charmaz, 2014). The goal of the initial coding was to remain open and curious to all possible theoretical directions suggested by participants’ perceptions of the referral process. Charmaz suggested focusing on exploration of the actions and processes that define the phenomenon (i.e., collegiate athletes’ experience being referred to mental health services) was crucial at the beginning stages of the data analysis because it helped provide evidence of fit (i.e., capturing the essence of the participants’ experiences via codes and categories) and relevance (i.e., creating a framework that captures what was happening and relationships between implicit and explicit processes) of the emerging theory. Then, the first author conducted focused coding (constructivist grounded theory), also called open coding (retroductive grounded theory) – a process through which the goal was to conceptualize the phenomenon by choosing the most significant and or frequent initial codes that categorized the data inclusively and completely, and then comparing them to additional data (Charmaz, 2014; Looker et al., 2021). During focused/open coding, the first author moved across interviews to compare participants’ referral experiences, actions, and meanings (the dolman of empirical) to synthesize the main themes across large amounts of data while also exploring the structures and mechanisms that may have underscored these experiences and meanings (the domain of real). Theoretical categories (constructivist grounded theory) or emergent properties (retroductive grounded theory; i.e., core elements in a theory) emerged during focused/open coding and memo writing as well as constant comparison between the data (Charmaz, 2014; Looker et al., 2021). This process was not linear; later interviews made some processes clearer and incited reanalysis of earlier interviews. Following focused/open coding, the first author engaged in theoretical coding – a process that hypothesized possible relationships among MENTAL HEALTH REFERRALS IN SPORT 16 theoretical categories/emergent properties (constructivist grounded theory; Charmaz, 2014), with retroductive coding that explored generative and context-specific causal mechanisms that helped explain those relationships (retroductive grounded theory; Looker et al., 2021). Consistent with constructivist and retroductive grounded theory, this phase involved constant comparison between the new data, memos, and codes as well as possible reanalysis (Charmaz, 2014; Looker et al., 2021) toward exploration of the domain of the actual. To support the process of describing and conceptualizing the phenomenon, the first author engaged in consistent memo writing described as an analytic process in both constructivist and retroductive grounded theory (Charmaz, 2014; Looker et al., 2021). Broadly, memo writing allowed the first author to generate ideas, develop and connect theoretical categories/emergent properties, gain insights early in the research process, and explore the possible causal mechanisms that explain the relationships between theoretical categories/emergent properties (Charmaz, 2006; 2014; Looker et al., 2021). Memo writing supported iterative data analysis as it allowed the first author to explore and discover ideas freely and spontaneously (Weed, 2009). When needed, memos were discussed with the research team to support the exploration of the phenomenon. An important part of memo writing was raising focused/open codes to theoretical categories/emergent properties (Charmaz, 2014; Hoddy, 2019). This was done by choosing focused/open codes that best capture what was happening in the data and why it was happening though comparison between the data, incidents, contexts, and other categories/properties. Via memo writing, the first author defined and explored characteristics of tentative theoretical categories/emergent properties, explored their relationships with other theoretical categories/emergent properties, and possible causal mechanisms that explained these MENTAL HEALTH REFERRALS IN SPORT 17 relationships (Charmaz, 2014; Looker et al., 2021). In advanced memos, the first author traced and categorized data to achieve the purpose of the study, describe how theoretical categories/emergent properties and possible causal mechanisms emerge and change, identify the beliefs and assumptions that supported them, explore various perspectives of the memo topic, and engage in constant comparisons. Throughout each phase of the study, the first author conducted constant comparison iteratively between data and data, data and codes, codes and theoretical categories/emergent properties, and theoretical categories/emergent properties and BPNT literature. The first author started theoretical sampling once there were preliminary theoretical categories/emergent properties from which to collect subsequent data that expanded and improved theoretical categories/emergent properties and related causal mechanisms informing the emerging theory (Weed, 2009). Theoretical sampling was facilitated by memo writing that helped identify incomplete theoretical categories/emergent properties and causal mechanisms, and gaps in the analysis. Weed (2009) argued theoretical sampling, based on tentative theoretical categories/emergent properties, continued until no new characteristics of theoretical categories/emergent properties and no new causal mechanisms emerged from new data (i.e., theoretical saturation; Charmaz, 2014; Hoddy, 2019). Based on what emerged from the existing data, theoretical sampling involved recruiting new participants with specific experiences, or collecting follow-up data collection from the existing participants (Charmaz, 2014; Hoddy, 2019). The first author regularly consulted with the research team about decisions regarding the specific approaches to theoretical sampling. To deepen the analysis and construction of the emerging theory, the first author engaged in theoretical sorting, comparing/diagramming, and integrating memos (Charmaz, 2014). This MENTAL HEALTH REFERRALS IN SPORT 18 involved comparing memos and exploring how the order and logic of memos capture the referral experiences of collegiate athletes. Additionally, drawing diagrams assisted in establishing and solidifying theoretical categories/emergent properties, their relationships, and causal mechanisms that explain them. Together, these strategies provided insight toward an emerging theoretical framework on referring collegiate athletes to mental health services. To support the process of theory development, the first author met with expert consultants regularly during each phase of the analysis regarding the quality and rigor of the analysis and relevance to the BPNT framework. Follow up member reflections and the research team interpretations were transcribed and analyzed with the rest of the data to refine the theoretical categories/emergent properties and emerging theory (Albas & Albas, 1988; 1993; Charmaz, 2014; Looker et al., 2021). Methodological Rigor To support the process of investigating, interrogating, and deepening different interpretations of the data (Harper, 2011), the research team included individuals with a variety of experiences in the collegiate sport and mental health fields. Some of the shared experiences of the research team involved completing post-secondary education in either sport psychology, mental health counseling, or both. Additional commonalities among the research team included being an athlete, a coach, a mental performance consultant, and a mental health counselor in various sport and clinical settings in the United States and Europe. Some of the unique experiences of the research team included identifying with different nationalities (i.e., American, German, Austrian, and Serbian) and gender identities (i.e., woman- and man-identified), competing and working for different sports and sport levels (i.e., high school and collegiate), and interacting with collegiate athletes in different capacities (e.g., as a therapist, a professor, a mental performance consultant, a supervisor, a former collegiate athlete). Additionally, the MENTAL HEALTH REFERRALS IN SPORT 19 research team had diverse experiences, expertise, and formal training regarding conducting qualitative research in sport psychology and counseling, BPNT, and making and receiving collegiate athletes’ mental health referrals. The approaches used to support data trustworthiness, credibility, and confirmability were engaging in self-reflexivity both in written (i.e., memo writing) and verbal (i.e., discussions with the critical friend) forms as well as regular consultations with the research team experts regarding conceptual and methodological decisions, and conducting member reflections, as previously discussed. Additionally, Carcary (2020) recommendations for audit trail best practices were followed (i.e., documenting the research process in all phases of the study, including key methodological decisions, and tracing how researchers’ thinking evolved during each phase). Results Data analysis resulted in a substantive grounded theory (Figure 1) that described and explained participants’ experiences of being referred to mental health services by support personnel and other athletes. Three overarching theoretical categories/properties emerged: (a) pre-referral factors (i.e., conditions and dynamics prior to referrals informing referral conversations); (b) referral conversations (i.e., interactions in which referrers recommended athletes seek appropriate mental health resources); and (c) referral outcomes (i.e., consequences of referral conversations). Figure 1 illustrates subcategories identified within each category, and the relationships between them, that together described participants’ experiences and mechanisms explaining those experiences. Figure 1 A Substantive Grounded Theory of Referring Collegiate Athletes to Mental Health Services MENTAL HEALTH REFERRALS IN SPORT 20 Note. White boxes represent experiences, and gray boxes represent mechanisms. Pre-Referral Factors Prior to the initiation of referrals, pre-referral factors shaped how referral conversations unfolded and, ultimately, the referral outcomes. These factors included aspects of participants’ identities and cultures and interactions with their family and sport environments. Although basic psychological needs were not explicitly explored with participants at this stage of the interview, pre-referral factors clearly also influenced autonomy, competence, and relatedness when shaping participants’ relationships with, and attitudes toward, mental health and, ultimately, the referral. Participants’ Identities and Culture Participants described how aspects of their identities and culture, such as their nationality, race, ethnicity, SES, religion, and gender identity, influenced their perceptions of mental health concerns and help-seeking behaviors that, in turn, informed their willingness to pursue referral MENTAL HEALTH REFERRALS IN SPORT 21 recommendations. For example, Fin referenced that “in Germany, we are…more private, very distant people” which is “probably also one of the reasons why I never really looked at [therapy] before.” Mia, on a different note, commented on SES status: “Growing up, the money aspect was hard. So, that’s why I never went [to therapy].” Other participants described how binary gender norms, informed by their upbringing and traditional sport culture, influenced their help-seeking attitudes. Gia reported that “girls are seen as weaker…guys [are] trying to be the strongest” and that “coaches would see you as weaker” for seeking mental health resources. Tom described how a lack of representation contributed to his mental health concerns and deterred him from seeking help: “I think not only is it hard to be a queer person [in the] outside world, but also being a queer person inside of athletics is incredibly difficult.” Further, some participants cited their religious background and spirituality as both a barrier and facilitator to seeking mental health services. Bri explained, “[My religious community is] very supportive…It gave me an opportunity…to talk about [my mental health] more.” Zoe similarly discussed how “the guiding principles of religion” encouraged her to “find the healthiest version of myself, mentally and physically.” Ana stated why she went to therapy: I realized there was a spiritual element to this… The enemy was telling me, ‘You’re a failure.’ And I was believing it… I need to get my faith back in order. This is a lie… This is not who God says I am… That faith…was HUGE because that was the catalyst that started changing things. Other participants believed religion sufficed as therapy and, accordingly, avoided facing their difficulties as a way to cope (i.e., spiritual bypassing). Mia reported, “I always just thought I could just pray it off…Why isn’t praying enough for me? I didn’t want it to feel like I couldn’t do it on my own with just God.” MENTAL HEALTH REFERRALS IN SPORT 22 Some participants reported ways their intersecting identities shaped their views on helpseeking. Ana described her “quite emotionally unavailable” English culture and “the culture of being an athlete” as making her “incredibly reluctant” to seek help. Others explained that support personnel failed to honor their intersecting identities, exacerbating their mental health concerns and unwillingness to seek help. Tom explained that, in his sport environment, the term “athlete” was used to generalize “a group of people that can be incredibly diverse.” He noted, “As someone who has been athletic since I was five years old, I just took onto that [athlete] title and didn’t allow other things in my life to define who I was.” He added, “[Sport personnel] don’t really talk too much about sexuality…It was never really a topic of conversation.” For the participants who recognized having privileged identities, representation in mental health settings was often not a concern. Ana stated, “I’m heterosexual, [that is] why I don’t feel there [were] any barriers in terms of those parts of my identity.” Ana also acknowledged her teammates may have had a different experience: “We had a couple of lesbians on the team. I could see how they wouldn’t want to go to a Christian counselor for fear that they would be judged.” For some participants who belonged to minoritized groups, representation was key to their willingness to seek mental health services. As a member of “the international community,” Lea reported noticing “more of a need for cross-cultural specialists… Our counseling center… has been staffed by older white people.” Lea suggested “having…knowledge of various backgrounds and…cultures…helps with the referral process” as professionals may “understand your experience and you feel represented in them.” Participants’ diverse identities and culture had strong effects on their help-seeking attitudes and behaviors, and, consequently, their openness to referral recommendations. Participants’ Family Environments MENTAL HEALTH REFERRALS IN SPORT 23 Participants in family environments that encouraged help-seeking were more likely to have positive attitudes toward help-seeking themselves. Max stated, “I’ve never thought [seeking therapy] was a bad thing… I’ve always been told…if you’re struggling mentally, there’s nothing wrong with talking to [psychotherapists].” Ana noted, “My parents didn’t see seeking counseling as a sign of weakness… I know my dad had gone…and…it was helpful for him… If anything, it encouraged me… They’re not gonna judge me…” Contrarily, negative attitudes toward help seeking in their immediate family deterred other participants from wanting to seek mental health services. Mia mentioned, “My parents are very against being mentally weak… [My extended family] don’t believe in therapy at all… I would never say [to them]…that I’m in therapy.” Some participants also said that help-seeking attitudes were passed down generationally, making it harder to shift their own attitudes. Lea reported, “[My mother] moved from [another country]… With my grandparents it very much was like, ‘You don’t need anything. It’ll be fine’…The cultural mindset travels with you.” Among these participants, some discussed slow but important shifts in intergenerational help-seeking attitudes. Gia reported that her “transition generation” is growing up in a time when they are “actually…listened to” instead of being told to just “toughen up,” and that younger generations will benefit from further shifts in this direction. Family members’ attitudes towards mental health help-seeking, whether positive or negative, strongly influenced participants’ own attitudes yet were noted as malleable. Participants’ Sport Environments Many participants similarly described their sport environments as supportive or unsupportive of mental health help. These participants were more likely to have positive attitudes toward help-seeking when athletic department cultures encouraged it. Joy felt “really good” about seeking services after noticing that “no one looked twice” when her teammate disclosed MENTAL HEALTH REFERRALS IN SPORT 24 pursuing therapy. Gia did not originally value mental health services, but because her head coach “wants to talk about mental health…it’s not uncomfortable.” Gia also described several benefits of mental health services being accessible and frequently promoted in her sport environment. Per Gia, coaches pointed to “posters with [the psychotherapist’s] contact information,” and athletic trainers frequently offered to “help you set up an appointment.” These participants also discussed having better access to services when mental health providers were integrated into sport. For Max, “the fact that [the psychotherapist in athletics] is around us and really looks out for us…definitely helped. Max noted, “I don’t know if it was some random person if I would have [sought therapy].” Conversely, some participants noted several barriers when athletic department cultures failed to promote mental health. Ana’s teammate “didn’t believe what was going on with me was a big deal… It made me feel like, ‘Oh, maybe she’s right. Maybe there’s nothing wrong with me. Maybe I’m just being dramatic,’ which was very painful.” Ana further noted, “Before that conversation [about referrals] even happens, …there’s more that can be done with the culture around [mental health],” explaining that requiring a referring athletic trainer to “deal with this” is “unfair…when there is not a culture already in place that makes those conversations accessible and comfortable.” Fin “wasn’t really aware of [existing therapy resources for athletes]… that wasn’t really too public that I would have the option to talk to [psychotherapists]…. That message never really came from the main coaches.” Ella had “never heard someone who goes to [the psychotherapist in athletics] and has a good experience… She’s trained…just…not very good.” Contrarily, some participants indicated that an overemphasis on mental health was also an issue. Ella described this as an “overcorrection,” as her coach’s efforts to normalize mental health made the coach “too emotionally involved”, thus “hindering…[team] performance.” Ella MENTAL HEALTH REFERRALS IN SPORT 25 also felt that some of her teammates were “too annoying and loud about mental health.” As with family environments, participants’ sport environments, including cultural messaging about mental health, impacted their pre-referral attitudes and intentions toward help-seeking. Reactive and Proactive Referral Conversations Participants’ identities, cultural backgrounds, and family and sport environments informed the help-seeking attitudes they, figuratively, brought with them to their referral conversations with support personnel and other collegiate athletes. In these referral conversations, referrers broached their concerns with participants and recommended mental health resources or services. Many participants described these conversations as having occurred reactively (i.e., in response to an experienced mental health crisis) or proactively (i.e., with the aim to prevent concerns from beginning or worsening). Participants further discussed ways they perceived their basic psychological needs to be supported or thwarted amid these interpersonal exchanges. Most participants reported being referred reactively, as a result of “hitting rock bottom” (Tom) or in response to crisis, such as sexual assault, suicidality, and panic. Referrals following a crisis that were experienced positively involved the referrers who promptly provided support, information, and choices to help them feel safer and more in control. Liz stated it “was helpful to know what I was walking into.” She further explained, “[The athletic trainer] said, ‘[The boyfriend]…can sit in [the session] with you…,’ prepared me it was going to be a guy [the psychotherapist],” and gave “me the basics of what I was going to experience.” In rare cases, some participants were referred proactively as a preventive measure to help them cope with upcoming stressors. Gia, who “had never done triathlon before”, explained that her head coach referred her “to make sure that you’re not feeling you’re in over your head.” Being referred MENTAL HEALTH REFERRALS IN SPORT 26 proactively increased some participants’ openness to services and reduced mental health stigma. For Gia, this approach showed her that “anyone can be referred… [Therapy] can be helpful for anybody” and “preventative.” Lea described being referred proactively as “a welcome little push to get me to take care of myself and prioritize wellbeing,” with others stating that it helped them overcome ambivalence or avoidance. Bri noted, “Had I not had that [referral] conversation with [the athletic trainer], I probably would have never gone to see anybody.” Such examples exemplified the importance of approaching each referral differently based on an athlete’s unique needs. Psychological Need Satisfaction and Thwarting In addition to the proactive/reactive nature of referral conversations, participants discussed ways in which the interpersonal exchanges with referrers supported, or thwarted, their basic psychological needs. These included participants’ autonomy (i.e., sense of selfgovernance), relatedness (i.e., sense of connection), and competence (i.e., sense of mastery). Autonomy Satisfaction and Thwarting. Many participants explained that common hierarchical power structures influenced their referral conversations and, subsequently, their decisions to pursue mental health services. When asked about what it was like to be referred by their teammates, two participants voluntarily compared it to referrals by coaches, stating it felt “more like my own decision… Athlete to coach is more a sense of authority” (Eva). Mia echoed, “If [the coach] were to suggest [therapy]… I would not have a comfortable conversation” and “would just go…feel I had no choice” and “be doing it for him.” For Ari, “Having [the athletic trainer and the coach]…reach out to [the psychotherapist] before I even gave consent…or approval…was upsetting. So, I didn’t feel I had the autonomy because it was not brought forward to me.” In contrast, a few participants discussed how financial privilege was another MENTAL HEALTH REFERRALS IN SPORT 27 form of power that supported autonomy during and following the referral. Bri reported she “went out and found [a psychotherapist] on my own… It’s privileged to be able to afford that… Privilege does create autonomy.” Many participants reported feeling autonomous when their referrers asked them for their thoughts and preferences and provided control around referral outcomes, including the opportunity to contemplate and choose whether to pursue services. Bri stated, “it was my choice” because the athletic trainer informed her about resources and said “It’s completely up to you. We’re not going to force you into it or judge you if you decide not to.” Fin reported, “[Therapy] was…brought up…[as] an option. And I was like, ‘Okay, I’m gonna give it a thought…’ It was never the end of the conversation and then a fixed, ‘Yeah, I’m gonna…[seek therapy].’” Fin further explained, “After a week… based on my own evaluation… [and] taking into consideration… what [the r

From Measur om Measurement t ement to Performance: Psy formance: Psychometric V chometric Validity and alidityFrom Measur om Measurement t ement to Performance: Psy formance: Psychometric V chometric Validity and alidity and Psychological Pr chological Predictors of Reser ors of Reserve Officer T e Officer Training Corps aining Corps Cadets’ Performance on the Army Combat Fitness Test Ari Joseph Sapinsley West Virginia University Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Sports Studies Commons Recommended Citation Sapinsley, Ari Joseph, "From Measurement to Performance: Psychometric Validity and Psychological Predictors of Reserve Officer Training Corps Cadets’ Performance on the Army Combat Fitness Test" (2024). Graduate Theses, Dissertations, and Problem Reports. 12672. https://researchrepository.wvu.edu/etd/12672 This Dissertation is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Dissertation in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Dissertation has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. From Measurement to Performance: Psychometric Validity and Psychological Predictors of Reserve Officer Training Corps Cadets’ Performance on the Army Combat Fitness Test Ari J. Sapinsley, MA, MS, CMPC A Dissertation submitted to the College of Applied Human Sciences at West Virginia University in partial fulfillment of the requirement for the degree of Doctor of Philosophy in Sport, Exercise, and Performance Psychology Sam Zizzi, Ed.D., Co-Chair Johannes Raabe, Ph.D, CMPC, Co-Chair Jeanette Garcia, Ph.D. William Hornsby, Ph.D. Department of Sport, Exercise, and Performance Psychology Morgantown, West Virginia December 13, 2024 Keywords: Psychometric evaluation, ROTC cadets, ACFT (Army Combat Fitness Test), Psychological predictors, Motivation, Resilience, Anxiety Copyright 2024 Ari J. Sapinsley Abstract From Measurement to Performance: Psychometric Validity and Psychological Predictors of Reserve Officer Training Corps Cadets’ Performance on the Army Combat Fitness Test Ari J. Sapinsley, MA, MS, CMPC Understanding the psychological and physical readiness of future military leaders is crucial for improving recruitment and retention. The U.S. Army faces increasing obesity rates and declining physical fitness among recruits, reducing the pool of eligible candidates and raising costs. The Reserve Officer Training Corps (ROTC), which commissions 59% of officers, has higher attrition rates than other sources, underscoring the need to identify psychological predictors of performance. This dissertation examines the psychometric properties of psychological instruments used to assess ROTC cadets and their relationship with Army Combat Fitness Test (ACFT) performance. Two research questions were explored: (1) What are the psychometric properties of instruments measuring the psychological characteristics of ROTC cadets? (2) What psychological characteristics are associated with ACFT performance? A sample of 180 cadets completed assessments, including the Academic Motivation Scale – Revised (AMS-R), Academic Motivation Scale – College (AMS-C), Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS), Cognitive and Somatic Anxiety Inventory – 2 Revised (CSAI-2R), and Resilience Scale (RS). Confirmatory factor analyses (CFA) indicated acceptable reliability and validity for most instruments, with strong model fit for CSAI-2R (CFI = 1.00, TLI = 0.99, α = 0.94) and AMS-C (CFI = 0.95, TLI = 0.95, α = 0.94). Regression analyses identified resilience (β = 0.21, p < 0.05) as a significant predictor of hand-release pushup scores, while self-confidence (β = 0.33, p < 0.05) predicted two-mile run performance. Cognitive anxiety was positively associated with the two-mile run (β = 0.31, p < 0.05), suggesting moderate anxiety may enhance focus. Academic identified regulation and intrinsic motivation were also significant predictors. This study provides insights into the psychometric properties of thirteen instruments among ROTC cadets and elucidates how psychological traits affect ROTC performance. These findings support integrating psychological assessments into training and selection processes to improve cadet identification, training, retention, and cost efficiency. Future research should validate these results in larger, diverse samples and use longitudinal designs to explore long-term impacts. iii Acknowledgments Although, technically, this is my dissertation, this document and project only exist because of a village of wonderful and supportive family, friends, colleagues, and mentors. First and foremost, I would like to thank Dr. Raabe. Your work ethic, perspective, and guidance have been and will continue to be pivotal to my development as a researcher and writer. I am incredibly grateful for your support and commitment to my (our) work, and the skills you have helped me hone over the past three and a half years. To Dr. Zizzi – thank you for stepping in when you, most certainly, had enough on your plate, making me feel comfortable and confident as a student and researcher, and for your limitless supply of pragmatism. If not for you, I would have never seen the forest through the trees or been able to traverse Research Mountain. I will forever be grateful for the impact you have had on me during my time in the Sport, Exercise, and Performance Psychology program at WVU, as well as for your continued contributions to our program and the broader field. To Dr. Shigeno and Dr. Fletcher – thank you both for your patience and your open doors. When I thought, “I think I want to pursue even more education,” you both met me with excitement and encouragement. Under your tutelage, I began my journey in the field of sport psychology, and you both have continued to be voices of reason and mentorship long after my departure. To my parents – thank you for providing me with the privilege and opportunity to pursue any dream, no matter how far-fetched it may have seemed. Your unwavering support, unconditional love, and steadfast belief in me have been the bedrock of everything I have accomplished. You taught me the value of hard work, resilience, and the courage to forge my own path, even when that path was unclear or daunting. I am endlessly grateful for your encouragement, your wisdom, and the example of love and perseverance you’ve set for me. To my brothers – Aaron, Zack, and Josh, thank you for your friendship (although mostly involuntary). From you all, I have learned about debate, intellectual curiosity, competition, friendship, and cooperation. You have each shaped who I am in your own unique way, challenging me to think critically, encouraging me to strive for excellence, and teaching me the value of both standing my ground and finding common ground. Our shared experiences, whether marked by laughter, spirited disagreements, or quiet support, have been a source of strength and inspiration throughout my life. I am grateful for the bonds we share and the lessons I continue to learn from you. Thank you for always being in my corner, even when we didn’t see eye to eye— it has made the journey all the more meaningful. To my in-laws – Mike and Peggy, thank you for your endless supply of generosity, for opening your home to me, and for always having a koozie at the ready. Your unwavering support and kindness have had a profound impact on my educational journey. From the very beginning, you welcomed me into your family with open arms, creating a space where I felt cared for and supported. Your constant encouragement, whether through thoughtful conversations, shared laughter, or the take-home supply of minestrone, has been invaluable. Thank you for being such a vital part of this journey, your impact on my life and this accomplishment is something I will always treasure. To my wife – thank you, Mary, for your unwavering support, love, and friendship. You have been my rock, my cheerleader, and my constant through every stage of this journey, from undergrad to my master's and now my PhD. Together, we have navigated the highs and lows, celebrated victories, and weathered the challenges that came with this long and winding path. iv Your patience, encouragement, and belief in me, even on the days when I doubted myself, have been nothing short of extraordinary. You’ve sacrificed so much to support my goals, and your faith in my ability to succeed has never faltered. I am endlessly grateful for your partnership and the countless ways you’ve made this journey not only possible but meaningful. This accomplishment is ours, and I am so lucky to have you by my side, not just in this, but in all things. Lastly – thank you to Lyla, our dog, you are, without a doubt, a good girl. When I was stressed, you were always available for a pet and a cuddle. When I was huddled over my computer for long stretches, you were always there to remind me that we should go outside for a walk. Your resolute loyalty and cheerful spirit brought light to even the most challenging days, and your gentle nudges reminded me to pause, breathe, and appreciate the world beyond my work. You’ve been my constant companion, my motivator, and my joy through this journey, and for that, I’m endlessly grateful. v Table of Contents From Measurement to Performance: Psychometric Validity and Psychological Predictors of Reserve Officer Training Corps Cadets’ Performance on the Army Combat Fitness Test............ 1 Method ............................................................................................................................................ 9 Participants.................................................................................................................................. 9 Study Design............................................................................................................................... 9 Measures................................................................................................................................... 10 Data Analysis............................................................................................................................ 17 Results........................................................................................................................................... 19 Psychometric Properties of Psychological Instruments (RQ1)................................................. 19 Psychological Predictors of ACFT Performance Among ROTC Cadets (RQ2)...................... 20 Discussion..................................................................................................................................... 21 Psychometric Properties of Psychological Instruments (RQ1)................................................. 21 Psychological Predictors of ACFT Performance Among ROTC Cadets (RQ2)...................... 31 Limitations and Future Directions................................................................................................ 37 Summary and Conclusion............................................................................................................. 39 References..................................................................................................................................... 41 Tables............................................................................................................................................ 58 Extended Review of the Literature ............................................................................................... 89 Military ..................................................................................................................................... 89 Psychosocial Factors............................................................................................................. 90 Psychosocial Predictors of Physical Performance and/or Selection ................................... 106 Sport........................................................................................................................................ 123 Psychosocial Factors........................................................................................................... 128 Psychosocial Predictors of Physical Performance and/or Selection ................................... 137 Future Research Directions..................................................................................................... 148 Extended References................................................................................................................... 151 Appendices.................................................................................................................................. 169 PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 1 From Measurement to Performance: Psychometric Validity and Psychological Predictors of Reserve Officer Training Corps Cadets’ Performance on the Army Combat Fitness Test Talent development within the United States (U.S.) Army is essential for maintaining operational readiness, ensuring mission success, and fostering organizational adaptability. Army officers must possess a blend of physical endurance, psychological resilience, and cognitive adaptability to navigate the multidimensional demands of military service (U.S. Department of the Army, 2023). However, challenges in officer recruitment, selection, and retention persist, threatening the sustainability of the Army’s leadership pipeline. Only approximately 23% of Americans aged 17 to 25 meet the eligibility requirements for military service, further emphasizing the importance of retaining already trained personnel to sustain the force’s effectiveness (Office of People Analytics, 2023). In response, the Army has renewed its focus on prioritizing quality over quantity in officer development, shifting toward a holistic approach to recruitment, training, and retention. Understanding the factors that predict successful officer performance, as well as why officers choose to remain or exit after fulfilling their Active Duty Service Obligation (ADSO), has become a burgeoning area of research aimed at improving resource allocation and organizational maintenance (Russell & Tremble, 2011). To address these challenges, the Army has emphasized integrating physical, cognitive, and psychological measures into its assessment systems. This holistic approach seeks to ensure the selection and development of officers capable of meeting evolving operational requirements (Allen et al., 2016). For example, standardized assessments such as the Tailored Adaptive Personality Assessment System (TAPAS) have undergone extensive psychometric evaluation to improve the precision of personnel selection and position assignments. These tools have provided valuable insights into factors that facilitate or inhibit organizational commitment PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 2 among active-duty soldiers (Kirkendall et al., 2020; Ellis et al., 2023). However, while efforts to evaluate and refine psychological assessment tools have yielded meaningful advances for activeduty personnel, little attention has been devoted to understanding psychological predictors of performance within the Reserve Officer Training Corps (ROTC), the Army’s largest source of commissioned officers. The Role of ROTC The ROTC is a college-based program that integrates military training with higher education, preparing students to become commissioned officers in the Active Duty Army, Army Reserve, or Army National Guard. Approximately 60% of newly commissioned Army officers come from ROTC programs, making it a cornerstone of the Army’s leadership pipeline (Paullin et al., 2014). Cadets participating in ROTC take military science courses covering leadership principles, team dynamics, physical readiness, and military tactics (U.S. Department of the Army, 2023). Beyond classroom instruction, cadets engage in field training exercises, leadership development activities, and physical fitness programs designed to foster the skills and competencies necessary for future leadership roles. Upon completing the program and earning their degrees, cadets are commissioned as Second Lieutenants, assuming critical leadership responsibilities within the Army. Additionally, cadets participate in summer training programs like Advanced Camp, a rigorous evaluation of leadership potential and tactical proficiency held at Fort Knox, Kentucky (U.S. Army Cadet Command, n.d.). These experiences, alongside regular ROTC training activities, immerse cadets in military culture, teamwork, and the demands of active-duty service. While invaluable for preparing cadets for their future roles, these requirements highlight the dual PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 3 pressures of balancing civilian life with military expectations, a challenge unique to the ROTC pathway compared to academy cadets or enlisted personnel (Baldwin & Young, 2020). Despite its importance, ROTC remains underexplored in research on military performance and retention. Compared to their counterparts at U.S. Military Academies, ROTC cadets operate in a dual-context environment that combines civilian academic responsibilities with military training. While this structure allows cadets to benefit from a less regimented experience and broader social interactions, it also introduces unique stressors. Cadets must balance the demands of academic coursework, leadership roles, and physical fitness requirements, all of which contribute to their overall readiness and success (Baldwin & Young, 2020; Legree et al., 2014). These challenges are compounded by ROTC’s more flexible structure, which contrasts sharply with the fully militarized environments of academies like West Point. Understanding the specific factors influencing ROTC cadet performance and retention is critical for sustaining the Army’s leadership pipeline and ensuring the readiness of future officers. Assessment of ROTC Cadets’ Performance The evaluation of ROTC cadets encompasses several performance domains, including academic achievement, leadership capability, and physical readiness. Key metrics include Grade Point Average (GPA), evaluations during the Leadership Development and Assessment Course (LDAC), cadre ratings of leadership potential, and scores on the Army Combat Fitness Test (ACFT). Together, these metrics contribute to the Order of Merit List (OML), which determines cadets’ branch assignments and positions upon commissioning (U.S. Army Cadet Command, n.d.; Baldwin & Young, 2020). Among these, the ACFT—introduced in 2020 to replace the Army Physical Fitness Test—plays a pivotal role in assessing physical readiness. Comprising six PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 4 events, including the deadlift, standing power throw, hand-release push-ups, sprint-drag-carry, plank, and a two-mile run, the ACFT provides a comprehensive measure of physical fitness (U.S. Department of the Army, 2023). While the ACFT offers valuable insights into cadets’ physical capabilities, it fails to account for the psychological factors that influence performance. Improving ACFT performance is vital not only for individual cadets’ success but also for broader Army organizational readiness. Cadets who fail to achieve high ACFT scores risk failure and attrition in their ROTC program along with stagnation in their military careers (Newman et al., 2022). These individual outcomes have cascading effects on leadership development and retention within the Army. For instance, as the Army faces a drastically reduced pool of eligible recruits, with only 23% of Americans between 17 to 25 years of age meeting military eligibility criteria (Office of People Analytics, 2023), reducing attrition of eligible ROTC cadets and retaining already trained personnel is paramount to organizational maintenance and continuity (Wardynski et al., 2010; White et al., 2017). Therefore, it is financially and institutionally essential to understand how to improve ROTC cadets’ physical readiness and ACFT capabilities. Psychosocial Predictors of Military Performance Maximizing ACFT performance requires a comprehensive approach that considers not only physical capabilities but also the psychological factors that underpin consistency and adaptability in high-pressure environments (U.S. Department of the Army, 2023). While physical attributes like aerobic capacity, muscular strength, and agility are well-documented performance predictors in fitness tests and occupational tasks (Acevedo et al., 2024; Hauschild et al., 2016; Hydren et al., 2017; Orr et al., 2021), psychological readiness plays an equally critical role in military performance and career longevity (Flood & Keegan, 2022). Initiatives like the Comprehensive Soldier and Family Fitness program underscore the military's commitment to PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 5 psychological readiness for long-term career success (Casey, 2011). Maintaining mental wellbeing has also been found to reduce attrition and improve operational effectiveness among active-duty and reserve soldiers (Tidwell & Lucier-Greer, 2024), underscoring that mental preparation is essential for sustained military effectiveness. Emerging research further emphasizes the importance of psychological factors in predicting performance, especially under stress, to boost readiness and retention (Richardson, 2023). The literature exploring psychological predictors of military performance has identified numerous traits associated with success. Key psychosocial factors – emotion regulation (Giles et al., 2023), psychological skills (Arthur et al., 2017; Hammermeister et al., 2010), mental toughness (Gucciardi et al., 2021), and hardiness (Normdo et al., 2022) – appear to correlate with military performance and selection. Longitudinal investigations of military personnel performance and selection in rigorous training courses have also highlighted predictive psychological characteristics such as grit (Benedict et al., 2023; Farina et al., 2019; Kelly et al., 2014; Schaefer et al., 2020a), resilience (Farina et al., 2019; Schaefer et al., 2020a), hardiness (Johnsen et al., 2013; Kelly et al., 2014), confidence (Schaefer et al., 2020b), optimism (Schaefer et al., 2020b), self-efficacy (Benedict et al., 2023), and coping (Johnsen et al., 2013). Among these studies, Giles et al. (2023) have been the sole research endeavor to incorporate the Army Combat Fitness Test (ACFT) as an outcome variable. This study employed psychometric network analysis on a sample of male active-duty US Army personnel (N = 191, Mage = 23.1, SD = 3.5) to examine cognitive, health, physical, and social-emotional factors associated with ACFT performance. Giles and colleagues (2023) found that social-emotional components, such as resilience, extraversion, and grit, significantly explained performance variance with minimal redundancy. However, the author’s focus on active-duty male soldiers and PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 6 the absence of psychometric validation limit the applicability of their findings to ROTC cadets, whose training context and developmental stage differ significantly (Baldwin & Young, 2020). Despite these limitations, such findings are promising and potentially foretell psychological factors as significant predictors of ROTC students’ performance on the ACFT. Although prior studies provide valuable insight into psychological predictors of military performance, research exploring military populations still faces several limitations. First, many studies are constrained by the relative homogeneity of their samples (e.g., Benedict et al., 2023). Second, while military academy studies (e.g., Kelly et al., 2014; Schaefer et al., 2020a) may display improved heterogeneity, they typically involve participants who meet higher academic and physical performance standards compared to traditional ROTC cadets (The United States Military Academy, n.d.). Third, much of the literature has been conducted outside the US (e.g., Bekesiene, 2023; Normdo et al., 2022), limiting the generalizability of findings to U.S. military settings due to significant differences in structure, requirements, and education. Lastly, many studies suffer from a lack of female representation in their samples, with some studies including no female participants at all (e.g., Hormeño-Holgado et al., 2019). This underrepresentation fails to reflect the makeup of the U.S. Army, which comprises 15.6% women (U.S. Department of the Army, 2022), further limiting the applicability of the research. Validity and Reliability of Psychological Instruments for ROTC Cadets To address the research gaps, the current study aimed to evaluate psychological constructs crucial for military performance, particularly in the context of ROTC cadets. Quantitative instruments must be rigorously assessed to ensure their relevance and utility in identifying the psychological characteristics that most influence performance (Haynes et al., 2018). Reliable and valid measures enhance assessment accuracy, enabling the identification of PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 7 key psychological predictors and supporting the development of tailored training programs that meet cadets' unique needs (Brunyé et al., 2024). Such programs not only improve training effectiveness and readiness but also foster long-term success and retention by aligning development pathways with individual psychological profiles (Seligman & Fowler, 2011). This study employed 13 established psychological instruments selected for their proven relevance in military, sport, and academic contexts. While these measures have demonstrated validity in various populations, their use within the ROTC population remains limited. Among these 13 instruments, only a subset has been tested in military populations (e.g., Barbour, 2014; Gucciardi et al., 2021; Kastle et al., 2021; Rice et al., 2013). Furthermore, only four studies utilizing these scales have been conducted within the U.S. (Barbour, 2014; Francis, 2021; Kastle et al., 2021; Seipel, 2020), with a singular study employing one of these tools among non-U.S. military cadets (Lepinoy et al., 2023). The limited use of psychological instruments within ROTC populations raises important concerns about their applicability and accuracy in this unique context. Psychological constructs such as motivation, resilience, and stress may manifest differently in ROTC cadets compared to other military populations due to their transitional developmental stage and the interplay of multifaceted responsibilities (Baldwin & Young, 2020). Unlike active-duty soldiers who operate within a singular military framework, ROTC cadets navigate a hybrid environment where civilian, academic, and military roles intersect. This intersection introduces variability in psychological experiences that existing instruments, often validated in more homogenous military or academic samples, may not adequately capture (Haynes et al., 2018; He & van de Vijver, 2012). For example, the construct of motivation in cadets may be shaped by the competing demands of completing academic degrees while simultaneously adapting to military PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 8 leadership structures (Raabe et al., 2020). Similarly, constructs like burnout—linked to performance and retention in military settings—may have distinct antecedents and manifestations in cadets due to their unique stressors (Hosseini et al., 2023). Instruments designed for active-duty personnel often overlook the dual civilian-military realities of cadets, risking biased or inaccurate assessments of psychological traits essential for success on the ACFT and in future military careers. These gaps underscore the need for more tailored approaches to measuring psychological constructs in this population. Accurate measurement of psychological constructs in ROTC cadets has direct implications for readiness, retention, and leadership development. Validating these instruments ensures they reliably identify key predictors of performance, such as mental toughness, resilience, and motivation regulation, which may be critical for success on the ACFT and broader military careers (Gucciardi et al., 2021; Brunyé et al., 2024). Following best practices in psychometric validation is essential for ensuring these tools are accurate and applicable to diverse populations (Boateng et al., 2018). Given the Army’s reliance on data-driven interventions to improve training and reduce attrition (e.g., Royston et al., 2022; Russel et al., 2023), validating these instruments aligns with organizational goals of readiness and leadership development. Without such evaluations, the risk of inaccurate assessments undermines efforts to optimize training, enhance cadet success, and support their progression into effective military leaders (Baldwin & Young, 2020; Flood & Keegan, 2022). Therefore, this study aims to investigate the psychological factors that may influence ROTC cadets' ACFT performance, focusing first on the suitability of existing assessment tools and then on identifying specific psychological traits linked to performance outcomes. PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 9 [RQ1] What are the psychometric properties of existing instruments measuring relevant psychological characteristics of ROTC cadets? [RQ2] What psychological characteristics are associated with ROTC cadets’ performance on the ACFT? Method Participants The study sample consisted of N = 180 ROTC cadets with an average age of 19.99 (± 2.07) years. There were n = 72 (40.0%) Military Science (MS) I cadets, n = 42 (23.3%) MSII cadets, n = 36 (20.0%) MSIII cadets, and n = 30 (16.7%) MSIV cadets. Most participants identified as male (n = 145, 80.56%), with 33 cadets identifying as female (18.33%) and two (1.1%) preferring not to disclose their gender. Most cadets identified as White/Caucasian (n = 149, 82.78%), followed by smaller groups identifying as Black or African American (n = 8, 4.44%), Asian (n = 4, 2.22%), Hispanic or Latino (n = 6, 3.33%), and multi-racial (n = 11, 6.11%); two participants (0.56%) preferred not to disclose their race. A total of 65 cadets (36.11%) held an ROTC scholarship, while 115 (63.89%) did not; 72 cadets (40.00%) reported prior enlistment experience, whereas 108 (60.00%) did not (see Table 1). Study Design Following Institutional Review Board approval, ROTC cadets actively enrolled at the first author’s university were invited to participate in this study. ROTC cadets were recruited using a convenience sampling approach. Approval was first obtained from the ROTC cadre, after which we were granted permission to recruit participants in person during military science courses and pre-ACFT procedures, such as cadre-led cadet weigh-ins. Participants were PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 10 informed that their involvement in the study was entirely voluntary and that all data collected would remain anonymous and confidential. The current study employed a cross-sectional design in which data was collected at four total time points over a two-year academic period: time point one (T1) occurred in Fall of 2022, time point two (T2) occurred in Spring of 2023, time point three (T3) occurred in Fall of 2023, and time point four (T4) occurred in Spring of 2024. However, only the initial time point for each participant was used in the analysis. Of the 427 total cadets who were contacted, 334 cadets agreed to participate (78.2% response rate). In line with the research questions for the current research, only the data of participants’ first participation in the study were analyzed for this study (N = 180). Measures The measures employed in the current study comprised 244 items and took approximately 30 minutes to complete. The following measures were presented in the order provided below and remained consistent across all data collection time points. Of the 244 survey items, eight questions collected demographic information on participants, including their age, gender, race, cadet class, years as a cadet, years in ROTC, ROTC scholarship status, and prior military enlistment. Army Combat Fitness Test (ACFT) ACFT data was collected via official scorecards filled out and submitted by the ROTC cadre (see Appendix O). The ACFT is comprised of a max deadlift (three repetitions), a standing power throw, hand-release push-ups, a spring/drag/carry, a plank, and a two-mile run (U.S. Department of the Army, 2023; see Appendix P). All scoring in the ACFT events is normed by age group and gender (e.g., 17-21 years old, male, and female) and each event has a total PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 11 possible score of 100 points. The max deadlift (3RMD) requires three successful repetitions of 140 pounds for males and 120 pounds for females regardless of age group. The standing power throw (STP), in which a cadet tosses a 10-pound medicine ball for maximum distance, requires a 6.0-meter and 3.9-meter score for males and females respectively in the 17–21-year-old age group. The hand-release push-up (HRP) event requires 10 successful repetitions of the push-up to pass regardless of age or gender. The sprint/drag/carry (C) event requires cadets to first sprint 50 meters, then drag a 90-pound sled 50 meters, then laterally sprint 50 meters, then carry two 40-pound kettlebells 50 meters, and lastly spring another 50 meters. Passing scores for the sprint/drag/carry event vary by age and gender, with a 2:28 minute and a 3:15 minute passing time for male and female cadets aged 17-21. The plank (P), also scored by time and varied by age and gender, has a passing score of achieving at least 1:30 seconds for male and female cadets aged 17-21. Lastly, the two-mile run (2MR) requires cadets to complete the event in under 22:00 minutes for males and under 23:22 minutes for females aged 17-21. To officially pass the ACFT, cadets are required to score a minimum of 60 points on each event and an overall raw score of at least 360 points. Academic Motivation Scale – College (AMS-C) The AMS-C (Vallerand et al., 1992) is a 28-item instrument measuring the degree of motivational regulation in the context of a university across seven subscales including: amotivation (four items; e.g., “”I don’t know; I can’t understand what I am doing in school”), extrinsic motivation – external regulation (four items; e.g., “in order to obtain a more prestigious job later on”), extrinsic motivation – introjected regulation (four items; e.g., “because I want to show myself that I can succeed in my studies”), extrinsic motivation – identified regulation (four items; e.g., “because this will help me make a better choice regarding my career orientation”), PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 12 intrinsic motivation – to experience stimulation (four items; e.g., “for the intense feelings I experience when I am communicating my own ideas to others”), intrinsic motivation – toward accomplishment (four items; e.g., “for the pleasure I experience while surpassing myself in my studies”), and intrinsic motivation – to know (four items; e.g., “because my studies allow me to continue to learn about many things that interest me”). Each item is rated on a seven-point Likert scale from 1 (does not correspond at all) to 7 (corresponds exactly) with a mid-point of 4 (corresponds moderately). To score the AMS-C, the responses for each subscale are first summed for each participant. A Self-Determination Index (SDI) is then calculated to determine the degree to which participants are self-determined in college, ranging from -18 (low selfdetermination) to +18 (high self-determination). The SDI is calculated by assigning weights to the motivation regulation subscales, multiplying each subscale’s mean score by its corresponding weight (Howard et al., 2020). The weighted scores across all subscales are then summed to compute the total SDI. Higher SDI values indicate greater self-determined motivation, while lower values suggest controlled or amotivated forms of motivation (Howard et al., 2020). Achievement Motives Scale – Revised (AMS-R) The AMS-R (Lang & Fries, 2006) is a 10-item questionnaire that assesses participants’ achievement motives across two subscales: hope for success (five items; e.g., “I like situations in which I can find out how capable I am”) and fear of failure (five items; e.g., “I feel uneasy to do something if I am not sure of succeeding”). Participants respond on a four-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Scores for each achievement motive are calculated by averaging items for each subscale. Basic Needs Satisfaction at College Scale (BNSC-S) PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 13 The BNSC-S (Jenkins-Guarniere et al., 2015) is a 13-item instrument measuring students’ need satisfaction in a university context across three subscales: autonomy satisfaction (four items; e.g., “I feel like I can pretty much be myself at school”), competence satisfaction (five items; e.g., “I do not feel very competent with school”), and relatedness satisfaction (four items; e.g., “I really like the people I go to school with”). Each item is rated on a five-point Likert scale from 1 (not at all true) to 5 (very true), with a mid-point of 3 (somewhat true). The score for each basic psychological need subscale is computed by averaging the respective items. Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS) The BPNSFS (Chen et al., 2015) is a 24-item scale measuring participants’ basic psychological need fulfillment across six subscales: autonomy satisfaction (four items; e.g., “I feel my choices express who I really am”), autonomy frustration (four items; e.g., “my daily activities feel like a chain of obligations”), competence satisfaction (four items; e.g., “I feel capable at what I do”), competence frustration (four items; e.g., “I feel disappointed with many of my performances”), relatedness satisfaction (four items; e.g., “I feel that the people I care about also care about me”), and relatedness frustration (four items; e.g., “I feel the relationships I have are just superficial”). Participants answer each item on a five-point Likert scale from 1 (not true at all) to 5 (completely true). The scoring of the BPNSFS can be computed in many ways (see Van der Kaap-Deeder et al., 2020). For instance, need satisfaction (i.e., autonomy, competence, and relatedness satisfaction) and need frustration may be scored separately by averaging the respective items to be then contrasted within the sample. To best fit the sample, the stem of the scale was changed from “we ask about the kind of experiences you actually have in your life” to “we ask about the kind of experiences you actually have in your life as a cadet.” Cognitive and Somatic Anxiety Inventory – 2 Revised (CSAI-2R) PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 14 The CSAI-2R (Cox et al., 2003) is a 17-item instrument assessing participants’ state anxiety and confidence levels regarding a specific task across three subscales: cognitive anxiety (five items; e.g., “I’m concerned about performing poorly”), somatic anxiety (seven items; e.g., “I feel jittery”), and self-confidence (five items; e.g., “I’m confident I can meet the challenge”). Each item is rated on a four-point Likert scale from 1 (not at all) to 4 (very much so), with midpoints of 2 (somewhat) and 3 (moderately so). To better fit the sampled participants, the stem of the CSAI-2R included “Army Combat Fitness Test (ACFT)” (e.g., “indicate how you typically feel right before your Army Combat Fitness Test (ACFT)”). The CSAI-2R is scored by first averaging each subscale for each participant and then multiplying the averages by 10. Coping Function Questionnaire (CFQ) The CFQ (Kowalski & Crocker, 2001) is an 18-item instrument that assesses individuals’ use of different coping functions across three subscales: problem- (six items; e.g., “I work harder to try to change the situation”), emotion- (seven items; e.g., “I try to find ways to control my emotions”), and avoidance-focused coping (five items; e.g., “I try to get away from the situation to reduce the stress”). Participants respond on a five-point Likert scale from 1 (not at all) to 5 (very much). Scores for each coping function are calculated by averaging items for each subscale. Locus of Control Scale (LCS) The LCS (Rotter, 1966) is a 29-item instrument that measures participants’ degree of external versus internal control of reinforcement by employing dichotomous questions (e.g., “many of the unhappy things in people’s lives are partly due to bad luck” versus “people’s misfortunes result from the mistakes they make”). The survey is scored by summing scores on all PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 15 items, in which a high score corresponds to greater levels of an external locus of control, whereas a low score corresponds to greater levels of an internal locus of control. Mental Toughness Inventory (MTI) The MTI (Gucciardi et al., 2015) is an eight-item instrument assessing a person’s perceived mental toughness (e.g., “I consistently overcome adversity”). Each item is rated on a seven-point Likert scale from 1 (false, 100% of the time) to 7 (true, 100% of the time). To better fit the sampled participants, the stem of the MTI was adapted from “how you think, feel, and behave as an athlete” to “how you think, feel, and behave as a cadet.” The score for the entire scale was calculated by averaging responses to all items, in which lower scores represent smaller indices of mental toughness for cadets. Military Academic Motivation Scale (MAMS) The MAMS (Filosa et al., 2021) is a 17-item instrument that measures cadets’ military academy motivation regulation across five subscales: amotivation (four items; e.g., “I am in ROTC just because I have to”), external regulation (four items; e.g., “because I want to move up and make lots of money”), introjected regulation (four items; e.g., “to show that I’m able to do anything, if I want to), identified regulation (four items; e.g., “to achieve the position I want in the future”, and intrinsic motivation (four items; e.g., “because in ROTC I can do things that I like”). Each item is rated on a five-point Likert scale from 1 (not at all) to 5 (very much). To better fit the sampled participants, the stem of the MAMS was adapted from “why did you decide to join the Guardia di Finanza?” to “why you are in ROTC.” Additional changes were made to six items by substituting the words “Guardia di Finanza” with “ROTC”. Scoring for the MAMS is equivalent to that of the AMS-C, in which an SDI is calculated to determine the PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 16 degree to which participants are self-determined in their military academy setting (Howard et al., 2020). Oldenburg Burnout Inventory (OLBI) The OLBI (Halbesleben & Demerouti, 2005) is a 16-item questionnaire that measures burnout across two subscales: disengagement (eight items; e.g., “I find my work to be a positive challenge”) and exhaustion (eight items; e.g., “when I work, I usually feel energized”). Participants respond to each item on a four-point Likert scale from 1 (strongly agree) to 4 (strongly disagree). The instrument is scored by first summing the two subscales, and then by summing the two subtotals, in which higher total scores are associated with greater levels of burnout. Perceived Stress Scale – 10 (PSS-10) The PSS-10 (Cohen & Williamson, 1988) is a 10-item survey measuring participants’ frequency of perceived stress (e.g., “in the last month, how often have you felt nervous and ‘stressed’”?). Responses to each item fall on a five-point Likert scale from 0 (never) to 4 (very often), with a mid-point of 2 (sometimes). The total score is calculated by adding the scores for all 10 items, in which higher total scores are indicative of higher levels of perceived stress. Resilience Scale (RS) The RS (Wagnild & Young, 1993) is a 25-item instrument that measures the resilience of participants (e.g., “I take things one day at a time”). Items in the RS are rated on a seven-point Likert scale from 1 (strongly disagree) to 7 (strongly agree). The RS is scored by summing the scores across all items, in which larger scores are associated with higher levels of resilience. Task and Ego Orientation in Sport Questionnaire (TEOSQ) PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 17 The TEOSQ (Duda & Nicholls, 1992) is a 21-item instrument that measures the degree of participants’ beliefs about the causes of success across four subscales: ego orientation (eight items; e.g., “others can’t do as well as me”), task orientation (eight items; e.g., “I learn something interesting”), work avoidance (three items; e.g., “I don’t have to try hard”), and cooperation (two items; e.g., “my friends and I help each other”). Each item is rated on a fivepoint Likert scale from 1 (strongly agree) to 5 (strongly disagree). The score for each subscale is computed by averaging the respective items. Data Analysis The data was analyzed using SPSS (version 26) and R Studio (version 4.4.1). Preliminary analyses included an evaluation of missing data patterns and outlier detection. Little’s MCAR test (Little, 1988) was conducted to determine if the missing data were missing completely at random, justifying listwise deletion for subsequent analyses. Cases with values beyond ± 3 standard deviations from the mean were identified as outliers and removed from the dataset to mitigate potential distortions in the analysis, following recommended practices to prevent undue influence by extreme values (Tabachnick & Fidell, 2019). To examine the psychometric properties of the instruments, internal consistency reliability was assessed for each scale and subscale using Cronbach’s alpha. Cronbach’s alpha values provide an estimate of reliability by measuring the extent to which items within each instrument are consistent with one another, with values closer to 1.0 indicating higher reliability. According to widely accepted guidelines, alpha values above 0.90 are considered excellent, values between 0.80 – 0.89 are good, values between 0.70 – 0.79 are acceptable, values between 0.60 – 0.69 are questionable, and values below 0.60 are poor (Taber, 2018). PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 18 Descriptive statistics were computed to summarize the characteristics of the study sample and the distribution of the variables of interest. Confirmatory Factor Analysis (CFA) was conducted using R Studio with the Weighted Least Squares Mean and Variance Adjusted (WLSMV) estimator. This estimator, a type of Diagonally Weighted Least Squares (DWLS) estimator, is appropriate given the ordinal nature of the data and the sample size (n < 200). The WLSMV estimator accounts for potential heteroscedasticity and non-normality, providing greater accuracy in parameter estimates and model fit assessments (DiStefano et al., 2019). Model fit was evaluated following the recommendations laid out by Hu and Bentler (1999) using scaled fit indices, including Comparative Fit Index (CFI) values close to 0.95, Tucker-Lewis Index (TLI) values close to 0.95, Root Mean Square Error of Approximation (RMSEA) values close to 0.08, and Standardized Root Mean Square Residual (SRMR) values close to 0.06 (DiStefano et al., 2019). Factor loadings of 0.40 or higher were considered acceptable, as recommended by Hooper et al. (2008), to ensure items meaningfully represented the latent constructs. Pearson correlation coefficients were computed to examine the bivariate relationships between each psychological characteristic and performance on each component of the ACFT and ACFT totals. Correlation analyses were used to identify potential associations between psychological traits and physical performance among ROTC cadets. Subsequent multiple linear regression modeling was performed to determine the extent to which psychological characteristics predicted performance on the components of the ACFT. ACFT sub scores served as the dependent variable, while the non-collinear psychological characteristics measured by the scales served as independent variables. Regression coefficients and associated p-values were PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 19 examined to assess the strength and significance of the relationships between psychological traits and ACFT performance. Results Psychometric Properties of Psychological Instruments (RQ1) The internal consistency of each instrument and the respective subscales was evaluated using Cronbach’s alpha. Following conventional reliability thresholds (i.e., Taber, 2018), analyses confirmed that most instruments and subscales possessed satisfactory internal consistency, supporting their use in psychological characteristics among ROTC cadets (see Table 2). Specifically, among the 13 total instruments and 35 scales (48 total), six were found to be poor or questionable: the BNSC-S competency satisfaction subscale (α = 0.51), the MAMS identified regulation subscale (α = 0.59), the TEOSQ work avoidance subscale (α = 0.65), the BNSC-S autonomy satisfaction subscale (α = 0.65), the LCS scale (α = 0.66), and the MAMS amotivation subscale (α = 0.68). Model fit indices and factor loadings from the confirmatory factor analyses are presented in Table 3 for all 13 instruments. Among these, five instruments demonstrated acceptable model fit and were included for further analysis: Academic Motivation Scale-College (AMS-C; CFI = 0.95, TLI = 0.95, RMSEA = 0.08, SRMR = 0.07, 0.58 ≤ λ ≤ 0.96), Achievement Motives ScaleRevised (AMS-R; CFI = 0.97, TLI = 0.97, RMSEA = 0.08, SRMR = 0.07, 0.45 ≤ λ ≤ 0.90), Cognitive and Somatic Anxiety Inventory-2 Revised (CSAI-2R; CFI = 1.00, TLI = 0.99, RMSEA = 0.05, SRMR = 0.05; 0.75 ≤ λ ≤ 0.97), Resilience Scale (RS; CFI = 0.94, TLI = 0.94, RMSEA = 0.08, SRMR = 0.07, 0.36 ≤ λ ≤ 0.77), and Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS; CFI = 0.97, TLI = 0.96, RMSEA = 0.07, SRMR = 0.07, 0.58 ≤ λ ≤ 0.93). PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 20 The initial CFA of the RS resulted in three items below 0.40 (i.e., 0.01, 0.39, 0.46). The item with a factor loading of 0.01 was removed to enhance model fit, while the remaining lowloading items were retained to preserve the integrity of the original scales (Hooper et al., 2008). Psychological Predictors of ACFT Performance Among ROTC Cadets (RQ2) The descriptive statistics for the psychological instruments administered to the cadets and correlational analysis among the psychological variables and ACFT events are presented in Tables 17 and 18. For each ACFT event, regression analyses were conducted to examine the predictive role of psychological factors. Significant models are presented first, followed by models without significant main effects. The regression model for the two-mile run (see Table 26) was significant, explaining 33% of the variance (R 2 = 0.33, Ajd. R 2 = 0.17, F(19, 148) = 1.91, p < .05). Altogether, five psychological constructs positively predicted performance on the 2MR: Amotivation (β = 0.41, p < .05), Identified Regulation (β = 0.42, p < .05), Intrinsic Regulation – Toward Accomplishment (β = 0.35, p < .05), Cognitive Anxiety (β = 0.31, p < .05), and Self-Confidence (β = 0.33, p < .05). Both External Regulation (β = -0.53, p < .05) and Intrinsic Regulation – To Know (β = - 0.33, p < .01) were significant negative predictors of cadet performance on the 2MR. The regression model for the deadlift (see Table 21) was significant, explaining 37% of the variance (R 2 = .37, Ajd. R 2 = .22, F(19, 148) = 2.13, p < .01). Within this model, Intrinsic Regulation to Experience Stimulation was a significant positive predictor of performance (β = 0.33, p < .05). PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 21 The regression model for the hand-release push-ups (see Table 23) was significant, explaining 32% of the variance (R 2 = 0.32, Ajd. R 2 = 0.16, F(19, 148) = 2.12, p < .05). Resilience was a significant positive predictor of performance (β = 0.21, p < .05). The regression model for the plank (see Table 25) was significant, explaining 33% of the variance (R 2 = 0.33, Ajd. R 2 = 0.18, F(19, 148) = 1.91, p < .05). Fear of Failure (β = -0.36, p < .05) negatively predicted performance, whereas Self-Confidence (β = 0.24, p < .05) positively predicted plank scores. Both the standing power throw (R 2 = 0.25, Ajd. R 2 = 0.07, F(19, 148) = 1.91, p > .05) and the sprint-drag-carry (R 2 = 0.28, Ajd. R 2 = 0.11, F(19, 148) = 1.68, p > .05) models did not reach significance. (see Tables 22 and 24). Discussion This study evaluated the psychometric properties of multiple psychological instruments in an ROTC cadet population (RQ1) and explored the relationships between these psychological constructs and ACFT performance (RQ2). The first section of this discussion provides a discussion of the key findings relative to RQ1, while the second section explores and integrates the results of RQ2 analyses. This section will conclude with a discussion of limitations and future directions for research. Psychometric Properties of Psychological Instruments (RQ1) Included Instruments The psychometric evaluation of 13 instruments within the ROTC cadet population provided insights into their strengths and limitations in predicting ACFT outcomes. Five instruments – AMS-C, AMS-R, BPNSFS, CSAI-2R, and RS – demonstrated acceptable internal consistency, model fit, and factor loadings, suggesting these measures effectively captured their PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 22 respective constructs in this sample. These results provide initial evidence that these scales can yield valid and reliable measurements, which may support future efforts to identify cadet characteristics aligned with ROTC training methods. To the author’s knowledge, these five instruments’ internal consistency results have been provided in a few prior studies with military samples, yet no factor loadings or fit indices were described. Across the six studies which reported Cronbach’s alpha of instruments among military participants, the current internal consistency of the AMS-C (Buekers, 2023; 2024; Seipel, 2020), the AMS-R (Cheng & Magraw-Mickelson, 2023), the BPNSFS (Lepinoy et al., 2023), the CSAI2R (Sánchez-Molina et al., 2019) and the RS (Francis, 2021) are in alignment. Notably, six studies utilizing the AMS-C, AMS-R, BPNSFS, CSAI-2R, or RS did not report psychometric properties (Barbour, 2014; Clemente-Suárez et al., 2016; Fuentes-García et al., 2021; Kastle et al., 2021; Sánchez-Molina et al., 2019; Wesemman et al., 2018). The scarcity of reported psychometric values presents challenges in ascertaining consistency with other tested military samples. Thus, it is necessary to juxtapose the current results across literature that sampled nonmilitary personnel. The AMS-C retained its seven-factor structure with acceptable loadings and fit, consistent with previous validations across diverse cultures, languages, and educational contexts (e.g., Akoto, 2014). However, alternate structures, such as the three-factor model reported by Colebrusco de Souza et al. (2021), suggest cultural or contextual influences and preferences for streamlined models, warranting careful evaluation in ROTC settings. Similarly, the AMS-R demonstrated factor loadings and fit indices consistent with its initial validation (Lang & Fries, 2006). However, the lack of subsequent studies validating the AMS-R in diverse contexts highlights a significant research gap, underscoring the current PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 23 study’s contribution to its applicability in military populations. Future research should replicate these findings with larger, more varied samples. The BPNSFS supported a six-factor model, in line with previous studies validating the distinction between need satisfaction and frustration (e.g., Chen et al., 2015). The corroborative support of the six-factor model, as opposed to the two-factor model (i.e., need satisfaction and need frustration), is further evidenced by the current results and may confirm the theoretical nature of basic psychological need satisfaction and frustration as distinct constructs (Chen et al., 2015). In the context of ROTC cadets, the ability to differentiate between need satisfaction and frustration may provide critical insights into how these constructs influence other factors (e.g., motivation, and performance). Future research is needed to validate the six-factor model in other ROTC cadet and military populations. The CSAI-2R demonstrated robust psychometric properties, consistent with prior research validating its three-factor model across languages and populations, including athletes and children (e.g., Martinent et al., 2010; Stadulis et al., 2002). The consistency of these results highlights the robustness of the CSAI-2R in measuring performance-related psychological constructs across diverse populations. In the current study, the CSAI-2R demonstrated psychometric properties consistent with prior findings, suggesting its applicability to high-stakes, structured environments like ROTC training. Finally, the RS displayed adequate reliability and validity across various populations and languages (e.g., Seong et al., 2024; Serrão et al., 2021). However, ongoing disputes about its dimensionality, with some studies supporting a unidimensional model (Serrão et al., 2021) and others a five-factor structure (Konaszewski et al., 2021), underscore the need for further investigation. Notably, this study identified a problematic item consistent with prior findings, PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 24 suggesting potential context-specific challenges. These somewhat contradictory results across the literature may be a consequence of cultural context (He & van de Vijver, 2012), methodological approach (Podsakoff et al., 2012), or item interpretation (DeVellis, 2016). For instance, it is possible that differences in statistical methods, such as exploratory factor analysis, may yield variations in the scale’s dimensionality. Yet, exploratory factor analysis, nor exploratory structural equation modeling, was employed in the current study, so further interpretation of the dimensionality variability of the RS in the current population is challenging. This study appears to be the first to assess ROTC cadets using these five instruments, emphasizing the need for additional psychometric reporting to reinforce evidence of reliability and validity within diverse military samples. Given the limited sample size and the specificity of the population examined here, future research should aim to replicate these findings across larger and more diverse military samples. Expanding the sample size and scope would allow for more robust testing of model fit and factorial invariance, helping to establish greater generalizability (Kline, 2016). Additionally, longitudinal studies could explore the stability of these instruments' psychometric properties over time and in varied military training contexts. Excluded Instruments The remaining eight scales (i.e., BNSC-S, CFQ, LCS, MAMS, MTI, OLBI, PSS, TEOSQ) did not demonstrate adequate psychometric properties in this study, suggesting potential misalignment between these instruments and the current sample population. Particular items across four of the excluded scales presented poor factor loadings. In the context of the current study, low item factor loadings may be indicative of a myriad of reasons, such as item irrelevance for the population (He & van de Vijver, 2012), poor item-construct alignment (Putnick & Borstein, 2016), complex or ambiguous wording of items (Clark & Watson, 2019), PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 25 lack of variability in responses (DeVellis, 2016), multidimensionality of constructs (Reise et al., 2007), small sample size, and possible random measurement error (Podsakoff et al., 2012). Specifically, two items from the BNSC-S (e.g., “I have been able to learn interesting new skills in college”), two items from the OLBI (e.g., “There are days when I feel tired before I arrive at work”), 14 items from the LCS (e.g., “One of the major reasons why we have wars is because people don’t take enough interest in politics”), one item from the TEOSQ (e.g., “I can goof off”), and one item from the MAMS (e.g., “Honestly, I joined ROTC because I felt compelled”) had factor loadings below 0.40. These poor item factor loadings might be suggestive of potential issues with content validity (Boateng et al., 2018), in which items may have weak associations with the underlying factor and, possibly, poor representation of the latent constructs (Hooper et al., 2008). Given the current study sample, (i.e., public university, a high proportion of 1st year cadets) for whom participation may have occurred in their first semester in university, participants may not have had enough exposure to university or ROTC experiences, possibly reducing the relevance of items and potentially impacting factor loading (He & van de Vijver, 2012). The fact that other instruments (e.g., AMS-C, AMS-R, BPNSFS, CSAI-2R, RS) maintained their psychometric integrity despite the sample characteristics may be due to the nature of the constructs they measure. Constructs like academic motivation may be more stable and less dependent on specific experiences, resulting in robust psychometric properties even for 1st-year cadets. Additionally, instruments like the AMS-C and RS have undergone extensive validation, enhancing their reliability across diverse contexts, which may account for their stronger performance in the current study. As seen with the BNSC-S in the current study, it is probable that the items with low factor loadings did not contribute strongly to the factor they are meant to measure (e.g., PSYCHOMETRICS & PREDICTORS OF ROTC PERFORMANCE 26 Competence Satisfaction), or destabilized the factor structure, resulting in fit indices that indicate poorer fit (Heene et al., 2011). Item irrelevance for the population may have also been evidenced within the Work Avoidance subscale of the TEOSQ, originally developed in sport (Duda & Nicholls, 1992), which may be interpreted differently in academic or ROTC settings. This impact on the interpretation of items may, through item irrelevance, affect factor structure. In contrast, the relatively greater psychometric performance of instruments like the AMS-C, AMS-R, BPNSFS, CSAI-2R, and RS may reflect their development in a context that aligns with the ROTC environment. For example, before efforts in validating the BPNSFS across a wide variety of contexts, the instrument was originally tested primarily among undergraduate students (Chen et al., 2015; Cordeiro et al., 2016), likely allowing for a degree of universality among ROTC cadets who must manage academic (i.e., university) responsibilities alongside their military training. Similarly, the CSAI-2R, des

West Virginia UniversityLindsey Leatherman West Virginia University Follow this and additional works at: https://researchrepository.wvu.edu/etd Part of the Psychology Commons, and the Sports Sciences Commons Recommended Citation Leatherman, Lindsey, "Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective" (2024). Graduate Theses, Dissertations, and Problem Reports. 12582. https://researchrepository.wvu.edu/etd/12582 This Thesis is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Thesis in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Thesis has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact researchrepository@mail.wvu.edu. Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective Lindsey Leatherman, B.S., B.A. Thesis submitted to the College of Applied Human Sciences at West Virginia University School of Sport Sciences in partial fulfillment of the requirements for the degree of Master of Science in Sport, Exercise, and Performance Psychology Samuel Zizzi, Ed.D., Chair Ashley Coker-Cranney, Ph.D. Julie Partridge, Ph.D. School of Sport Sciences Morgantown, West Virginia 2024 Keywords: Injury, multidisciplinary model of care, collegiate student-athletes, social support Copyright: 2024 Lindsey Leatherman ABSTRACT Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective Lindsey Leatherman, B.S., B.A. Sport injuries continue to be unavoidable disruptions in student-athletes’ athletic careers with over 200,000 injuries estimated to be reported each year in college sport (Kerr et al., 2015). Researchers continue to emphasize the importance of an interprofessional approach to rehabilitation to help athletes manage the adverse psychological and emotional reactions to injury (Appaneal et al., 2009; Gervis et al., 2020; Putukian, 2016). The purpose of this study was to extend and replicate the research of Clement and Arvinen-Barrow (2021) by incorporating perspectives of Division I US student-athletes. The current study describes 321 NCAA Division I collegiate athletes’ experiences of receiving interprofessional care during injury rehabilitation. A secondary purpose of the study was to explore perceptions of, and access to, sport psychology professionals during rehabilitation. Participants were asked to complete a multidisciplinary team categorization tool (e.g., primary vs. secondary), a modified version of the Social Support Survey (Corbillon et al., 2008), open-ended questions, injury details, and demographic variables. After several rounds of email and in-person recruitment lasting approximately three months, 321 Division I student-athletes across 16 NCAA conferences participated in the cross-sectional study. Athletes placed athletic trainers, athletic coaches, and strength and conditioning coaches most commonly on the primary rehabilitation team. Additionally, athletic coaches, strength and conditioning coaches, and physicians were most frequently identified as secondary rehabilitation team members. Overall, mental health supports were the most missed services identified by participants. For those that did work with one of these professionals, the main themes that emerged were helpfulness of a safe space and feeling supported beyond sport. This study provided support for the use of the multidisciplinary model of sport injury rehabilitation within the context of collegiate athletics. College Athlete Perspective iii Table of Contents Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective..... 1 Methods.......................................................................................................................................... 5 Design ......................................................................................................................................... 5 Participants.................................................................................................................................. 5 Procedure .................................................................................................................................... 6 Measures..................................................................................................................................... 7 Demographics..................................................................................................................... 7 Multidisciplinary Team Categorization .............................................................................. 7 Modified Social Support Survey......................................................................................... 8 Open-ended questions......................................................................................................... 8 Data analysis............................................................................................................................... 9 Results.......................................................................................................................................... 10 Demographics........................................................................................................................... 10 Primary and Secondary Team Categorizations......................................................................... 11 Perceptions of Social Support During Rehabilitation............................................................... 12 Effect of Sport Type and Rehabilitation Length on Social Support Perceptions ..................... 13 Sport Type Categorizations............................................................................................... 13 Length of Rehabilitation ................................................................................................... 13 Qualitative Analyses of Open-Ended Responses...................................................................... 14 Rehabilitation Team Members’ Categorizations.............................................................. 14 Identification of Missing Professionals ............................................................................ 15 Experiences Working with Either an SPC or LMHP........................................................ 15 Discussion .................................................................................................................................... 16 Limitations................................................................................................................................ 22 Conclusions............................................................................................................................... 23 References.................................................................................................................................... 25 Tables........................................................................................................................................... 32 Table 1 ...................................................................................................................................... 33 Demographic Information on the Participants Who Provided Their Information................... 33 Table 2 ...................................................................................................................................... 34 Injury Descriptives of Participants........................................................................................... 34 Table 3 ...................................................................................................................................... 35 Identified Members of Injury Rehabilitation Process and Perceptions of Support.................. 35 Table 4 ...................................................................................................................................... 36 College Athlete Perspective iv Means, Standard Deviations, and Results of Mixed Analyses of Variance Regarding Variables Influencing Social Support Scores............................................................................................ 36 Figures.......................................................................................................................................... 37 Figure 1 ..................................................................................................................................... 38 Frequencies of professionals/individuals identified as either the primary or secondary sport injury rehabilitation team. ........................................................................................................ 38 Figure 2 ..................................................................................................................................... 39 Social Support Means and Sport Type...................................................................................... 39 Figure 3 ..................................................................................................................................... 40 Social Support Means and Rehabilitation Length: Currently Completing Rehabilitation....... 40 Figure 4 ..................................................................................................................................... 41 Social Support Means and Rehabilitation Length: Previous Completion of Rehabilitation.... 41 Figure 5 ..................................................................................................................................... 42 Frequencies of different categories of professionals/individuals distributed between the primary and secondary sport injury rehabilitation teams........................................................ 42 Figure 6 ..................................................................................................................................... 43 Structure of multidisciplinary team to rehabilitation: primary and secondary teams ............. 43 43 Appendix A: Extended Literature Review ............................................................................... 44 Introduction............................................................................................................................... 44 Psychological Factors Influencing Sport Injury ....................................................................... 45 Psychosocial Responses of Injury Rehabilitation............................................................. 45 Psychological/Emotional Responses to Sport Injury............................................ 49 Professionals Involved in Injury Rehabilitation ....................................................................... 52 Athletic Trainer................................................................................................................. 52 Education .............................................................................................................. 52 Current Usage and Understanding of Sport Psychology Interventions ............... 55 Perceptions of Interprofessional Practice Model to Injury Rehabilitation .......... 57 Sport Psychology Consultant............................................................................................ 60 Education and Competencies................................................................................ 60 Perceptions Toward Interprofessional Approach to Injury Rehabilitation.......... 61 Athlete............................................................................................................................... 62 Perceptions and Responses of Psychological Interventions During Injury.......... 62 College Athlete Perspective v Attitudes and Perceptions Towards Multidisciplinary Approach......................... 65 Proposed Professional Practice Models for Injury Rehabilitation............................................ 66 Summary................................................................................................................................... 69 References.................................................................................................................................... 72 College Athlete Perspective 1 Multidisciplinary approach to injury rehabilitation: The D1 college athlete perspective Sport comprises a large part of society and remains popular with people of all age levels. The National Federation of State High School Association reported over 7.5 million youth participating in high school athletics during the 2021-2022 academic year, and in continuation, 528,627 athletes were reported to be participating across all divisions within the National Collegiate Athletic Association (NCAA: 2021). Considering the high number of athletes involved in sports, it is expected that many will encounter injuries during their careers. Injuries continue to be an unavoidable reality encompassing complex components that athletes must overcome during the recovery process. Along with the physical detriments, emotional consequences of injuries can emerge in many different forms such as frustration, anxiety, and depression (Appaneal et al., 2009; Putukian, 2016). Numerous factors can impact the way an athlete perceives an injury and how that individual approaches the rehabilitation process. The Integrated Model of Response to Sport Injury (Wiese-Bjornstal et al., 1998) provides a comprehensive framework for understanding the sport injury experience, identifying involvement of both personal factors (e.g., athletic identity, self-motivation, and motivational orientation) and situational factors (e.g., social support, rehabilitation environment, and sport culture) that influence athlete cognitions, emotions, and behaviors, in turn affecting treatment outcomes. Previous researchers have identified that an injured athlete’s personal and situational factors are likely to affect risk behaviors (e.g. overadherence and inclination to prematurely return to sport) and beliefs following injury (Podlog et al., 2013). The most frequently reported emotional responses to more severe athletic injuries, that require at least 8 weeks out of sport, are depression and anxiety (Gervis et al., 2020). With the wide array of both physiological and emotional factors that can present during an athlete’s injury recovery process, and their ultimate College Athlete Perspective 2 impact on treatment outcomes, it is imperative to understand the comprehensive impact of these injuries on athletes’ overall well-being. In rehabilitation, a diverse team of professionals may be involved to address the various physical and psychological aspects of the injury recovery process. Within college athletics, certified athletic trainers (ATCs) are recognized by both themselves and other professionals as the directors of an athlete’s injury rehabilitation process (Arvinen-Barrow & Clement, 2015; Kraemer et al., 2019). Along with providing essential social support to the athlete for a successful recovery and return to sport (Bianco, 2001; Clement et al., 2015), ATCs also refer to and collaborate with other professionals as needed. While athletic trainers are well-educated and highly trained in addressing the physical aspects of injuries, they often receive limited training regarding the emotional ramifications of injury (CAATE, 2020). Nonetheless, many ATCs recognize the importance of providing psychological support to injured athletes (Clement et al., 2013; Cormier & Zizzi, 2015). In a study by Cormier and Zizzi (2015) assessing ATCs’ abilities to identify psychological concerns and make appropriate referral decisions, 43% of the 326 respondents believed it was their responsibility to implement psychosocial interventions during injury rehabilitation, despite other research indicating a lack of training and confidence in this domain (Arvinen-Barrow et al., 2010; Zakrajsek et al., 2017). Furthermore, Cormier and Zizzi (2015) found that while ATCs showcased a strong ability to recognize psychological concerns, many struggled to match suitable interventions with varying levels of distress. Thus, when an injured athlete presents with potential mental health concerns, it may be appropriate for an ATC to refer or consult with other professionals, such as sport psychology professionals or licensed mental health providers (LMHP), who are better equipped to provide psychosocial interventions. These mental College Athlete Perspective 3 performance or mental health professionals can assist throughout the injury rehabilitation process by addressing important components of psychological readiness regarding athletes returning to sport such as focus, confidence, and realistic expectations (Donald et al., 2024). Interprofessional collaboration, defined as a “mutually beneficial and well-defined relationship entered into by two or more [professionals] to achieve common goals” (Mattessich & Monsey, 1992, p. 7), is essential within college sport injury rehabilitation. For instance, an ATC may collaborate with a physician, sport psychology consultant, registered dietitian, certified strength coach, or any other necessary professional to facilitate comprehensive care for the injured athlete. Research indicates that ATCs recognize the importance of interprofessional collaboration in the successful rehabilitation of injured athletes (Arvinen-Barrow & Clement, 2017). Additionally, Zakrajsek and colleagues (2016) documented many ATCs already engaging in interprofessional practice within the collegiate setting. Further research has examined the perspectives of sport psychology consultants (SPCs), other professionals involved in interprofessional practice within injury rehabilitation. ArvinenBarrow and Clement (2017) explored the experiences and views of 62 SPCs regarding interprofessional care teams based on the proposed multidisciplinary team approach to sport injury rehabilitation (Clement & Arvinen-Barrow, 2013) through an online survey. The study revealed substantial support for the importance of injured athletes’ access to an interprofessional care team during injury rehabilitation, with approximately 95% of SPCs endorsing each individual listed in the conceptual multidisciplinary care team model (Clement & ArvinenBarrow, 2013) as being integral to the interprofessional rehabilitation approach (Arvinen-Barrow & Clement, 2017). College Athlete Perspective 4 Despite being central to the injury rehabilitation process, there are fewer documented cases attempting to capture athletes’ perspectives within interprofessional practice. Clement and Arvinen-Barrow (2021) retrospectively explored the experiences of 182 former high school athletes regarding their involvement in interprofessional care during injury rehabilitation. Participants were asked to complete both a blank multidisciplinary team diagram and draw a sociogram, visually depicting the communication patterns among care team members during their rehabilitation. Notably, athletes more frequently included coaches and family as part of the primary care team than the secondary team, which differed from the proposed model. However, no research has examined multidisciplinary teams through the lens of college-level athletes. Recently, the NCAA has mandated Division I schools to provide mental health services to athletes, either directly through their athletic departments or through campus services (Brutlag Hosick, 2019). However, the extent to which these services have been integrated and utilized within the injury context has not been explored. While the current literature on interprofessional approaches to injury rehabilitation demonstrates the perspective of high school athletes, athletic trainers, sport psychology consultants, and team dynamics, the viewpoints of collegiate athletes are notably absent. The purpose of this study was to replicate elements of Clement and Arvinen-Barrow’s (2021) research within the collegiate athlete population while simultaneously expanding knowledge surrounding current athlete experiences within a multidisciplinary approach to injury rehabilitation. Therefore, the research questions were: 1a) Who do college athletes interact with during their injury rehabilitation? 1b) Do injured collegiate athletes’ experiences align with the multidisciplinary sport injury rehabilitation team model? 2a) How satisfied are injured athletes with support received during rehabilitation? 2b) Does sport type or rehabilitation length College Athlete Perspective 5 influence support perceptions? 3a) Who did athletes wish to interact with during rehabilitation but did not, and why? 3b) What are injured collegiate athletes’ experiences with sport psychology consultants or licensed mental health professionals during rehabilitation? Methods This section outlines the methodological approach including research design, participant selection, data collection procedures, and data analysis methods. The objective was to explore the experiences and perspectives of collegiate student-athletes regarding their interprofessional rehabilitation teams, using a comprehensive approach to gather both qualitative and quantitative data. Design A multimethod cross-sectional survey design was used to collect descriptive data exploring college athletes’ experiences of the injury rehabilitation process. This approach was grounded in Clement and Arvinen-Barrow’s framework, facilitating comparison with the multidisciplinary model of care for sport injuries and across the variables of sport type and rehabilitation length. Descriptive research is used to identify the how, when, and where of a particular situation by attempting to identify characteristics, frequencies, trends, and/or categories to provide surrounding context (Baumgartner et al., 2021). Participants Participants were purposively recruited from NCAA Division I collegiate institutions across the United States. The inclusion criteria for schools selected included (1) the institution was an NCAA DI school and (2) a secondary team member was available to injured athletes from at least one professional (e.g. sport psychology consultant and/or licensed mental health provider). The researcher determined if institutions met the inclusion criteria by accessing College Athlete Perspective 6 athletic department websites or upon correspondence with a professional employed within the athletic department at targeted schools. The second level of sampling occurred for Division I student-athletes currently enrolled at the recruited NCAA DI institutions. To be included in the study, participants had to 1) be current student-athletes, 2) be either currently completing injury rehabilitation at their current institution or have previously completed injury rehabilitation during their time at their current institution and 3) the reported injury required time out of sport as prescribed by either a certified athletic trainer or medical doctor. Procedure Following Institutional Review Board approval in the Fall of 2023, the researcher recruited participants by visiting undergraduate classes at one institution. Upon arrival to the classroom, the researcher introduced the study (i.e., purpose, potential benefits, time commitments) and provided a QR code for interested participants to scan, directing them to the Qualtrics survey. During the same period, the researcher sent recruitment emails to employees (e.g. athletic directors, coaches, sport psychology consultants) within the athletic departments of institutions that met the inclusion criteria to request the participation of student-athletes at those institutions. The researcher informed these contacts of the study information including the purpose, potential benefits, and time commitments, and included a link for the Qualtrics survey. These methods persisted for over one month. The third method of recruitment began when the researcher collected and emailed student-athletes, individually. The researcher again, through a recruitment script, provided potential participants with the study information, potential benefits, time commitments, and a link to the online Qualtrics survey. Data collection occurred for a total of three months. Through these recruitment methods, 12,606 emails were sent to individual student-athletes and 424 college students were present for in-person recruitment. Out of the College Athlete Perspective 7 13,030 total potential participants contacted, 742 responses were received resulting in a response rate of 5.7%. This percentage is a slight underestimate due to the limitations in calculating inperson and email response rates independently. Of the responses received, 321 respondents met inclusion criteria for the present study. Each participant was contacted only once. Measures Demographics Participants were asked to report age, gender, sport type, school conference, injury type, rehabilitation length, current rehabilitation status (i.e. currently or not currently completing), and previous injury experience. Multidisciplinary Team Categorization The titles of all professionals/individuals who may have participated as part of the rehabilitation team, according to Clement and Arvinen-Barrow (2013), were listed in random order for the athlete to choose from and categorize into either primary or secondary care teams. The definitions of the terms primary care team and secondary care team were provided for participants. Primary care team members were defined as “[professionals and/or individuals] who work closely with the injured athlete from injury occurrence through the entire rehabilitation process until their successful return to [sport]”. The secondary care team was defined as “[professionals and/or individuals] who have varying degrees of interaction throughout the [athlete’s] injury rehabilitation”. Athletes were instructed to first select professionals/individuals from the randomized list and then asked to categorize only those selections. College Athlete Perspective 8 Modified Social Support Survey Participants were then asked to complete a modified version of the Social Support Survey (SSS; Corbillon et al., 2008). This modified SSS consisted of three items designed to assess perceived satisfaction with social support using a 5-point Likert scale (1 = very dissatisfied to 5 = very satisfied). The items asked, “In general, how satisfied were you with the quality of support you received during your rehab?” First, participants rated their perceived satisfaction with support from each individual or professional they specified as part of their injury rehabilitation team from the multidisciplinary team categorization instrument. Next, they rated their satisfaction with the overall quality of support received during their rehabilitation. Finally, participants rated their satisfaction with support from their reported primary rehabilitation team and their reported secondary rehabilitation team. Open-ended questions Finally, participants were invited to answer four open-ended questions, including: (1) “Describe why you rated the level of support provided by your primary rehabilitation team the way you did. Feel free to comment on individuals in your primary rehabilitation team that were more or less helpful/supportive in your recovery,” (2) “Describe why you rated the level of support provided by your secondary rehabilitation team the way you did. Feel free to comment on individuals in your secondary rehabilitation team that were more or less helpful/supportive in your recovery,” (3) “Which services would you have liked to receive during your rehabilitation that you did not get? For each service you missed, please describe how you believe the inclusion of that service would have helped your injury rehabilitation,” and (4) for those who included a CMPC or LMHP in their multidisciplinary team, “You indicated a sport psychology consultant College Athlete Perspective 9 or licensed mental health professional as part of your injury rehabilitation team, please describe your experience with this professional including what was helpful and/or unhelpful.” Pilot Study Before recruiting participants, the researcher conducted pilot testing of the survey materials. Cognitive interviews were conducted with four current NCAA Division I studentathletes who met the study’s inclusion criteria and two former DI student-athletes who retrospectively met inclusion criteria. Pilot study participants were directed to complete the survey and encouraged to provide commentary on their thoughts. There were minor adjustments made to the survey based on the responses from the six cognitive interviews. Data analysis The researcher conducted the quantitative data analysis for this study using SPSS to address several research questions. Descriptive statistics were calculated for demographic variables. Frequencies of interactions with various professionals or individuals were calculated and visually represented in a diagram to compare with the published multidisciplinary sport injury rehabilitation model (Clement & Arvinen-Barrow, 2013). This descriptive comparison allowed for the identification of similarities and differences in the interactions reported by collegiate athletes as compared to professionals during their rehabilitation process. Dependent t-tests were conducted to assess perceptions of satisfaction with the social support received from the various professionals and individuals identified, using mean scores. This analysis facilitated comparisons of support satisfaction across different levels of the rehabilitation team and among individual professionals. Additionally, the researchers performed 2x2 mixed-ANOVAs to examine the impact of sport type and rehabilitation length on social support perceptions. Initial analyses confirmed the College Athlete Perspective 10 normality of the data and verified that all theoretical assumptions were met. Interaction graphs illustrated the effects of the independent (i.e., sport type, rehabilitation length) variables on the dependent variable (i.e., social support). The independent variable “sport type” (individual vs. team sport athletes) was chosen to explore potential differences in social support, considering team sport athletes may have access to larger support networks and are accustomed to working within a team dynamic towards collective goals. The independent variable “rehabilitation length” was chosen to explore if the amount of time spent in rehabilitation influenced perspectives of social support, hypothesizing that extended rehabilitation lengths may increase interactions with a broader range of rehabilitation team members. Utilizing thematic analysis (Braun & Clarke, 2012), the researcher identified and interpreted significant patterns of data within participants’ open-ended responses. Specifically, thematic analysis permitted a nuanced understanding of collegiate athletes’ injury rehabilitation experiences and their interactions with sport psychology and mental health professionals via theme identification. Furthermore, the researcher integrated the identified themes with the quantitative findings to enrich the explanation of the data. Results Demographics Participants included 321 collegiate student-athletes representing 21 different NCAA Division I sports and 16 different conferences; 104 participants did not provide demographic information (e.g., sport, college conferences, gender, race). Given that approximately one-third of the participants did not complete the demographic questionnaire, there may be additional sports and conferences represented that were not fully documented in the analysis. The average age of participants completing the web-based questionnaire was 20.3 years old (SD = 1.4). Of College Athlete Perspective 11 these participants, 69% (n = 149) self-identified as female, 29.6% (n = 64) as male, 0.9% (n = 2) preferred not to disclose their gender, and 0.5% (n = 1) identified as non-binary/third gender. Most of the sample identified as White or Caucasian (81.5%, n = 176). For a detailed breakdown of demographics, see Table 1. Regarding rehabilitation status, 55.6% (n = 178) of participants were currently completing injury rehabilitation protocols at the time of data collection, whereas 44.4% (n = 142) reported previous completion of injury rehabilitation protocols. Using the Orchard Sport Injury and Illness Classification System (OSIICS; Rae & Orchard, 2007), respondents most commonly reported injuries to the lower limbs (e.g., knee, thigh, ankle; 54.7%; n = 173). In terms of injury severity, 72.6% (n = 233) reported severe injuries requiring over 4 weeks of rehabilitation, with the minority (27.4%; n = 88) reporting injuries requiring less than 4 weeks of rehabilitation. For detailed percentages of other injury locations and severities, see Table 2. Primary and Secondary Team Categorizations Among the primary care team, the most frequently identified members included athletic trainers (n = 264), athletic coaches (n = 106), strength and conditioning coaches (n = 92), and physicians/orthopedic surgeons (n = 92). For the secondary rehabilitation team, the most frequently identified members were athletic coaches (n = 112), strength and conditioning coaches (n = 105), and teammates (n = 104). For the visual representation corresponding to this data, consult Figure 1. Athletic coaches (n = 106) were the second most frequently reported professionals on the primary care team, but a higher percentage of participants (51.4%; n = 112) associated this profession with the secondary rehabilitation team. Similarly, strength and conditioning coaches College Athlete Perspective 12 were the third most identified members of the primary rehabilitation team (n = 92) but were more frequently placed on the secondary care team (n = 105). Mental health and mental performance professionals (i.e. psychiatrists, sport psychologists, clinical/counseling psychologists, sport psychology consultants, licensed mental health providers) were identified a total of 139 times as primary or secondary caregivers. Specifically, 20% of participants (n = 82) reported that a sport psychologist was involved in their injury rehabilitation process. Additionally, 8.8% of participants noted the involvement of licensed mental health providers, 6.6% identified sport psychology consultants, 5.6% identified clinical/counseling psychologists, and 2.5% identified psychiatrists as part of their rehabilitation team. Mental health and performance professionals were most frequently categorized as part of the secondary care team. Perceptions of Social Support During Rehabilitation Analysis of individuals involved in the injury recovery process revealed differences regarding frequency of identification and perceived support levels (see Table 3). A total of 320 participants initially indicated involvement of at least one professional provided on the randomized list. The most frequently identified professionals were athletic trainers, who received an average social support rating of 4.1 (SD = 1.2, n = 312). They were followed by athletic coaches (M = 3.7, SD = 1.2, n = 240), strength and conditioning coaches (M = 4.3, SD = 0.96, n = 214), and family/parents (M = 4.7, SD = 0.6, n = 173). Specifically pointing out mental health and mental performance professionals, based on rankings of ratings, licensed mental health providers received an average rating of 4.3 (SD = 1.10, n = 28), followed by clinical/counseling psychologists (M = 4.2, SD = 1.30, n = 18), sport College Athlete Perspective 13 psychologists (M = 4.1, SD = 0.92, n = 64), sport psychology consultants (M = 4.1, SD = 1.10, n = 21), and psychiatrists (M = 4.1, SD = 1.20, n = 8). Effect of Sport Type and Rehabilitation Length on Social Support Perceptions Sport Type Categorizations A 2x2 mixed analysis of variance was conducted to investigate differences in ratings of social support for rehabilitation care teams (primary vs. secondary) based on the classification of sport type as either team or individual sport. The results indicated no significant main effect on social support ratings for rehabilitation team levels, F(1, 204) = 0.49, p = .488. Additionally, there was a non-significant effect for the interaction of sport type on social support ratings for rehabilitation care teams, F(2, 204) = 1.16, p = .315. For a visual representation, see Figure 2. Length of Rehabilitation Researchers conducted a second set of mixed-ANOVAs to explore differences in social support ratings for rehabilitation care teams based on rehabilitation length, which were grouped into two categories to maximize group size and power for the analysis. The first category included all athletes with less than or equal to 4 weeks of rehabilitation and the second group included athletes who reported over 4 weeks of rehabilitation. These 2x2 analyses were conducted separately in the sub-group of athletes currently completing rehabilitation and those who previously completed rehabilitation. Refer to Table 4 for a visual representation of the data. Currently Rehabilitating Group. Results showed that among participants currently undergoing rehabilitation (n = 157), there was a significant main effect on social support perceptions between primary and secondary rehabilitation teams, F(1, 155) = 8.99, p = .003, η2 = .06, indicating significantly higher ratings of social support for the primary care team (M = 4.3, SD = 0.98) compared to the secondary care team (M = 3.8, SD = 1.1), with a medium effect size. College Athlete Perspective 14 However, no significant effects were found for the interaction of rehabilitation length on perceptions of social support overall, F(1, 155) = 1.33, p = .251. Although not statistically significant, participants with rehabilitation lengths equal to or less than 4 weeks tended to rate the level of social support for the secondary care team higher (M = 4.04) than those with over 4 weeks of rehabilitation (M = 3.77). Refer to Figure 3 for a visual representation. Previous Completion of Rehabilitation Group. There was another significant main effect on social support perceptions between primary and secondary rehabilitation teams, F(1, 130) = 8.90, p = .003, η2 = .06, with a medium effect size. The interaction effect between rehabilitation length and level of social support ratings was not significant F(1, 130) = 0.82, p = .368). Participants with over 4 weeks of rehabilitation (M = 4.06) rated the secondary team higher than those with equal to or less than 4 weeks of rehabilitation time (M = 3.94). Refer to Figure 4 for further insights. Qualitative Analyses of Open-Ended Responses Thematic analysis procedures set forth by Braun and Clarke (2012) were conducted to investigate themes relevant to (a) participant distinctions between primary and secondary sources of support during injury rehabilitation, (b) identification of missing professionals, and (c) experiences working with either a SPC or LMHP. The researcher reviewed all participants' openended responses to become familiar with the data before coding the data to identify recurring themes (identified below in italics). Rehabilitation Team Members’ Categorizations Two primary themes emerged as criteria for categorical differences in participant decisions regarding the placement of individuals on either the primary or secondary rehabilitation care teams: the amount of contact time and support functions. Participants College Athlete Perspective 15 expressed that individuals were frequently placed on the secondary rehabilitation team due to a lack of consistent involvement (i.e., contact time) compared to members of the primary rehabilitation team. One participant remarked, “The secondary support team, even though their support wasn’t as frequent, was always beneficial when working with them.” Secondly, participants more commonly reported receiving and seeking psychological and emotional support from the secondary team, whereas they predominantly looked to the primary team for physical support more specific to injury rehabilitation protocols. “[The secondary team] were more the emotional/mental side and they kept me motivated,” stated one participant. Conversely, about the primary team, one participant noted, “I felt that I was supported physically, but not mentally.” Identification of Missing Professionals The most frequently identified missing service was mental support. The desire for the inclusion of mental support was mentioned a total of 33 times by participants, with several individuals named as potential providers of this support, including sport psychologists, mental health counselors, and psychiatrists. One participant stated, “If I had a sports psychologist, I feel this would help me get through mental blocks, depression, and anxiety.” Other professionals that participants wished to include during rehabilitation were sport massage therapists (n = 11), either nutritionists or dieticians (n = 7), and chiropractors (n = 4). Experiences Working with Either an SPC or LMHP Of participants who identified working with either a sport psychology consultant or a licensed mental health provider, which were the two professions added to the list by the researcher, two main themes emerged regarding experiences with these professionals: a safe space and support beyond sport. Concerning a safe space, many participants described relief College Athlete Perspective 16 associated with the ability to express feelings and emotions about their injury to an individual not directly involved in their sport. One participant expressed, “It was the only place where I felt safe to break down because I was trying so hard to be strong.” Indicative of support beyond sport, participants appeared to find comfort in talking with someone who discussed topics outside sport and injury. One participant described their experience, reporting, “He talked to me like I was more than just my athletics and checked in on other areas of my life.” Despite these overarching themes, some participants indicated dissatisfaction with their experience working with these professionals. For instance, one participant stated, “I never received any coping techniques or ways to improve my mental state which was not very helpful.” Discussion According to data from over 300 collegiate student-athletes, these findings represent the first sample of student-athletes concerning their perspectives on, and perceptions of, multidisciplinary rehabilitation teams in the collegiate setting. In this sample, sport injury rehabilitation in the collegiate setting closely resembled the multidisciplinary model of sport injury rehabilitation (Clement & Arvinen-Barrow, 2013), with all professionals from the original model accounted for by at least one participant in the present study. Professionals Involved in Collegiate Injury Rehabilitation The current sample demonstrated the comprehensiveness of the individuals and professionals outlined in the multidisciplinary model (Clement & Arvinen-Barrow, 2013). Despite the original model featuring ATCs and physicians/surgeons as the only primary team members, according to ATC and SPC viewpoints (Arvinen-Barrow & Clement, 2015; 2017), student-athlete participants identified 16 additional roles they considered integral to the primary rehabilitation team. Notably, collegiate student-athletes more frequently reported athletic College Athlete Perspective 17 coaches as part of the primary rehabilitation team in comparison to the secondary team, similar to the experiences of former high school athletes (Clement & Arvinen-Barrow, 2021). This difference in athlete perceptions highlights the significant role athletic coaches play in injury rehabilitation and suggests that coaches may be well-positioned to promote interprofessional approaches to injury rehabilitation (Podlog & Dionigi, 2010). Additionally, it indicated that coaches’ roles may align closely with those of ATCs, acting as directors of injury rehabilitation processes and coordinating the involvement of other professionals (Arvinen-Barrow & Clement, 2015; Kraemer et al., 2019). Differing from previous literature, the current sample identified strength and conditioning coaches more consistently on the primary rehabilitation team, at a frequency matching that of physicians/orthopedic surgeons. This finding is not only inconsistent with the model (Clement and Arvinen-Barrow, 2013) but also contradicts the perspective of ATCs and SPCs, who considered strength and conditioning coaches as essential secondary team members (ArvinenBarrow & Clement, 2015; 2017). However, this finding can be explained by the significant roles strength and conditioning coaches typically play in collegiate athletics, particularly in developing athletes’ physical strengths (Stewart et al., 2017). Additionally, Eisner and colleagues (2014) found that both DI and DII athletes regard strength and conditioning coaches as vital to their development as athletes, with a significant positive correlation between the perceived importance of strength and conditioning and increased time spent in the weight room. Contrastingly, strength and conditioning coaches at the professional level have reported a limited role primarily toward the end of the rehabilitation process, despite recognizing the potential benefits of a more significant involvement (Armstrong et al., 2021). Barriers to earlier and increased involvement at College Athlete Perspective 18 the professional level were related to relationships and communication among other members of the rehabilitation team that may not be present at the collegiate level. Like the sample of former high school student-athletes (Clement & Arvinen-Barrow, 2021), parents and family emerged as significant support providers for injured college athletes. While parents and family were equally represented across primary and secondary rehabilitation teams, spouses and partners were more frequently identified as primary rehabilitation team members, a finding not previously documented in related literature. Additionally, sport nutritionists were predominately assigned to the primary rehabilitation team, a finding also not previously reported in the literature. This finding contradicts the original model Clement & Arvinen-Barrow, 2013), and previous perspectives of ATCs (Arvinen-Barrow & Clement, 2015), SPCs (Arvinen-Barrow & Clement, 2017), and former high school athletes (Clement & ArvinenBarrow, 2021), all who typically considered these professionals as secondary rehabilitation team members. Importantly, the incorporation of a suitable and balanced nutrition plan into athletes’ rehabilitation processes can be essential for mitigating inflammation and promoting physical healing (Papadopoulou, 2020), thus encouraging quicker recoveries (Smith-Ryan et al., 2020). Similar to the finding with strength coaches appearing on the primary team, it is possible that some Division I athletes have consistent access to nutrition professionals and consider these services central to their recovery. Compared to athletes participating at the high school level, college athletes likely have much higher access to both strength coaches and nutrition professionals. To explore potential interactions with mental performance and mental health professionals, this study expanded the list of professionals within the multidisciplinary team to include sport psychology consultants and licensed mental health providers. Approximately 15% College Athlete Perspective 19 of participants in the current study indicated the involvement of either an SPC or LMHP in their injury rehabilitation, with another 20% indicating sport psychologists, 5.6% indicating clinical or counseling psychologists, and 2.5% indicating a psychiatrist. A possible explanation for these seemingly high numbers could be attributed to the NCAA’s attempts to support student-athlete mental health, such as the release of two documents to facilitate understanding and recommended best practices (NCAA, 2014; 2016). Per the release of “Mental Health Best Practices” in 2016, the NCAA required all institutions to have mental health services available for student-athletes. Data from the current study could serve to indicate that the NCAA mandates are having a positive impact on some athletes experiencing the emotional consequences of injury. Determinants of Rehabilitation Team Categorization and Social Support Perceptions Thematic analysis revealed that participants primarily considered the consistency of interactions when categorizing team members, aligning with the model (Arvinen-Barrow & Clement, 2013). Participants also highlighted the type of support as a main determinant. Most participants expected more direct support related to the physical aspects of their injury from primary team members and rated their satisfaction with this support higher than secondary team members. This finding corresponds with previous research indicating that athletes typically seek the most support from athletic trainers during the rehabilitation phase, particularly for both informational and emotional support (Bianco, 2001; Clement et al., 2015). Participants relied more heavily on secondary team members for mental and emotional support, confirming distinct types of support received from rehabilitation team members. These novel qualitative findings can help researchers and practitioners more clearly understand athletes’ perceptions of support during rehabilitation. College Athlete Perspective 20 One explanation for higher support ratings of primary team members could be their frequent contact with participants and more instrumental role in physical healing. Previous researchers in the field of medicine found positive correlations between patient satisfaction ratings and the amount of time spent with physicians (Chung et al., 1999; Like & Zyzanski, 1987). Despite overall moderate to high perceptions of support, individual sport athletes and those undergoing rehabilitation lasting over four weeks reported lower mean ratings for social support. Whereas it may be logical to assume that participants with more severe injuries could perceive a decline in support throughout their lengthy rehabilitation, this finding contradicts previous research. Taylor and May (1995) found significantly higher levels of satisfaction among athletes experiencing more severe injuries requiring at least four weeks of rehabilitation. Conversely, the overall highest support for the primary team was reported by participants who had previously completed rehabilitation and had less severe injuries requiring less than four weeks of recovery. A potential explanation for the influence on perceptions of past support could be “rosy retrospective bias,” (Mitchell et al, 1997), where individuals tend to recall experiences more positively after they are over compared to during the experience. Additionally, it is possible that progress in rehabilitation is more tangible and measurable for the physical aspects of recovery than for the psychological components. Interestingly, the highest rating for the secondary rehabilitation team was reported by participants who had previously completed rehabilitation and had been in protocols for over four weeks. Injury severity is a contributing factor to how an athlete perceives and responds to a sport injury (Wiese-Bjornstal et al., 1998) and more severe injuries can contribute to more severe emotional responses (Gervis et al., 2020). Thus, athletes with more severe injuries facing longer rehabilitation durations may rely more heavily on the secondary rehabilitation team than athletes College Athlete Perspective 21 with less severe injuries. This assertion is supported by data from the current participants who noted the most important functions of the secondary team as mental and emotional support. A further explanation could be that those requiring longer rehabilitation periods may just have had more time to have contact with secondary rehabilitation team members. Professions Missing in Collegiate Rehabilitation Even in Division I environments, participants highlighted the absence of certain professionals and services in their injury rehabilitation. Missing services and professionals included mental support from various providers, sport massage therapists, nutritionists or dietitians, and chiropractors. Participants also expressed a desire for increased coach understanding and communication during injury recovery. Athletes commonly seek support from their coaches during injury rehabilitation (Yang et al., 2010), and the absence of this support can negatively impact their emotional responses to injury, potentially impeding the rehabilitation process (King et al., 2023). The significance of communication, as highlighted in participants’ open-ended responses, emphasizes its crucial role in effective interprofessional collaboration and athletes’ perceptions of support (Hess & Meyer, 2021). Consistent with the multidisciplinary team concept, ATCs typically serve as central communicators within the collegiate environment, coordinating between various professionals (Karol, 2014). Whereas multidisciplinary collaboration offers numerous benefits in injury rehabilitation, it also presents challenges, such as communication breakdowns, where stakeholders, including athletes, may not receive timely and adequate updates on injury and rehabilitation status. Although transdisciplinary team approaches represent the ideal for interprofessional collaboration, a more realistic shift for the collegiate injury rehabilitation environment would be towards interprofessional collaboration, first. This transition College Athlete Perspective 22 would foster greater collaboration among individuals involved in the injury rehabilitation process for treatment planning (Karol, 2014), aiming to alleviate communication stressors for injured athletes. The mention of communication is key to the importance of this study and for future research to continue to explore. This study, along with previous research (e.g., Arvinen-Barrow & Clement, 2015; 2017; Clement & Arvinen-Barrow, 2021, Hess & Meyer, 2021; Hankemeier & Manspeaker, 2018) has provided support for the multidisciplinary model of injury rehabilitation for multiple sport contexts. However, it remains crucial for further research to investigate how multidisciplinary teams can operate more effectively, with communication a pivotal factor in this regard, and how potential shifts could be made towards a more interdisciplinary approach to injury rehabilitation within the collegiate environment. Subsequent studies should explore athlete viewpoints across diverse competition levels (e.g. Division II, Division III, NAIA, etc.,) as athletic departments’ financial resources can influence the care provided and thus the injury experience. To better understand potential aspects of change that could enhance the quality of injury rehabilitation care, future research should also consider a qualitative approach. Limitations Whereas this study explored the first sample of collegiate student-athletes on their experiences with a multidisciplinary model of sport injury rehabilitation, several limitations persisted. One limitation is the low response rate of 5.7%, as only a small proportion of the targeted sample participated in the study. Low response rates can potentially lead to issues with generalizability, meaning the data may not be representative of all NCAA Division I athletes who have experienced an injury at their collegiate institution. Despite the NCAA reporting a College Athlete Perspective 23 response rate of 31% for NCAA Division I athletes in response to an emailed time demand survey when distributed by athletic directors and coaches (NCAA, 2016), the present study represents one of the largest datasets on Division I college athletes’ perceptions of social support amongst interprofessional rehabilitation team collaboration relative to injury recovery. Another limitation is the cross-sectional nature of this study as this data is only representative of studentathlete perceptions at a single time point, limiting the ability to establish causal relationships between variables. Further research should look to assess changes over time from the onset of injury through return-to-sport phases of injury recovery. There may also be recall bias present in the study for those participants who had previously completed rehabilitation, which could affect accurate depictions of recollections of their experience. Conclusions Injured collegiate student-athletes interact with many individuals throughout their rehabilitation, with ATCs remaining in a crucial “director” role. College athletes were moderately to highly satisfied with all stakeholders and overall rehabilitation teams. Additionally, the study revealed some nuances within the collegiate environment compared to previous research, which is crucial for understanding how improvements can be made to the rehabilitation process for better care of injured athletes. In general, a significant number of injured student-athletes interacted with either a mental performance or a mental health professional, indicating their access to these resources throughout the rehabilitation process. Moreover, there was a notable level of interest among those who were not currently working with these professionals, suggesting a desire for these services. 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