Amy Baltzell

Learning from Collegiate Athletes who have Recovered from Eating Disorders: Advice to Coaches, Parents, and Other Athletes with Eating Disorders

The objective of this study was to elicit advice from female collegiate athletes who achieved recovery from an eating disorder for coaches, parents, and other athletes with eating disorders. Participants were 16 female collegiate athletes who had experienced eating disorders. Data was obtained through structured interview questions. Advice for coaches included confronting athletes with a suspected eating disorder and receiving education about nutrition and eating disorders. Advice for parents included providing emotional support while trusting the athlete to make her own decisions. Advice to other athletes included maintaining hope that full recovery is possible and identifying triggers for the disorder.

Self-Compassion, Distress Tolerance, and Mindfulness in Performance

The focus of this chapter addresses both theoretical and applied considerations of how to help athletes deescalate from performance triggered emotionally reactivity through self-compassion. Researchers and practitioners bringing mindfulness to the performance realm are offering new pathways to cultivate mind states that support enhanced performance. Yet, for some athletes, being asked to accept aversive thoughts or just focus on novel stimuli is not enough. Some performers who suffer from intense negative emotions as a result of fear or harsh self-criticism, particularly resulting from high-pressure performance expectations, may need more than current mindfulness interventions in sport. Some athletes require more support coping with debilitating thoughts and emotions beyond practitioners guiding athletes to tolerate their feelings (such as terror) and refocus on the task at hand. Zella Moore (in Chapter 2) offers a persuasive theoretical and conceptual argument for the place of emotion regulation in the mindfulness and performance arena. The ultimate goal is to help performers be more empowered to emotionally regulate appropriately in the face of intensive anxiety or fear with the goal of optimal performance. The quality of the internal experience of the athlete must be given more attention as we consider how to create mindfulness interventions such that athletes are willing to accept and, at worst, tolerate what emerges internally while engaged in the world of competition and high-demand performance. We need to offer athletes more than simply prompting them toward raw acceptance and exploration of what is occurring moment to moment; athletes who are suffering need more guidance than simply to hold an openness and curiosity to moment-to-moment internal and external experience, when such moments are at times extremely difficult to tolerate (e.g., performance anxiety). I contend that helping performers with emotional tolerance via practices of self-compassion is a pathway to support athletes becoming more mindful and fully engaged in moment-to-moment experience and ultimately perform better. As a practicing sport psychologist, I have witnessed myriad stories of elite athletes and musicians who become unable to function in their performance realm due to overwhelming thoughts and emotions. Many of these said performers had first seen psychologists, psychiatrists, and/or medical doctors for help (for psychological and somatic symptoms, respectively) – and to no avail.

Flow and Mindfulness in Performance

When in flow, everything comes together and actions follow actions seamlessly, creating high levels of task performance. Flow creates order out of chaos, complexity out of the ordinary, and, most importantly, experiences that are optimal. It is the feeling of being in flow that draws people back to this state. It is what is created when in flow that contributes to the most enjoyable moments of ones life. The flow model also provides a way of understanding an optimal mindset for performance. Much has been written about flow, its attributes and benefits, and I will summarise some of this work, including some of my research on flow, in this chapter. However, a link that has been receiving growing empirical attention is that between flow and mindfulness. Having worked in both areas in the fields of performance psychology and in yoga/meditation, and having found a synchronicity between the two constructs as an applied practitioner, I would like to share a bit about why I believe flow is important to mindfulness, and mindfulness to flow. Some of the recent research that has been examining relationships between flow and mindfulness will be overviewed and possible directions for future research and applied initiatives outlined. What Is Flow? Csikszentmihalyi (1975, 1990) developed the flow concept after investigating the experiences of individuals during times when they were totally involved in what they were doing and when everything came together during their performances. Csikszentmihalyi has operationally defined flow as being a psychological state that can occur when challenges and skills in a situation are both high. More precisely, flow is predicted to occur when an individual is being extended by virtue of performing in a challenging situation and has a skill level that matches the challenge being faced. Flow occurs when the individual moves beyond his or her average experience of challenge and skill in a situation. The results of being in flow are outstanding levels of performance and memorable experiences. Challenges and skills play a critical role in understanding flow and, more broadly, a variety of psychological experiences. In what have become known as the four and eight quadrant flow models, a range of psychological experiences have been predicted to result from different mixes of challenges and skills, or more precisely, from the perception of challenges and skills in a situation.

Mindfulness, Eating, Body, and Performance

We are regularly out of touch with our immediate conscious experiences due to “ignoring our present moments in favor of others” (Kabat-Zinn, 2005, p. 5), a habit of operating on autopilot at the cost of truly engaging with our surroundings. This chapter discusses the ways that such automaticity can, and typically does, extend to eating and body awareness. As detailed in this chapter, mindless eating is commonplace and is linked to poor body image, disordered eating, and obesity. For athletes and performers, training in mindful eating may assist performance and help counter unique body image and eating concerns found in elite sport and performance environments. In the pages that follow, you will find relevant research regarding the relationship between mindfulness and eating behaviors, body image, and performance. In parallel, at the end of the chapter, there are specific suggestions for positively influencing eating behaviors through a mindful approach. Mindless Eating and Eating Disorders Making automatic food choices, without awareness of possible environmental and emotional cues, or consuming food while distracted from the physical sensations of eating is deemed mindless eating ( Wansink & Sobal, 2007). In modern culture, mindless eating is rampant; we eat on couches with minds absorbed in television shows; we eat past the point of fullness with friends, distracted by stimulating conversation. These tendencies divert our attention from fully experiencing meals, predictably leading to increased consumption (Wansink, 2004) because we fail to notice when we are satiated. How many total decisions have you made about food and beverages in the past twenty-four hours? Wansink and Sobal (2007) asked a similar question to a group of research participants, who estimated that they made a total of fourteen decisions in the previous day. Through detailed follow-up questions, the researchers determined that the 139 adults in the study actually made an average of 227 decisions regarding food and beverages. The participants’ gross underestimation indicates that much of food-related behavior is outside of conscious awareness; they failed to accurately assess the multifaceted elements of eating, such as when, where, how much, and with whom they ate. Mindless eating is also fueled by environmental and cultural factors. For example, Wansink and colleagues have repeatedly shown that food container sizes influence consumption (e.g., Wansink & Kim, 2005).

Langerian Mindfulness and Optimal Sport Performance

This chapter celebrates the brilliance of the pioneering and broadly impactful life work of Ellen Langer. In particular, the chapter makes a call for sport psychology practitioners to intentionally apply Langerian mindfulness to interventions focused on facilitating athletes’ optimal sport performance. Sport psychology consultants have long understood the value of being fully engaged to achieve optimal performance, yet still there seems to lack a theoretical grounding about how to create a fully present state of mind. Traditional sport psychology interventions are focused on using techniques to help athletes replicate their past best performances. This chapter offers a theoretical discussion that connects Langerian mindfulness as a direct pathway to enhance performance to Czikszentmihalyi’s concept of flow (a fully engaged experience). In addition, we offer an example that demonstrates how Langerian mindfulness can be integrated into a sport intervention and provide case examples of elite athletes applying Langerian mindfulness that, together, highlight the significant benefit of applying Langerian mindfulness to the world of sport.

Mindfulness and performance

My experience is what I agree to attend to. William James (cited in Gallagher, 2009, p. 1) As a performer, the act of mindfulness is a valuable and optimal state of being. Ones ability to be mindful can discernibly affect physical performance in a diverse range of contexts; for example, a dancer performing as part of a group, or a doctor answering a question in an oral exam. This chapter explores the notion of mindfulness, with a particular focus on the aligned concepts of attention and centering, among performing artists and medical practitioners. Despite the obvious disparities of challenges and tasks between the performing arts and medical specialties, the relevance of mindfulness proves a distinguishable commonality across the disciplines. Throughout this chapter, case study examples will be drawn upon to illustrate the pertinence of mindfulness for the performer and also the important contextual considerations for the performance psychologist. Mindfulness is being in touch with the present moment. It also involves paying attention in an engaged way. Deciding what to pay attention to takes work. When the performance psychologist is working with the client, he or she needs to be aware of the sociocultural context in which the performance is embedded. Understanding the social norms of the performance domain and the expectations of important others (e.g., family and/or colleagues) is beneficial when endeavoring to enhance the clients performance. In the case studies that follow, we apply a range of psychological skills within different sociocultural contexts, with the goal of enhancing the mindful approach of the performer. It is essential to understand the context when tailoring mindfulness-based interventions. For example, the anesthetist mixing a cocktail of sleep-inducing drugs prior to an operation has substantially different demands and pressures placed upon her or him than an actor about to walk on stage to a full house on the first night. While the hospital registrar and voice student may share similar performance anxiety in relation to their exams, they have different social norms that create a set of background expectations in which performance is compared. However, one thing they all have in common is the need for mindfulness in what they do, and the effective psychologist encourages adaptation of mindfulness to a variety of different performance domains and deals with numerous factors that inhibit mindful performance.

Mindful Sport Performance Enhancement (MSPE): Development and Applications

Many traditional mental training strategies for athletes are based on the assumption that negative cognitions need to be altered or stopped in order to optimize performance (Gardner & Moore, 2006). However, attempting to change negative internal states may ironically lead to greater focus on these states, potentially increasing their frequency and interfering with performance (Wegner, 1994; Wenzlaff & Wegner, 2000). Rather than trying to control or eliminate them, athletes may thus benefit more from developing skills in present-moment awareness and nonjudgmental acceptance of negative internal states (Gardner & Moore, 2004, 2007; Kaufman, Glass, & Arnkoff, 2009). This paradigm shift is a central tenet of mindfulness-based interventions, which represent an emerging direction in sport psychology (see Birrer, Rothlin, & Morgan, 2012; Gardner & Moore, 2012). There are various ways to define mindfulness. One definition, which stems more from Buddhist philosophy, is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn, 1994, p. 4). This view of mindfulness involves maintaining attention on immediate experience while taking an orientation of openness, acceptance, and curiosity (Bishop et al., 2004). Langer (2000) has proposed an alternate conceptualization of mindfulness as “a flexible state of mind in which we are actively engaged in the present, noticing new things and sensitive to context” (p. 220). Her view entails observing the context in which one acts, actively processing new information, and recognizing that stimuli can be seen from multiple perspectives (see also Chapter 5). The former approach to mindfulness has been used more widely to date in psychological research and practice, and is the primary perspective underlying mindfulness-based approaches to sport performance enhancement. For a review of the literature on mindfulness and sport, including relevant studies and associations between sport performance and both conceptualizations of mindfulness, see Pineau, Glass, and Kaufman (2014). The growing emphasis on mindfulness for athletes derives, at least in part, from an explosion of interest in mindfulness throughout the entire field of psychology and society at large. Due to its rapidly expanding popularity, mindfulness has become a media buzzword. For example, a recent cover story of TIME Magazine (Pickert, 2014) dealt with “The Mindful Revolution,” and a Huffington Post article (Gregoire, 2014) immediately followed, arguing that TIME had only hit the tip of the iceberg. This follow-up article boldly claimed that mindfulness is for everyone, regardless of gender, race, age, income, and culture.

Mindfulness and Exercise

American lifestyles are becoming increasingly sedentary. Consequently, diagnoses of health conditions related to sedentary lifestyles are on the rise in the United States. While Americans’ participation in physical activity has decreased, gym memberships have recently hit an all-time high (IHRSA, 2014; Ng & Popkin, 2012). How can this contradiction be explained? We hypothesize that while many Americans have good intentions when signing up for gym memberships, they lack the psychological skills needed to overcome physical and psychological blockages that often interfere with establishing consistent, committed behavior change. When used to address psychological blockages associated with the development of exercise habits, mindfulness- and acceptance-based practices can help exercisers establish the consistent, high-quality exercise practices required to experience the health benefits of exercise and physical activity. Just as air, food, and water are necessary for the well-being of the human body, so too is exercise. The American College of Sports Medicine (ACSM, 2014) has identified many health-related benefits associated with regular exercise, including improved cardiorespiratory endurance, muscular strength, muscular endurance, body composition, and flexibility, as well as decreased cardiovascular disease risk factors, morbidity, anxiety, and depression. Additionally, engagement in regular exercise has been shown to promote and support motor and cognitive development, hormone release and regulation, and generation of neurons in the brain (Ratey, 2008). Despite the well-documented health benefits of regular exercise, Americas growing reliance on comfort- and convenience-oriented technology has dramatically stripped physical activity and exercise from many Americans’ daily lives (ACSM, 2014; Ng & Popkin, 2012). In a 2012 study, Ng and Popkin quantified physical activity trends organized in five domains (sleep, leisure, occupation, transportation, and home-based activities). Ng and Popkin (2012) found that Americans’ physical activity levels fell dramatically from an estimated 235 MET hours per week in 1965 to an estimated 160 MET hours per week in 2009. Based on these data, Ng and Popkin (2012) predict that Americans’ physical activity levels will fall to an estimated 142 MET hours per week in 2020 and an estimated 126 MET hours per week in 2030. As a result of Americans’ decreasing physical activity levels, incidences of health conditions related to sedentary lifestyles have risen dramatically. Health survey data reported by the National Center for Health Statistics (NCHS, 2006, 2014) estimates that American adults’ (ages eighteen to seventy-five) body mass indexes (BMI) have steadily increased since 2005.

Mindfulness Strategies: Consulting with Coaches and Athletes: Background and Presentation of the 2013 AASP Annual Convention Workshop

The purpose of this article is to provide a summary and discussion of the main workshop ideas presented at the national 2013 AASP Conference, entitled Mindfulness Strategies: Consulting with Coaches and Athletes. In this article a brief overview of the meaning of mindfulness and potential benefits of mindfulness-based strategies are offered. Specific mindfulness-based strategies for sport psychology consultants working with athletes and coaches are presented. The mindfulness-oriented strategies offered, integrated with traditional mental skills training, include normalizing the experience of negative emotions, accepting aversive emotions, clarifying and committing to task-focused efforts in performance, visualizing success and noticing the good.

The Power of Mindfulness: (Module 1, Part A)

We welcome you to a journey of learning a new way of using a mindfulness approach (and self-compassion when you need it) to improve your experience in sport and ultimately your performance. We have found over the years that bringing mindfulness, which really is simply being present and accepting of (or tolerating or being interested in) whatever is showing up, can make the difference in performance. With such an approach, you are open to actually being present to what you are doing, instead of being lost in regret of mistakes or lost in anxiety of what the future might hold (e.g., not getting selected; not starting; not making the team).