Impact of COVID-19 on Athlete Mental Health-Strategies to Promote Emotional Wellness

1Editor in Chief, International Journal of Strength and Conditioning; 2Athlete Health and Performance Lead, Basketball New Zealand 3School of Health and Wellbeing, Sport and Exercise Science, University of Southern Queensland, Ipswich QLD Australia. Bird, S. P. (2021). Impact of COVID-19 on Athlete Mental Health – Strategies to Promote Emotional Wellness. International Journal of Strength and Conditioning https://doi.org/10.47206/ijsc.v1i1.33

Recently, I have been heavily involved in discussions with my international colleagues and research teams from New Zealand, Europe, Canada, and United States, around identifying key strategies, solutions and protocols for elite basketball organizations following the unprecedented circumstances and challenges presented by Coronavirus disease (COVID-19). [1][2][3] Our discussions have centred specifically on two key areas of player health and wellbeing, those being: (1) the potential mental health challenges faced by coaches, players and support staff, 4-6 due to quarantine and isolation 7 demands of the unique, yet unknown "NBA bubble"; 8,9 and (2) the overall impact of COVID-19 and the NBA bubble on player health and wellbeing, in the context of 'emotional wellness'. 6,10,11 It is important to provide context regarding the discussion themes, which centred around psychological strategies such as 'situational reframing', a technique strongly linked to 'next play mindset' -that is to reset one's mindset and use this time as an opportunity for personal growth and development. 2 This is an extremely important consideration as elite athletes may also be at a heightened risk of mental health issues, sleep problems, self-harm behaviors, and suicidal ideation, citing possible risk factors such as anxieties over performance, injury, pressure to win, trade rumours, substance abuse, and a comparatively early retirement from their professional career. 12,13 It is reasonable to assume that the stress and anxiety associated under the current COVID-19 environment resulting in significant sleep-related issues, 14 may further exacerbate such risk factors. This has certainly been an area of much discussion within the Basketball New Zealand COVID-19 Framework Project Team. Such is the importance of psychological strategies they are extensively referenced in the recently published Basketball New Zealand guidelines for safe return to training for players following COVID-19 restrictions. 3 The National Basketball Players Association (NBPA) highlighted that impact of COVID-19 on the players, like many people, would result in a range of emotions given the uncertainty of the situation. The initial season suspension, subsequent COVID-19 safety protocols, and the NBA bubble could induce "anxiety, fear, uncertainty, confusion, hypervigilance, depression, an increased sense of vulnerability, boredom, and a heightened awareness of the needs for self-care." 13 Given the significance of mental health, the NBA expanded their mental health guidelines by adopting new rules that require all teams to have at least one mental health professional on their full-time staff for 2019-2020 season. 15 Several NBA players including DeMar DeRozan, 6 Paul George, 16 and Kevin Love, 17 have all openly spoken about the mental health challenges they have faced. DeRozan 6 and George, 16 along with former LA Clippers Head coach, Doc Rivers, 5 have all discussed the psychological and emotional struggles of being in the NBA bubble, and the impact on emotional wellness.
In a recent ESPN report, 6 DeRozan discussed the mental toll the NBA bubble takes on players. "It's tough. You're taking guys that have been with their families every single day for the last few months and all of sudden, separating everybody into this one confined space and taking away a lot of joyful things we do outside of basketball .... It'll be something for every single player when it comes to mental health."

International Journal of Strength and Conditioning. 2021
Similar comments were echoed by George, 16 who said, "I underestimated mental health, honestly. I had anxiety, a little bit of depression … Just being locked in here is really hard. It's not easy. All day it's just basketball. It's hard to get away from it." This highlights the impact on 'emotional wellness'.
For the purpose of this editorial, 'emotional wellness' is defined as a "person's ability to cope with daily circumstances and to deal with personal feelings in a positive, optimistic, and constructive manner". 11 This is important to define in context of the discussions with my colleagues, as two reoccurring interrelated themes presented regarding the impact of COVID-19 on player emotional wellness. These being the potential benefits of mindfulness on reducing pessimism and anxiety; 18 and the impact of sleeprelated issues in athletes on mental health. 19 The link between stress and anxiety, 14 mental health and wellbeing, 20 sleep-related issue, 14,19,21 and the overall impact on health, recovery and performance, 19,22,23 is unquestionable. Strategies associated with promoting emotional wellness may help to create a more positive and proactive mental approach to face difficulties and problems. Briefly, I address two simple strategies that may provide immense benefits to athletes, these being sleep hygiene and situational reframing.

1) SLEEP HYGIENE
Such is the importance of sleep in relation to mental health and wellbeing, many, if not all, mental health problems are suggested to be linked with problems sleeping. 24 That is to say -sleep affects mental health, and mental health affects sleep. Hence the recent emergence of the important role of sleep science in athlete health and wellbeing. From a sleep perspective, the concept of sleep hygiene, 25,26 refers to behaviours that influence the sleep environment. This involves avoiding behaviours that interfere with sleep patterns and/or engaging in behaviours that promote good sleep in an attempt to promote optimal sleep conditions. 25 This is considered an important education starting point and highly relevant to athletic populations. A leader in this field is Dr, Meeta Singh, Service Chief and Section Head at the Henry Ford Sleep Disorders Center Detroit. 19,27 Sleep hygiene strategies presented in Table 1 are recommended to be incorporated into the athlete's sleep routine. 25

2) MINDFULNESS AND SITUATIONAL REFRAMING
Mindfulness is an ancient practice about being completely aware of what's happening in the present -of all that's going on inside and all that's happening outside. That is to say -mindfulness is complete awareness that emerges through paying attention, on purposes, and non-judgmentally to each unfolding experience, moment by moment. 28 It means not living your life on "autopilot", instead, experiencing life as it happens, here and now, the good and bad, all without judgment or preconceived notions. A major benefit of mindfulness is that it encourages you to seek clarity, to pay attention to your thoughts, your actions and your body. Importantly, this inherent capacity can be developed, with mindfulness-based skills such as, flexible, non-defensive, receptive, and present-focused awareness and attention, 29 assisting athletes to remain in the present-moment rather than ruminating on the past or worrying about the future.30 In relation to mindfulness, I would like to introduce the psychological strategy of 'situational reframing', which is central to the 'Next play mindset', approach credited to Mike Krzyzewski, 31 Nutrition: Avoid coffee, alcohol, and high-sugar foods in the hours before bed.

5.
Bed is for sleep: Avoid watching TV, eating, or working in bed. 6.
Lighting: Keep room dark; use blackout curtains, and/or eye shades. Coach of the all-conquering USA Men's Basketball Team (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). In this excerpt from my recently co-authored book, When Winning Matters: Lessons learned from sport's elite, we discuss the 'Next play mindset' approach. 33 Next play is a mindset that Krzyzewski instilled in each of his teams whether dealing with on-court performance or off-court issues, whether the previous result was beneficial or detrimental to the team. No matter what happened previously -good or bad, it's time to focus on the task at hand. When players allow their minds to attach emotions to previous events, their intensity wanes and performance plummets.
Central to the next play concept is the ability to stay focused in the present moment. Sport's elite possess the unique ability to refocus their situational awareness, thereby filtering out all potential distractions. This allows players to display an attentional field that is purely immersed in the very next task related to the 'here and now.' The most successful athletes do not get drawn into the darkness of emotional reactivity. That is to say -they avoid attaching negative emotions to past events. Next play mindset is the link between mindfulness and performance flow. This is an important consideration, as mindfulness techniques are often used to quiet the inner-self critic. But to do that, we first must acknowledge our own mindset tendencies. Do you possess a growth or fixed mindset? When winning matters, sport's elite know that 'Next play mindset' and 'mindfulness' hold the secrets to success. Table 2 outlines four key steps to help you adopt 'Next play mindset'.
It is fitting to leave the final word on mindfulness and situational reframing to an athlete who has immersed himself with such a mindset his entire career, Michael Jordan:  Table 2.
Steps to Adopt 'Next Play Mindset' 1.
Process the mistakes, but don't allow yourself to become emotionally attached to it, ask yourself, "What's the next play?" 2.
Prompting helps refocus on what you 'have to do next'. This gets your head out of the last play and puts your focus in the present moment.

3.
Consistently asking yourself this question develops, 'What the next play?' That is the habit formation of focusing on 'play present'.

4.
Instead of thinking about how well you performed the last play, tell yourself 'Next play'.