A Mindfulness-Acceptance-Commitment-Based Approach

BEHAVIOR THERAPY 35,707--723, 2004 A Mindfulness-Acceptance-Commitment-Based Approach to Athletic Performance Enhancement: Theoretical Considerations F~aNI~ L. GARDNER ZELLA E. MOORE La Salle University While traditional cognitive-behavioral skills-training-based approaches to athletic performance enhancement posit that negative thoughts and emotions must be con- trolled, eliminated, or replaced for athlete-clients to perform optimally, recent evi- dence suggests that efforts to control, eliminate, or suppress these internal states may actually have the opposite effect. Interventions based on mindfulness and ac- ceptance suggest that internal cognitive and emotional states need not be eliminated, changed, or controlled in order to facilitate positive behavioral outcomes. Rather, it is suggested that an alternative or supplemental approach to the enhancement of ath- letic performance may be achieved through strategies and techniques that target the development of mindful (nonjudgmental) present-moment acceptance of internal experiences such as thoughts, feelings, and physical sensations, along with a clarifi- cation of valued goals and enhanced attention to external cues, responses, and con- tingencies that are required for optimal athletic performance. Applied sport psychology, in its efforts to enhance the competitive perfor- mance of athletes, has traditionally utilized cognitive behavioral methods and techniques with an emphasis on developing self-control of internal states, commonly referred to as psychological skills training (Whelan, Mahoney, & Meyers, 1991). In contrast, behavioral theorists in professional psychology have recently begun to advocate and demonstrate empirical support for inter- ventions that emphasize acceptance, rather than direct change, suppression, or control, of cognitive and affective experiences (Hayes, Strosahl, & Wilson, 1999; Roemer & Orsillo, 2002; Segal, Williams, & Teasdale, 2002). With modern meta-cognitive and acceptance-based theory, research, and practice as a foundation, and theoretical aspects of self-regulatory processes in athletic performance carefully considered, the purpose of this article is to present a new approach to performance enhancement that, adapted and developed Address correspondence to Frank L. Gardner, Department of Psychology, La Salle Univer- sity, 1900 W. Olney Avenue, Box 842, Philadelphia, PA 19141; e-maih gardner@lasalle.edn. 707 005-7894/04/0707~3723 $1.00/0 Copyright 2004 by Association for Advancement of Behavior Therapy All rights for reproduction in any form reserved. 708 GARDNER & MOORE specifically for use with an athletic population, may elaborate on and increase the effectiveness of traditional performance enhancement approaches. This approach is referred to as Mindfulness-Acceptance-Commitment (MAC) based performance enhancement, and is adapted from clinical models of Accep- tance and Commitment Therapy (Hayes et al., 1999) and Mindfulness-Based Cognitive Therapy (Segal et al., 2002). This innovative approach to athletic performance enhancement efforts is markedly different in both theoretical assumptions and intervention strategies and techniques from the traditional psychological skills training approaches that have to date dominated applied sport psychology. Historical Development of Psychological Skills Training Historically, efforts to enhance athletic performance have been most clearly related to the development of social cognitive theory (Bandura, 1977) and early skills training models of cognitive-behavioral interventions (Meichen- baum, 1977). From this perspective, athletes develop and utilize psychologi- cal (mental) skills such as goal setting, imagery/mental rehearsal, arousal control, self-talk, and precompetitive routines as vehicles to aid in the devel- opment of self-control of internal processes such as thoughts, emotions, and bodily sensations, in an attempt to create the ideal performance state (Hardy, Jones, & Gould, 1996). Within the domain of interventions for athletic performance enhancement, a number of authors frequently describe and support the use of psychological skills training (PST) procedures, while concurrently commenting on the inconsistent and inconclusive empirical support for such approaches (Burton, Naylor, & Holliday, 2001; Gould, Damarjian, & Greenleaf, 2002; Gould & Udry, 1994; Meyers, Whelan, & Murphy, 1996; Weinberg, 1994, 2002; Wil- liams & Leffingwell, 2002; Zaichkowsy & B altzell, 2001). In addition, questions may be raised regarding the theoretical assumptions that are at the foundation of these procedures. Fundamental to PST is the long- held assumption that reduction of negative emotions and bodily states, and associated increases in positive cognitions and confidence levels, are directly related to an "ideal performance state," which in turn is directly related to optimal athletic performance (Hardy et al., 1996). Based primarily on corre- lational studies, practitioners of sport psychology have long accepted the notion that more successful performers are less anxious, more confident, and experience fewer negative thoughts (Gould, Eklund, & Jackson, 1992; Gould, Weiss, & Weinberg, 1981; Orlick & Partington, 1988). What follows from this theoretical position is the related assumption that interventions target- ing the enhancement of athletic performance focus on supplanting negative thoughts with positive ones and reducing or controlling negative affective states (Hardy et al., 1996). In those few studies that have carefully studied the mechanisms of change mediating traditional PST procedures and competitive performance, results MAC PERFORMANCE ENHANCEMENT 709 have generally not been supportive of the assumptions made in the use of tra- ditional psychological skills training procedures. These studies, utilizing a variety of different sports, suggest that reduction in "negative" affective states such as anxiety, and/or increases in self-confidence, do not consistently result in significant increases in athletic performance (Burton, 1989; Daw & Burton, 1994; Holm, Beckwith, Ehde, & Tinius, 1996; Maynard, Smith, & Warwick- Evans, 1995; Murphy & Woolfolk, 1987; Weinberg, Seabourne, & Jackson, 1981). This conclusion receives additional support from a recent study by Cohen and colleagues (Cohen, Pargman, & Tannenbaum, 2003) in which physiolog- ical arousal was experimentally manipulated during a dart-throwing competi- tion. The results of this study found no relationship between arousal levels and actual performance. In addition, a recent meta-analysis examined the effects of competitive anxiety and self-confidence on athletic performance (Craft, Magyar, Becker, & Feltz, 2003). In this review, using multivariate meta-analytic techniques, characteristics such as design features, subjects, and type of sport were separately coded. From this analysis, the authors con- cluded that a weak relationship appears to exist between competitive anxiety, self-confidence, and athletic performance. It should be noted that these studies are limited by their assumption that all athletes are at nonclinical levels of anxiety or other affective states and thus would all benefit from a single intervention protocol based upon a common goal of enhancing athletic performance. It may very well be that those ath- letes for whom anxiety (or other affective states) is at subsyndromal or actual clinical levels might benefit from different interventions than those whose anxiety/affective levels are at nonclinical levels. That being said, these studies do suggest that for a number of athletes, reduction of anxiety (with corre- sponding reduction of "negative" thinking and increases in self-confidence) may have little significant impact on actual competitive performance enhance- ment. This in turn suggests the possibility that for many competitive performers, particularly for those not experiencing unusually high levels of pre-competitive anxiety, an alternative to traditional interventions targeting reduction of anxiety, increased confidence, and reduced "negative" thinking, may be appropriately considered for use in athletic performance-enhancement efforts. An Alternative Approach to Athletic Performance Enhancement In recent years, there has been an increasing body of literature that calls into question the position that "negative" internal experiences invariably lead to negative behavioral outcomes (Hayes et al., 1999). In essence, this literature suggests that attempting to suppress unwanted thoughts and emotions can actually have a paradoxical effect, triggering a meta-cognitive scanning pro- cess that actively searches for signs of "negative" or unwanted cognitive activity and brings it to awareness when detected (Purdon, 1999; Wegner, 1994). As such, excessive cognitive activity and task-irrelevant focus replaces meta-cognitive task-relevant attention and functional goal-directed behavior. 710 GARDNER & MOORE The literature further suggests that efforts at thought suppression or control might actually result in an increase in frequency of unwanted thoughts and emotions (Clark, Ball, & Pape, 1991). Further, the reactivation of previously suppressed thoughts has been found to result in corresponding increases in affective states and increased autonomic activity (Wegner, Shortt, Blake, & Page, 1990), which is most often contrary to the desired outcome when work- ing with competitive athletes. These processes and consequences of thought suppression have often been referred to as "ironic process of mental control" (Wegner, 1994). Recent empirical data describing self-regulatory processes across a wide range of human performance domains (Barlow, 2002; Rapee & Lim, 1992; Sbrocco & Barlow, 1996; Stopa & Clark, 1993) and athletic performance in particular (Moore & Gardner, 2001) suggest that consistent functional human performance involves meta-cognitive attention to external cues, options, and contingencies involved in both immediate performance tasks and valued distal goals. At the same time, optimal self-regulation requires minimal self-judgment, minimal vigilance to external or internal threat, and mini- mal worry (i.e., scanning for threat) about possible performance conse- quences and ramifications. Conversely, Crocker and colleagues (Crocker, Alderman, & Smith, 1988) utilized a stress-management intervention including meditation and in-practice integration of coping skills to develop the capacity to focus on performance, attend in the moment, and cope with experienced emotion for elite volleyball players. In this study, while no reductions in competitive anxiety and minimal changes in actual negative cognitions were noted, there were significant com- petitive performance improvements, and these improvements were main- tained at 6-month follow-up. In a more recent study utilizing qualitative ana- lytic methods, D'Urso and colleagues (D'Urso, Petrosso, & Robazza, 2002) found that when assessing the contribution of psychological skill utilization and physical skill utilization differences between best and worst athletic perfor- mances, only the physical skill-based constructs were reliably related to per- formance differentiation. Consistent with contemporary contextual-acceptance theory, the authors also noted that "both positive and negative emotions may exert beneficial or detrimental effects depending on their idiosyncratic mean- ing and intensity" (D'Urso et al., 2002, p. 172). The empirical evidence appears to suggest that for many athletes, the inter- vention goals of anxiety reduction, minimization of negative cognition, and/ or increased confidence may not be necessary, essential, or even related to an outcome of enhanced athletic performance. In addition, internal control- based approaches to performance enhancement may inadvertently result in overly cognitive (verbal-semantic, self-focused) rather than meta-cognitive (in- the-moment, nonjudgmental) activity, resulting in a reduced capacity to auto- matically engage (i.e., trust) previously developed athletic skills, appropriately respond to necessary contextual cues, and maintain optimal task-relevant focus. In response to the empirical limitations and theoretical questions associated MAC PERFORMANCE ENHANCEMENT 711 with traditional change-based PST approaches to enhance athletic perfor- mance, introduction to and utilization/supplementation of newer approaches to athletic performance based upon contemporary theory and research in meta- cognitive processes, acceptance, and self-regulation would appear warranted. Specifically, burgeoning mindfulness and acceptance-based approaches have direct theoretical relevance to efforts at performance enhancement. In addition to their utility in clinical populations, these approaches have demonstrated some preliminary success in studies focusing on work-site stress reduction (Bond & Bunce, 2000) and pitching and batting performance in collegiate softball players (Little & Simpson, 2000). Rather than emphasizing control/reduction of internal experiences, emerg- ing approaches to psychological intervention emphasize mindful, nonjudging awareness and acceptance of in-the-moment cognitive, affective, and sensory experiences. Internal experiences are viewed as naturally occurring events that regularly come and go as normal, expected facets of human existence. From this overarching perspective, human difficulties evolve, at least in part, from the tendency for individuals to "fuse" with their internal experiences such as thoughts, feelings, and self-other evaluations, and thus view internal processes as absolute literal truths that provide reasons for events and in turn guide/cause behavioral choices (Hayes et al., 1996). As a result, rather than engaging in behaviors reflective of a commitment to valued goals (quality practice, hard training, aggressive competitive performance, maintenance of strategic plans and choices), competitive choices/behaviors are often made for the purpose of avoiding and thus controlling/limiting internal experiences judged as unacceptable or uncomfortable. Of particular importance in acceptance-based models are the associated concepts of willingness and commitment. Willingness refers to a decision to fully experience thoughts and emotions (including those defined as "nega- tive") which in turn allows behavioral choices to be made not for the immedi- ate goal of a reduction of discomfort, but rather, in the service of active efforts to achieve distal goals (commitment). Commitment, then, can be defined as the process of actively choosing behaviors that are directly in pursuit of clearly delineated valued goals. Closely associated with acceptance is the concept of mindfulness. Mindful- ness, as a form of present-moment awareness, stems from concepts grounded in Eastern religion and philosophy, and has been defined as " . . . paying atten- tion in a particular way: on purpose, in the present and nonjudgmentally" (Kabat-Zinn, 1994, p. 4). As a technique, mindfulness has been used as a component in therapeutic interventions targeting many diverse clinical prob- lem areas (Kabat-Zinn, 1994; Linehan, 1994; Miller, Fletcher, & Kabat-Zinn, 1995; Roemer & Orsillo, 2002; Segal et al., 2002). Mindfulness techniques emphasize the development of nonjudging, nonevaluative attention to present realities, including both external stimuli and internal processes. That is, inter- nal or external stimuli that enter awareness are noticed, but not evaluated as good, bad, right, or wrong. Mindfulness from this perspective can be thought 712 GARDNER & MOORE of as an attentional skill. It is developed through regular practice of mindful- ness exercises, and with particular relevance to athletic performance, can be viewed as a form of self-regulated present-moment attention (Kabat-Zinn et al., 1992). In addition to enhancing moment-to-moment attention, mindfulness-based techniques have also demonstrated efficacy in reducing the verbal-linguistic component of anxiety and worry (Roemer & Orsillo, 2002). In this regard, a number of studies have confirmed the idea that worry (a central feature of anxiety) is characterized most clearly by a preponderance of cognitive activ- ity and low levels of imagery and autonomic activity (Borkovec & Intz, 1990; Borkovec, Lyonfields, Wiser, & Deihl, 1993; Lyonfields, Borkovec, & Thayer, 1995). This may be of particular importance in athletic populations, as one study has demonstrated decreased levels of left-hemisphere cortical activity, indicative of lowered levels of verbal-linguistic activity in high-performing golfers (Crews & Landers, 1993). Similar results have been found in other studies utilizing elite marksmen and archers (Hatfield, Landers, & Ray, 1984; Janelle, Hillman, Apparies, et al., 2000; Janelle, Hillman, & Hatfield, 2000; Salazar, Landers, Petruzzello, & Hart, 1990). To date, these results have only been noted with athletes engaged in self-paced (closed skill) sports, such as golf, pistol shooting, and archery. As such, it is still an open empirical question as to whether these same results would be found in athletes engaged in exter- nally paced (open skill) sports such as basketball and hockey. That being said, the data do suggest the potential value of mindfulness-based interven- tions for use in athletic performance enhancement. Further, as it has been suggested that the use of mindfulness techniques may lead to the development of greater self-awareness (Roemer & Orsillo, 2002), habitual ways of responding to external cues can be more easily iden- tified, which may result in enhanced behavioral flexibility in response to athletic demands. The present-focused nature of mindfulness techniques does not pro- mote excessive self-focus or cognitive activity related to past or future events, but rather, promotes attention to performance-relevant cues and enhanced behavioral flexibility as competitive demands and internal experiences fluctu- ate. An example of the important role of task-relevant, in-the-moment focus and associated attention to contextual cues in sport can be seen in a study by Klinger and colleagues (Klinger, Barta, & Glas, 1981). In this study, reversals in game performance and an enhanced level of play by the competition shifted the attentional focus of intercollegiate basketball players from appro- priate external game-related cues to a more self-judging future-oriented anticipatory focus, which in turn resulted in impaired performance. This attentional shift was associated with changes in "momentum" and was asso- ciated with mini-slumps and more long-term performance dysfunction. Simi- larly, a study by Edwards, Kingston, Hardy, and Gould (2002) found that an attentional shift to self-evaluation of performance was a significant contribu- tor to in-competition catastrophic performance decline in high performing athletes. MAC PERFORMANCE ENHANCEMENT 713 MAC-Based Performance Enhancement The Mindfulness-Acceptance-Commitment-based approach to performance enhancement is an integration and adaptation of Acceptance and Commit- ment Therapy (Hayes et al., 1999) and Mindfulness-Based Cognitive Ther- apy (Segal et al., 2002) for use with an athletic population. This approach draws heavily on the extensive research on rule-governed behavior by Hayes and colleagues (Hayes et al., 1999). Their research suggests that when an individual has a negative emotional response to an external stimulus (such as anxiety in response to a skilled opponent), and then directly thinks about the stimulus ("I can't keep up"), he or she is likely to develop a negative emo-