Systematic Review of Stress Management Interventions With Sport Performers

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DOI: 10.1037/a0026628
Abstract
The purpose of this review was to systematically identify and evaluate the psychosocial interventions used to manage a component of the stress process in competitive sport performers. Inclusion criteria were devised to select research relevant to the topic area. Studies were assessed for inclusion by examining their title, abstract, and then full text. Based on the outcome of this process, 64 studies were included in the review. These studies encompassed a variety of cognitive (n = 11), multimodal (n = 44), and alternative interventions (n = 9). The results indicate that, in general, a variety of stress management interventions are associated with athletes’ optimized stress experience and enhanced performance. The findings suggest that the effectiveness of stress management is moderated by a number of diverse design features (e.g., treatment adopted, stress component outcome measured). These design features are important to consider when designing interventions for athletes of varying sports, ages, and competitive standards.
A Systematic Review of Stress Management Interventions With
Sport Performers
James L. Rumbold, David Fletcher, and Kevin Daniels
Loughborough University
The purpose of this review was to systematically identify and evaluate the psychosocial
interventions used to manage a component of the stress process in competitive sport
performers. Inclusion criteria were devised to select research relevant to the topic area.
Studies were assessed for inclusion by examination of their title, abstract, and then full
text. On the basis of the outcome of this process, 64 studies were included in the review.
These studies encompassed a variety of cognitive (n 11), multimodal (n 44), and
alternative interventions (n 9). The results indicate that, in general, a variety of stress
management interventions are associated with athletes’ optimized stress experience and
enhanced performance. The findings suggest that the effectiveness of stress management
is moderated by a number of diverse design features (e.g., treatment adopted, stress
component outcome measured). These design features are important to consider when
designing interventions for athletes of various sports, ages, and competitive standards.
Keywords:
anxiety, athletes, emotions, evidence-based, psychological skills
The competitive sport arena is a highly de-
manding and potentially stressful environment.
On the basis of a transactional conceptualiza-
tion, stress is defined as “an ongoing process
that involves individuals transacting with their
environments, making appraisals of the situa-
tions they find themselves in, and endeavoring
to cope with any issues that may arise”
(Fletcher, Hanton, & Mellalieu, 2006, p. 329,
adapted from Lazarus, 1999). In line with this
perspective of stress, it is widely acknowledged
that sport performers must manage a wide range
of environmental demands and psychological
responses if they are to enhance their athletic
performance and sport experience. Although
some performers are able to manage the various
causes and consequences of the stress process,
many others struggle, resulting in severe im-
pairments to their performance and health (e.g.,
burnout, depression, illness). For this reason,
stress management interventions are important
for facilitating athletes’ experiences and perfor-
mances in a range of sport-related settings.
Within the sport psychology literature, it is
acknowledged that intervention research
should be of paramount importance to better
understand the most appropriate approach to
manage sport performers’ stress (Anshel,
2005; Jones & Hardy, 1990; Thomas, Mella-
lieu, & Hanton, 2008). Aligned with this
view, researchers have implemented several
stress management interventions to optimize
different aspects of the transactional stress
process in typically one of the following
ways: (a) a reduction in stressors, (b) a mod-
ification of cognitive appraisals, (c) a reduc-
tion in negative affect and an increase in
positive affect, or (d) facilitating effective
coping behaviors. Hence, for the purposes of
this article, optimization of the stress process
involves the interrelation and balance be-
tween the components of the stress process to
benefit an individual’s well-being and perfor-
mance. However, there is still debate as to the
This article was published Online First December 12, 2011.
James L. Rumbold and David Fletcher, School of Sport,
Exercise, and Health Sciences, Loughborough University,
Leicestershire, United Kingdom; Kevin Daniels, School of
Business and Economics, Loughborough University, Leic-
estershire, United Kingdom.
This research was supported in part by a grant from the
Lane4 Management Group Ltd., and David Fletcher dis-
closes that he has a research agreement with Lane4 Man-
agement Group Ltd.
The authors disclose that they have a research agreement
with Lane4 Management Group, Ltd.
Correspondence concerning this article should be ad-
dressed to James L. Rumbold, School of Sport, Exercise,
and Health Sciences, Loughborough University, Epinal
Way, Loughborough, Leicestershire, LE11 3TU United
Kingdom. E-mail: j.l.rumbold@lboro.ac.uk
Sport, Exercise, and Performance Psychology © 2011 American Psychological Association
2012, Vol. 1, No. 3, 173–193 2157-3905/11/$12.00 DOI: 10.1037/a0026628
173
effectiveness of different stress management
interventions in optimizing athletes’ stress
and performance.
This study was the first to synthesize results
from across the research literature on the stress
management interventions that have attempted
to optimize athletes’ stress experience and per-
formance. Of the intervention reviews that have
been published to date within sport psychology,
the emphasis has been placed on evaluating
performance-enhancing treatments that are
solely focused on improving performance-
related outcomes. Greenspan and Feltz (1989)
reviewed 23 interventions with athletes and
concluded that relaxation-based and cognitive
restructuring programs were generally effective
in improving athletes’ performance. Martin,
Vause, and Schwartzman (2005) also reviewed
psychological interventions with sport perform-
ers, although they had more stringent inclusion
criteria than Greenspan and Feltz (1989). They
incorporated only 15 studies that used single-
subject and experimental designs to evaluate
performance enhancement. These interventions
mainly consisted of cognitive– behavioral-based
multimodal programs. Of the seven single-
subject designs that were evaluated by Martin et
al. (2005), it was found that five studies reported
positive effects for all participants. In addition,
eight of eight experimental designs reported
performance improvements for the treatment
group in comparison with a control group. Al-
though these reviews (Greenspan & Feltz, 1989;
Martin et al., 2005) have provided support for
athletes’ performance enhancement, psychoso-
cial programs also play a salient role in contrib-
uting toward performers’ affective well-being
(Miller & Kerr, 2002). In particular, the prom-
inence of stress in athletes’ experience of com-
petitive sport indicates that intervention reviews
should also assess the extent to which interven-
tions alter athletes’ stress experience. However,
to date, no reviews have specifically assessed
the effectiveness of interventions that aim to
optimize athletes’ stress experience and perfor-
mance.
Effective Stress Management
Effectiveness has been referred to as “the
applicability, feasibility, and usefulness of the
intervention in the local or specific setting
where it is to be offered” (American Psycholog-
ical Association [APA], 2002, p. 1053). Re-
searchers who seek to assess effectiveness gen-
erally recommend that manipulation checks are
conducted to assess participants’ perceptions of
and satisfaction with a specific program (Green-
span & Feltz, 1989; Vealey, 1994). These
checks are generally in the form of quantitative
social validation measures or interviews postin-
tervention. Other evaluations of effectiveness
include calculating the overall effect size and
power of behavior change for the various stress
process component and performance outcomes
measured. To date, the sport psychology litera-
ture has indicated that stress management inter-
ventions may generally be effective in reducing
state and trait anxiety in athletes (Thomas et al.,
2008). However, anxiety is only one component
of the dynamic, ongoing stress process. It is,
therefore, important that researchers seek to
broaden their understanding of the interventions
that are effective in optimizing the wider stress
process (e.g., stressors, appraisals, emotions,
coping). Establishing the circumstances in
which programs are effective would assist sport
psychologists in assessing when treatments are
effective for performers of particular age groups
and competitive levels. Notwithstanding the im-
portance of assessing effectiveness to accurately
reflect a rigorous and robust evidence base, the
treatment efficacy should also be considered.
Treatment Efficacy of Stress Management
As stated in the “Criteria for Evaluating
Treatment Guidelines” (APA, 2002), treatment
efficacy is the “systematic and scientific evalu-
ation of whether a treatment works” (p. 1053).
The difference between efficacy and effective-
ness is that efficacy is concerned with effective
outcomes that are based on acceptable internal
validity. When attempting to reliably estimate
the effect of stress management for sport per-
formers, applied researchers should also con-
sider the research designs that are able to infer
causality and increase confidence in the strength
of an intervention effect. According to the APA
framework, such interventions use randomized
controlled trials (RCTs) that include a control or
comparison group. The randomization of partic-
ipants to treatment and control groups allows
for causality to be inferred and provides reliable
estimates of effects (Martin et al., 2005). Such
designs are considered more likely to be classi-
174 STRESS MANAGEMENT WITH SPORT PERFORMERS
fied at the highest level of empirically supported
treatments (Chambless & Ollendick, 2001).
Other noteworthy evaluations of efficacy in-
clude: (a) whether interventions included infor-
mation descriptions to allow other researchers
to replicate studies, (b) whether interventions
were conducted in naturalistic settings, and (c)
whether manipulation checks and follow-up as-
sessments were conducted.
It is important, therefore, that stress manage-
ment interventions with sport performers are
considered in terms of both their effectiveness
and their efficacy. Although the primary focus
in this review is the assessment of effective
stress management, at the highest level of em-
pirical support it is necessary to demonstrate
efficacy before demonstrating effectiveness. In-
deed, for the field of sport psychology to report
good evidence-based programs, researchers
need to incorporate designs and validation
methods that are robust enough to infer causal-
ity but also, on a more practical level, take into
account the personal and situational needs of
sport performers (Anshel, 2005; Mellalieu,
Hanton, & Fletcher, 2006; Thomas et al., 2008).
The latter point was illustrated by Mellalieu et
al. (2006), who noted that using certain anxiety-
reducing programs (e.g., relaxation training)
may not be appropriate in sports that may re-
quire higher cognitive and physical activation
states before performance (e.g., weightlifting).
In view of this observation, it is likely that
various personal and situational characteristics
act as moderators that influence the relationship
between treatments and effects. These modera-
tors, therefore, should be considered before de-
signing interventions and when assessing the
various types of effective stress management
interventions that have been applied with sport
performers.
Moderators of Intervention Effects
In assessing the effectiveness of stress man-
agement with sport performers, it is important
to consider the various study characteristics that
may be associated with effective outcomes for
athletes’ stress experience and performance.
Identifying moderating variables could help to
explain inconsistencies across findings, improve
intervention efficiency, and enhance dissemina-
tion of effective evidence-based programs. Un-
derstanding which characteristics may moderate
the main effect of treatment is important be-
cause this may enable applied researchers to
identify who will benefit most from particular
treatments. For example, it is possible that dif-
ferent types of treatment (e.g., cognitive, mul-
timodal, alternative) may be an important pre-
dictor of change for performers of particular
competitive ages or standards. In this way, it is
possible that cognitive restructuring techniques
may be more beneficial for elite athletes in
comparison with non-elite and younger per-
formers who may find stress reduction treat-
ments more effective (Fletcher & Hanton,
2001).
An important message to emerge from this
overview is that applied researchers require a
greater understanding of the programs that are
effective at managing performers’ stress experi-
ence. In addition, there is a need to provide prac-
titioners with a greater awareness of the treatments
that are deemed to be effective for optimizing
competitive athletes’ stress and performance. To
date, however, there has been no systematic
attempt to critically review the effectiveness of
stress management interventions or outline their
treatment efficacy. The purpose of this research,
therefore, was to systematically identify and
evaluate the psychosocial interventions used to
manage a component of the stress process in
competitive sport performers. The systematic
review examined the effectiveness of these in-
terventions in facilitating athletes’ stress expe-
rience and performance and reported the highest
level of empirically supported treatments.
Method
Design
Through critical exploration, evaluation, and
synthesis, a systematic review identifies and
summarizes all of the empirical studies that
pertain to a research topic (Cooper, 1982; Green
et al., 2008). This approach involves a rigorous
protocol that reduces reporter bias and random
error (Cook, Mulrow, & Haynes, 1997). For
these reasons, a systematic review was deemed
the most appropriate method to address the re-
search question because a large number of find-
ings may be evaluated in combination (Mulrow,
1994; Mulrow, Cook, & Davidoff, 1997). Sys-
tematic reviews can include the statistical meth-
ods of meta-analysis if studies provide suffi-
175RUMBOLD, FLETCHER, AND DANIELS
cient data to calculate effect sizes (Eysenck,
1995). However, because a large number of
studies provided insufficient statistics (e.g.,
means and standard deviations) to calculate ef-
fect sizes, and because some of the studies were
qualitative in nature, narrative analysis was un-
dertaken in conjunction with vote-counting
methods (Cooper, 1998).
Search Strategy
The procedure for identifying appropriate
studies was based on well-established system-
atic review guidelines reported in the fields of
health care (Edwards, Hannigan, Fothergill, &
Burnard, 2002; Egger & Davey Smith, 2001),
occupational psychology (Cooper, 1982, 2003),
and sport psychology (Goodger, Gorely, La-
vallee, & Harwood, 2007; Nicholls & Polman,
2007). The search strategy adopted three main
approaches to gather research evaluating stress
management interventions with sport perform-
ers. First, between April 2009 and May 2010,
research papers were gathered and identified
from the following electronic databases: Arti-
cleFirst (1990 to present), Applied Social Sci-
ences Index and Abstracts (1987 to present),
MEDLINE (1965 to present), Physical Educa-
tion Index (1970 to present), PsycARTICLES
(1894 to present), PsycINFO (1967 to present),
SPORTDiscus (1985 to present), Web of Sci-
ence (1945 to present), and Zetoc (1993 to
present). For each database, various keyword
combinations were used to identify relevant em-
pirical studies, including the following: affect
regulation, anxiety, appraisals, athletes, bio-
feedback, burnout, cognitive– behavioral ther-
apy, coping, demands, depression, emotions,
goal setting, imagery, interventions, relaxation,
self-talk, sport, strain, stress, stressors, stress
inoculation training, stress management, stress
management interventions, stress management
programs, and well-being. James L. Rumbold
contacted eight experts in stress in sport to
establish if there were any keywords missing
from this list. This resulted in the inclusion of
two additional keywords: competition and
pressure. The second search strategy involved
conducting a manual search of the following
journals from the first issue of publication:
International Journal of Sport and Exercise
Psychology (2003 to 2010), International Jour-
nal of Sport Psychology (1994 to 2010), Journal
of Applied Sport Psychology (1989 to 2010),
Journal of Clinical Sport Psychology (2007 to
2010), Journal of Sport Behavior (1990 to
2010), Journal of Sport and Exercise Psychol-
ogy (1979 to 2010), Journal of Sports Sciences
(1983 to 2010), Psychology of Sport and Exer-
cise (2000 to 2010), Research Quarterly for
Exercise and Sport (2001 to 2010), and The
Sport Psychologist (1987 to 2010). Once this
strategy was complete, the third search strategy
involved citation pearl growing (Hartley, 1990),
which involved searching reference lists of the
full papers that were collected and met the in-
clusion criteria.
Inclusion Criteria
The literature search was conducted to gather
and identify the studies that used psychosocial
interventions applied to manage a component (or
components) of the psychological stress process in
sport performers. In this way, psychosocial inter-
ventions refer to studies of social influences and
their effect in modifying individual behavior
(Frosh, 2003). Examples of some typical interven-
tions include cognitive (e.g., imagery, self-talk)
and multimodal (e.g., stress inoculation training,
progressive muscular relaxation) treatments. For
research papers to be included in the review, the
participants within each study were required to
train and compete regularly in a specific physical
activity to be considered authentic sport perform-
ers. In this way, novice individuals were not con-
sidered as sport performers. On the basis of this
criterion, a selection of intervention studies were
excluded from the review. For example, two stud-
ies by Griffiths and colleagues (Griffiths, Steel,
Vaccaro, Allen, & Karpman, 1985; Griffiths,
Steel, Vaccaro, & Karpman, 1981) that tested the
effects of relaxation techniques on anxiety levels
of scuba divers were rejected. These studies were
not included because of the sample of novice
students. Additionally, psychophysiological inter-
ventions were not included because they did not
measure athletes’ psychological stress. When re-
trieving the interventions that had been conducted
with sport performers, it was also a requirement
that the papers were published in peer-reviewed
journals and available in the English language.
Although this approach represents a publication
bias (Egger & Davey Smith, 2001), it is imprac-
tical and expensive to obtain copies of unpub-
lished documents and translate foreign written
176 STRESS MANAGEMENT WITH SPORT PERFORMERS
material. In addition, given the limited amount of
information that is provided in published abstracts
of conference proceedings, it is unlikely that these
studies can be evaluated with sufficient rigor to
determine whether an intervention is effective
(Scharf et al., 2008).
Sifting of Research Papers
The research papers that were potentially ap-
propriate for the review were assessed by title,
abstract, and then full text (see Figure 1). At
each stage of evaluation, studies were excluded
from the sifting process if certain inclusion cri-
terion were not satisfied. To elaborate, studies
were required to provide information pertaining
to study demographics (e.g., sample size), the
experimental study design (e.g., whether the
method incorporated a control or comparison
group), and the stress component(s) outcome
measured (e.g., stressors, appraisals, emotions).
It was important that we identify these features
in the systematic review to consider any poten-
tial moderators that may influence the relation-
ship between treatments and effects. Moreover,
because the review focused on the stress man-
agement interventions conducted in sport per-
formers, studies of other populations (e.g., sport
coaches, managers, parents) were excluded
from the analysis. The following descriptive
information was extracted and coded from each
study: sample size, gender, mean age, type of
sport, skill classification, competitive standard,
country, type of intervention, measures used,
stress process and performance outcomes mea-
sured, the design used, the duration of interven-
tion, where the intervention was conducted,
whether treatment manuals were provided, and
whether manipulation checks and follow-up as-
sessments were conducted.
David Fletcher coded approximately 10% of
the original titles (n 80/845), abstracts (n
40/417), and full-text papers (n 10/109) to
assess intercoder reliability. On the basis that
interrater agreement was 95%, James L. Rum-
bold coded the remaining studies and, when
necessary, received assistance from David
Fletcher to evaluate any ambiguous informa-
tion. Any discrepancies were resolved through
discussion until a consensus was reached. The
vote-counting procedure adopted meant that
studies were coded on the outcome effects re-
ported for each intervention variable. More spe-
cifically, we used statistical significance of ef-
fects as the criterion for a positive effect. In
addition, where computable, we calculated ef-
fect sizes (Cohen’s d) using Comprehensive
Meta-Analysis software, Version 2, to reduce
the likelihood of human error (Borenstein,
Hedges, Higgins, & Rothstein, 2005). In the
case where qualitative analyses were conducted,
outcome effects were coded on the basis of the
interpretations of the original authors.
Results
Study Characteristics
Of the original 845 citations that were re-
trieved, 63 research papers (64 studies) were
included in the systematic review. Moreover, a
study by Weinberg, Seabourne, and Jackson
(1982) reported two interventions with separate
samples; therefore, this research article was re-
ported as two separate intervention studies. Ta-
ble 1 summarizes the following study charac-
teristics of the interventions that were included:
sample size, gender, mean age, type of sport,
skill classification of the sport, competitive
standard of the athletes, research design used,
type of measures used, stress concept measured,
type of intervention implemented, and the du-
ration of intervention. In terms of the sample
sizes gathered for each of the studies, 52 studies
(82%) recruited between 1 and 50 participants,
and only 2 studies (2%) had sample sizes over
100 (viz., Bakker & Kayser, 1994; and Devlin
& Hanrahan, 2005). In view of smaller sample
sizes, it is possible that any significant effects
reported are more likely to display insufficient
power.
When we considered the potential moderators
of intervention effects, it was revealed that the
mean age of participants ranged from 12 to 21
years for over half of the intervention research
(n 38; 59%). Seventeen of the studies (27%)
failed to provide participant age-related data. With
regard to the sport classification of studies, the
results showed that 26 studies (40%) were classi-
fied as team sports, 32 (50%) were classified as
individual sports, and only 3 (5%) combined both
sport types. Fifty-three interventions (83%) in-
cluded sports that require gross-motor-skill move-
ments, with only one study sampling a fine-motor-
skill sport in isolation (viz., Prapavessis, Grove,
177RUMBOLD, FLETCHER, AND DANIELS
Figure 1. Flow diagram of the stages of the systematic review.
178 STRESS MANAGEMENT WITH SPORT PERFORMERS
Table 1
Descriptive Analysis of Study Characteristics
Characteristic
Frequency (and %) of
studies
Sample size
1 7 (11)
2–20 21 (33)
20–50 24 (38)
51–100 10 (16)
101–200 1 (1)
200 1 (1)
Gender
Females only 17 (27)
Males only 19 (29)
Combined 23 (36)
Not reported 5 (8)
Mean age (in years)
12–21 38 (59)
22–40 8 (13)
40 1 (1)
Not reported 17 (27)
Type of sport
Team only 26 (40)
Individual only 32 (50)
Combination 3 (5)
Not reported 3 (5)
Skill classification
Open-skill sport 20 (31)
Closed-skill sport 23 (36)
Combination of open and closed skills 18 (28)
Gross-motor-skill sport 53 (83)
Fine-motor-skill sport 1 (1)
Combination of gross and fine skills 7 (11)
Sport unclear/not reported 3 (5)
Competitive standard
High school 3 (5)
Collegiate 20 (31)
Club (nonprofessional) 6 (9)
Regional (nonprofessional) 2 (3)
National (nonprofessional) 4 (6)
Semiprofessional 2 (3)
Elite (international, Olympic, professional) 4 (6)
A variety of competitive levels 10 (16)
Not reported 13 (21)
Design
Preexperimental designs
Case study design (posttest only) 6 (9)
One group design (pretest–posttest) 5 (8)
Single-subject designs
Single-subject designs with comparison 2 (3)
Single-subject designs without comparison 14 (22)
Quasi-experimental designs
Nonrandomized controlled trial (pretest–posttest) 11(17)
Nonrandomized trial with comparison (pretest–posttest) 2 (3)
Nonrandomized controlled interrupted time-series 3 (5)
True experimental designs
Randomized controlled trial (pretest–posttest) 16 (25)
Randomized controlled trial (posttest only) 1 (1.5)
179RUMBOLD, FLETCHER, AND DANIELS
McNair, & Cable, 1992). Turning to the compet-
itive standard of participants, 20 studies (31%)
recruited collegiate performers, whereas elite
(n 4, 6%) and semiprofessional populations
(n 2, 3%) were largely neglected. Thirteen
studies (21%) did not provide sufficient informa-
tion as to the competitive standard of the partici-
pants. An analysis of the research designs revealed
that 21 studies (33%) used true experimental de-
signs, which involved the randomization of par-
ticipants to an intervention and control or compar-
ison group. Of the remaining studies, 16 (25%)
used single-subject designs, 16 (25%) used a va-
riety of quasi-experimental designs, and 11 (17%)
used preexperimental designs. Additionally, the
use of predominantly experimental designs meant
that 47 studies (74%) implemented quantitative
measures, 15 used mixed methods (23%), and
only 2 studies (3%) used qualitative methods ex-
clusively (viz., Mace, Eastman, & Carroll, 1986,
1987).
A perusal of the stress component outcomes
that were measured revealed that 46 interven-
tions assessed state and trait anxiety (72%).
When further analyzing the anxiety interven-
tions (n 46/64), we found that imagery (n
28), relaxation (n 27), and self-talk training
(n 10) were the most frequently imple-
mented, either in isolation or in combination
with other treatments. In terms of the imagery
programs that measured state anxiety (n
26), 17 studies (65%) reported a postinterven-
tion reduction in state anxiety, whereas 3 of the
total 28 imagery interventions (11%) reported a
decrease in trait anxiety. Mainly, imagery pro-
duced beneficial effects for anxiety when in-
cluded as part of a multimodal intervention, of
which 35 intervention studies (76%) were ef-
fective. When assessing relaxation techniques,
we found that 16 of 23 (70%) studies reported
state anxiety reductions. When imagery and re-
laxation were both used with a combination of
additional treatments (n 18), the findings
showed positive effects for state anxiety in 11
studies (61%). In terms of the self-talk tech-
niques that were utilized exclusively, or as part
of a multimodal program, 9 of the 10 studies
were effective in reducing state anxiety.
Effectiveness and Efficacy of Stress
Management Interventions
When assessing the overall effectiveness for
interventions that measured both stress and per-
formance outcomes, we found that 22 of 39 stud-
ies (56%) provided evidence for combined posi-
tive effects. In addition, in the evaluation of the
effects for performance only, 30 of the 39 studies
(77%) reported positive effects. However, in the
evaluation of the effects for stress component out-
Table 1
(continued)
Characteristic
Frequency (and %) of
studies
Randomized trial with comparison group (pretest–posttest) 3 (5)
Randomized controlled interrupted time series 1 (1.5)
Measures
Quantitative measures (e.g., questionnaires, surveys) 47 (74)
Qualitative measures (e.g., interviews) 2 (3)
Mixed methods 15 (23)
Type of intervention
Cognitive 11 (17)
Multimodal 44 (69)
Alternative 9 (14)
Duration of intervention
1–5 sessions 9 (15)
6–12 sessions 4 (6)
1–4 weeks 5 (8)
5–8 weeks 20 (31)
9–12 weeks 4 (6)
6 months 11 (17)
Not reported 11 (17)
180 STRESS MANAGEMENT WITH SPORT PERFORMERS
comes only, we found that positive effects were
reported for 52 of the 64 studies (81%). Con-
versely, when establishing treatment efficacy for
the highest level of empirical support, we found
that only 21 RCTs and 2 single-subject designs
with a comparison group (36%) were evaluated.
Of these studies, 22 of 23 studies (96%) altered
performers’ stress experience beneficially. When
turning attention to the programs that measured
both stress and performance outcomes (13 of 23
studies), we found that the findings were mixed,
with only 7 studies (54%) providing evidence of
positive effects for both variables. To assess the
effectiveness of stress management programs in
more depth, we grouped the interventions that
shared common techniques into cognitive, multi-
modal, and alternative interventions. When ac-
counting for the number of treatments within each
intervention category, we found that 11 of the 64
studies used cognitive treatments (17%), 44 im-
plemented a combination of different multimodal
programs (69%), and 9 implemented alternative
interventions (14%). The following subsections
detail the programs used in these treatments and
their effects on various components of the stress
process and performance. In addition, the treat-
ment efficacy of these interventions is outlined.
Cognitive interventions. Within cogni-
tive intervention studies (n 11; 17%), the
content of treatments consisted of cognitive–
behavioral therapy, coping, goal setting, hyp-
nosis, imagery, rational–emotive therapy, and
self-talk. Table 2 illustrates the summary of
effects for cognitive interventions on various
stress component and performance outcomes.
The summary of study effects revealed that
there were 23 positive effects, 6 null effects,
and 1 negative effect for stress components
and performance. When considering the com-
petitive level, we found that 13 of the 23
(57%) positive effects were reported in stud-
ies that sampled collegiate performers. Six of
the 11 studies measured stress and perfor-
mance, of which 4 reported combined posi-
tive effects (66%) for both outcomes (viz.,
Barker & Jones, 2008; Burton, 1989; Hamil-
ton & Fremouw, 1985; Hatzigeorgiadis, Zour-
banos, Mpoumpaki, & Theodorakis, 2009).
Although the interventions ranged in duration
from one session to one season, studies that
Table 2
Summary of Effects for Cognitive Stress Management Interventions (n 11)
Outcome Positive effect () No effect (0)
Negative
effect ()
No. of
studies
Summary
of study
effects
0
Appraisals
Positive thoughts 25 1 1 0 0
Thought listing 21 1 1 0 0
Affective responses
Anxiety perceptions 49 (.43) 1 1 0 0
Cognitive anxiety 9 (.63), 16 (1.38), 21, 28 (.67) 49 (.09) 5 4 1 0
Cognitive anxiety direction 44 (2.07), 46 2 2 0 0
Cognitive anxiety intensity 44 (0.00) 1 0 1 0
Negative affect 5, 46 45 3 2 1 0
Positive affect 3 (.59), 5, 45, 46 4 4 0 0
Somatic anxiety 16 (2.04), 28 (.46) 21, 49 (.14) 4 2 2 0
Somatic anxiety direction 44 (2.07), 46 2 2 0 0
Somatic anxiety intensity 44 (.94) 1 0 0 1
Performance 5, 9 (.25), 25, 28 (.54) 21, 44 6 4 2 0
Stress components and performance 5, 9, 25, 28 21
d
,44
d
642
d
0
Note. Parentheses indicate effect sizes (Cohen’s d) where calculable. Study reference numbers are as follows: 3
Arathoon & Malouff (2004); 5 Barker & Jones (2008); 9 Burton (1989); 16 Cumming, Olphin, & Law (2007); 21
Elko & Ostrow (1991); 25 Hamilton & Fremouw (1985); 28 Hatzigeorgiadis, Zourbanos, Mpoumpaki, & Theodorakis
(2009); 44 Maynard, Smith, & Warwick-Evans (1995); 45 McCarthy, Jones, Harwood, & Davenport (2010); 46
Mellalieu, Hanton, & Thomas (2009); 49 Page, Sime, & Nordell (1999).
d
Mixed effects for stress components and performance.
181RUMBOLD, FLETCHER, AND DANIELS
implemented treatments over a 2-month period
have provided support for prolonged positive
effects for different components of the stress
process (viz., Barker & Jones, 2008; Burton,
1989; Maynard, Smith, & Warwick-Evans,
1995; Mellalieu, Hanton, & Thomas, 2009) and
performance (viz., Barker & Jones, 2008; Bur-
ton, 1989). In terms of the research methods
adopted, only two studies used RCT designs
(viz., Arathoon & Malouff, 2004; Hatzigeorgia-
dis et al., 2009), which both enhanced positive
affect and reduced cognitive anxiety, respec-
tively. However, although these studies had
comparatively large sample sizes (n 68), the
intervention lengths were only between one and
five sessions. Of the remaining nine studies, two
used non-RCTs, six used single-subject designs,
and one used a one-group design. An examina-
tion of the cognitive interventions revealed that
five studies were conducted within the training
environment and two were delivered before or
after competition. Furthermore, interventions
produced 9 of the 23 positive effects (39%) for
stress and performance outcomes when deliv-
ered in training environments. In addition, six
studies (55%) supplied standardized treatment
manuals and five (45%) provided manipulation
checks. No follow-up assessments were con-
ducted.
Multimodal interventions. Within multi-
modal interventions (n 44, 69%), the content
of treatments consisted of a combination of the
following: arousal control, attentional training,
centering, cognitive control, cognitive and so-
matic relaxation training, concentration, COPE
therapy, energizing, goal setting, hypnosis, im-
agery, meditation, motivation, preperformance
routines, positive thinking, self-talk, stress in-
oculation training, team building, thought stop-
ping, and visuomotor behavior rehearsal. These
studies assessed a wide variety of grouped treat-
ments, stress components, and performance
measures.
Table 3 illustrates the summary of effects for
multimodal interventions on various stress com-
ponent and performance outcomes. The sum-
mary of study effects revealed from 44 studies
that there were 86 positive effects, 36 null ef-
fects, and 6 negative effects for various stress
components and performance. When consider-
ing the competitive level, we found that 27 of
the 86 (32%) positive effects were reported in
studies that sampled collegiate performers. In
addition, 25 of the 85 (29%) positive effects
were reported from studies that did not provide
information as to the competitive level. Thirty
studies (68%) measured both stress process and
performance outcomes, of which 16 reported
positive effects (53%), with 13 (43%) reporting
mixed effects and 1 (3%) reporting no effect for
both variables. In addition, when evaluating the
effects for performance only (n 30, 68%), we
found that 23 studies (77%) reported positive
effects and 7 studies reported null effects. When
considering the efficacy of these interventions,
we found that a large number of studies pro-
vided treatment procedures (n 33; 75%) but a
smaller proportion included manipulation
checks (n 17; 39%) or follow-up assessments
(n 6; 14%). These programs were conducted
in training (n 10; 23%), competition (n 9;
20%), and laboratory (n 13; 30%) environ-
ments, although 12 studies (27%) did not report
this information. In addition, interventions pro-
duced 33 positive effects (38%) when delivered
in laboratory environments.
Alternative interventions. Within alterna-
tive interventions (n 9; 14%), the content of
treatments consisted of the following: anger
awareness, applied relaxation, biofeedback, mu-
sic interventions, personal goal management,
and progressive relaxation training. Table 4 il-
lustrates the summary of effects for alternative
interventions on stress component and perfor-
mance outcomes. The summary of study effects
showed that there were 15 positive effects, 11
null effects, and no negative effects for stress
components and performance. When consider-
ing the competitive level, we found that 3 of
the 15 (20%) positive effects were reported in
studies that sampled high school, national, and
semiprofessional performers and a mixture of
competitive levels. Three studies measured both
stress process and performance outcomes, of
which two reported positive effects (viz.,
Bishop, Karageorghis, & Kinrade, 2009; Lan-
ning & Hisanga, 1983). These studies were con-
ducted over a wide range of intervention time
periods and appear to provide mixed findings for
optimizing performers’ stress experiences in par-
ticular. For example, the findings from two RCTs
provided contradictory support for reducing anger
within team sports (viz., Brunelle, Janelle, & Ten-
nant, 1999; Simpson & Karageorghis, 2006). Us-
ing anger awareness as a treatment, Brunelle et al.
(1999) found no effect for state anger but found a
182 STRESS MANAGEMENT WITH SPORT PERFORMERS
Table 3
Summary of Effects for Multimodal Stress Management Interventions (n 44)
Outcome Positive effect () No effect (0)
Negative
effect ()
No. of
studies
Summary of study
effects
0
Stressors
Athletic stressors 32 (.80)
a
1100
Athletic and life stressors 32 (.89)
a
1100
Appraisals
Benign appraisals 35 (.33)
a
1100
Challenge appraisals 35 (.18)
a
1100
Irrelevant appraisals 35 (.08)
a
1010
Negative thoughts 23 (.79)
b
14 (.34)
c
,15(.52)
c
3120
Positive thoughts 15 (.21)
c
,38
a
14 (.31)
c
3210
Threat appraisals 35 (.69)
a
1100
Affective responses
Affect reactions 2 1100
Anxiety 64 (1.21) 1100
Cognitive anxiety 15 (.85)
c
, 20 (1.19), 29, 31, 50,
53, 54, 55, 58 (.08)
10 (.63), 11 (.88), 14 (.38)
c
,41(.12)
13 (.52) 14 9 4 1
Cognitive anxiety direction 24 (.77), 27, 40, 42 (.73), 60 1 (.58) 6 5 1 0
Cognitive anxiety intensity 1 (.93), 24 (.77), 42 (.94), 60 27, 47 6 4 2 0
Negative affect 56 (.53) 1100
Negative emotions 59 (.64) 1100
Positive affect 56 (.64) 1100
Somatic anxiety 15 (.60)
c
, 20 (1.09), 29, 39
a
, 50,
51 (1.02), 53, 54, 55
10 (.63), 11 (.28), 14 (.24)
c
,
41 (.20), 58 (.21)
4, 13 (1.15) 16 9 5 2
Somatic anxiety direction 24 (.77), 27, 40, 42 (1.04), 60 1 (.66) 6 5 1 0
Somatic anxiety intensity 1 (1.06), 24 (.77), 42 (.18), 60 27, 47 6 4 2 0
State anxiety 37
a
, 48 (1.09), 62
b
,63
b
, 52 (.24)
a
5500
Stress reaction 22 (.27) 1 0 1 0
Tension 30 (.85) 1 0 0 1
Trait anxiety 26 (.15), 61 (.18)
b
,62
b
,63
b
14 (.41)
c
, 15 (.01)
c
, 18,
35 (.23)
a
,47
33 (1.04)
a
10451
Coping
Adaptive coping 26 (.37) 1 0 1 0
Approach coping 47 1 0 1 0
Avoidance coping 47 1 0 1 0
183RUMBOLD, FLETCHER, AND DANIELS
Table 3
(continued)
Outcome Positive effect () No effect (0)
Negative
effect ()
No. of
studies
Summary of study
effects
0
Control over emotions 2 110 0
Coping with negative thoughts 17 110 0
Maladaptive coping 26 (.33) 110 0
Negative thinking coping 35 (1.03)
a
110 0
Positive thinking coping 35 (.04)
a
101 0
Wishful thinking coping 30 (1.47) 1 0 0 1
Performance 4, 10, 14 (.57)
c
, 17, 18, 23
b
, 27,
29, 33 (.12)
a
,35
a
,38
a
,39
a
, 40,
48 (.97), 50, 51 (1.17), 53,
54, 56 (.85), 59 (.36, .49,
.64), 60, 61 (.11, .17, .24)
b
,
63
b
1 (-.29, .36), 13, 15 (.04)
c
, 20 (.24), 22,
62
b
,64
30 23 7 0
Stress components and perfor-
mance
17, 23
b
, 29, 38
a
,39
a
, 40, 48, 50,
51, 53, 54, 56, 59, 60, 61
b
,63
b
1
d
,4
d
,10
d
,13
d
,14
c,d
,15
c,d
,18
d
, 20, 22
d
,
27
d
,33
a,d
,35
a,d
,62
b,d
,64
d
30 16 1,13
d
0
Note. Parentheses indicate effect sizes (Cohen’s d) where calculable. Study reference numbers are as follows: 1 Abouzekri & Karageorghis (2010); 2 Anshel & Gregory
(1990); 4 Bakker & Kayser (1994); 10 Carter & Kelly (1997); 11 Cogan & Petrie (1995); 13 Crocker (1989a); 14 Crocker, Alderman, & Smith (1988); 15 Crocker
(1989b), follow up to Crocker et al. (1988); 17 Davis (1991); 18 Daw & Burton (1994); 20 Edwards & Steyn (2008); 22 Fournier, Calmels, Durand-Bush, & Salmela
(2005); 23 Gravel, Lemieux, & Ladouceur (1980); 24 Hale & Whitehouse (1998); 26 Haney (2004); 27 Hanton & Jones (1999); 29 Holm, Beckwith, Ehde, & Tinius
(1996); 30 Johnson (2000); 31 Jones (1993); 32 Kerr & Goss (1996); 33 Kerr & Leith (1993); 35 Larsson, Cook, & Starrin (1988); 37 Mace & Carroll (1986);
38 Mace, Eastman, & Carroll (1986); 39 Mace, Eastman, & Carroll (1987); 40 Mamassis & Doganis (2004); 41 Maynard & Cotton (1993); 42 Maynard, Hemmings,
Greenlees, Warwick-Evans, & Stanton (1998); 47 Mesagno, Marchant, & Morris (2008); 48 Owen & Lanning (1982); 50 Prapavessis, Grove, McNair, & Cable (1992);
51 Robazza, Pellizzari, & Hanin (2004); 52 Ross & Berger (1996); 53 Savoy (1993); 54 Savoy (1997); 55 Savoy & Beitel (1997); 56 Sheard & Golby (2006);
58 Terry, Coakley, & Karageorghis (1995); 59 Thomas & Fogarty (1997); 60 Thomas, Maynard, & Hanton (2007); 61 Weinberg, Seabourne, & Jackson (1981); 62
Weinberg, Seabourne, & Jackson (1982a); 63 Weinberg, Seabourne, & Jackson (1982b); 64 Wojcikiewicz & Orlick (1987).
a
Stress inoculation training.
b
Visuomotor behavioral rehearsal.
c
Cognitive affective stress management.
d
Mixed effects for stress components and performance.
184 STRESS MANAGEMENT WITH SPORT PERFORMERS
positive effect for reducing angry behavior
(d 1.18). On the other hand, Simpson and
Karageorghis (2006), who used synchronous mu-
sic treatments, found that anger remained the same
from pre- to postintervention. When considering
the efficacy of alternative interventions, we
found that seven of the nine studies provided
at least some description of a standardized
treatment procedure and only one study (viz.,
Bishop et al., 2009) conducted a manipulation
check. Five studies were conducted within the
training environment, and three were deliv-
ered before competition. Also, programs pro-
duced 5 of 15 positive effects (33%) for stress
and performance when delivered in training
environments. No follow-up assessments
were conducted.
Discussion
This systematic review extends stress re-
search by identifying the psychosocial interven-
tions that measured a component (or compo-
nents) of the stress process and performance
outcomes in sport performers. In addition, the
evidence for the effectiveness of stress manage-
ment interventions was evaluated and their
treatment efficacy reported.
Effective Stress Management Interventions
The evidence from cognitive, multimodal,
and alternative stress management interventions
appears to indicate that, for the most part, stress
components were optimized in one of the fol-
lowing ways: (a) Stressors were reduced; (b)
cognitive appraisals were modified; (c) negative
affect states were reduced, and positive affect
states increased; and (d) effective coping behav-
iors were facilitated. More specifically, our re-
sults offer initial support for an overall positive
Cohen’s d treatment effect of stress manage-
ment interventions on various components of
the stress process. Tables 2– 4 illustrate the
Table 4
Summary of Effects for Alternative Stress Management Interventions (n 9)
Outcome Positive effect () No effect (0)
Negative
effect ()
No. of
studies
Summary of
study effects
0
Affective responses
Anger 57 1 0 1 0
Angry behavior 8 (1.18) 1 1 0 0
Arousal 7 (1.38) 1 1 0 0
Cognitive anxiety direction 19 (.11), 43 (.36) 2 0 2 0
Cognitive anxiety intensity 43 (.24) 19 (.11) 2 1 1 0
Confusion 36 (.05) 1 0 1 0
Depression 36 (.60) 57 2 1 1 0
Fatigue 36 (.56) 1 1 0 0
Hostility 36 (.78) 1 0 1 0
Mood 6 1 1 0 0
Pleasantness 7 (1.5) 1 1 0 0
Somatic anxiety direction 43 (2.81) 19 (.22) 2 1 1 0
Somatic anxiety intensity 43 (.41) 19 (.12) 2 1 1 0
State anger 8 1 0 1 0
State anxiety 12 1 1 0 0
Tension 36 (.42) 1 1 0 0
Trait anxiety 34 1 1 0 0
Vigor 36 (.53) 1 0 1 0
Performance 7 (.40), 34, 57 (1.36) 3 3 0 0
Stress components and performance 7, 34 57
d
321
d
0
Note. Parentheses indicate effect sizes (Cohen’s d) where calculable. Study reference numbers are as follows: 6 Bishop,
Karageorghis, & Loizou (2007); 7 Bishop, Karageorghis, & Kinrade (2009); 8 Brunelle, Janelle, & Tennant (1999);
12 Costa, Bonaccorsi, & Scrimali (1984); 19 Devlin & Hanrahan (2005); 34 Lanning & Hisanaga (1983); 36
Laurin, Nicolas, & Lavallee (2008); 43 Maynard, Hemmings, & Warwick-Evans (1995); 57 Simpson & Karageorghis
(2006).
d
Mixed effects for stress components and performance.
185RUMBOLD, FLETCHER, AND DANIELS
range of effect sizes reported over the 30 years
of stress management interventions with com-
petitive sport performers. The evidence in favor
of optimized stress and performance, on the
other hand, appears to be weaker than that for
the effectiveness of all interventions that mea-
sured the stress process solely. This was most
apparent in relation to the multimodal interven-
tions used. Therefore, reducing athletes’ stress
in certain sporting situations may not necessar-
ily result in improved performance. This sup-
ports the salience of considering appropriate
activation states before designing interventions
to increase the chances of athletes performing
optimally (Mellalieu et al., 2006). In a more
detailed examination of the stress management
interventions, the results revealed that a large
number of programs measured sport perform-
ers’ anxiety. A closer inspection of these inter-
ventions showed that self-talk, when used
within a cognitive or multimodal intervention,
seemed to be the most effective technique at
reducing state anxiety. Moreover, it appears that
multimodal interventions were most effective in
reducing cognitive and somatic anxiety when
self-talk and imagery were used. The findings
also revealed that relaxation techniques seemed
to be generally effective at reducing state anx-
iety, either in isolation or when combined with
imagery. Mainly, however, imagery alone ap-
peared to produce positive effects as part of a
multimodal program.
Multimodal interventions, therefore, may be
the most effective approach to stress manage-
ment for competitive athletes, which supports
previous narrative reviews for performance en-
hancement (Greenspan & Feltz, 1989; Martin et
al., 2005). However, in contrast to these re-
views, the findings from this systematic review
seem to indicate that these programs were gen-
erally effective for optimizing the stress pro-
cess, and to a lesser extent, performance. Al-
though multimodal interventions may help to
reduce both cognitive and somatic symptoms
(Jones & Hardy, 1990), it is also possible that
these programs serve the purpose of optimizing
various components of the stress process in
succession (e.g., appraisals, affect, coping). For
example, a multimodal program may be effec-
tive in enabling a performer to appraise com-
petitive stressors in a challenging way, which
acts as a condition for more adaptive emotional
responses, and facilitative coping.
Treatment Efficacy
Despite this systematic review’s findings,
which suggest that stress management interven-
tions with sport performers may be generally
effective, it is worth exercising a degree of
caution in light of the results regarding the
treatment efficacy of these programs. As pro-
posed in the “Criteria for Evaluating Treatment
Guidelines” (APA, 2002), only research designs
that provide comparison with another group
should be evaluated at the highest level of em-
pirically supported treatment. On the basis of
this criterion, approximately less than one third
of the interventions (n 23) would be consid-
ered at this level of empirical support in report-
ing positive effects for optimizing performers’
stress experience. Of these studies, 22 of 23 stud-
ies (96%) altered performers’ stress experience
beneficially. In the assessment of programs that
measured stress and performance outcomes (n
13), seven empirically supported treatments re-
ported positive effects (54%). Although, in a large
number of studies, randomized or controlled ex-
periments were not conducted, the interventions in
these studies should not necessarily be deemed
ineffective; it is simply not possible to infer cau-
sality (APA, 2002).
Approximately one third of all studies (23 of
64) provided a manipulation check to assess
whether participants felt that the programs were
effective. However, less than half of these pro-
grams (10 of 23) provided extracts from case
studies or segments from social validation data.
In her review of sport psychology interventions,
Vealey (1994) concluded that one of the weak-
nesses of many interventions was the lack of
appropriate manipulation checks to evaluate
participants’ perceptions of treatment. Indeed,
the value of manipulation checks should not be
underestimated in supplementing the objective
outcomes of each intervention. More than 15
years later, the findings of this review suggest
that it is still an issue within stress management
research. More extensive assessment is there-
fore needed to provide greater confidence in
treatment effects and support for validity. These
checks are important in contributing to the
knowledge of empirically supported treatments
for future replication. One of the most salient
findings from the overall analysis was that fol-
low-up assessments of intervention effects were
conducted in only six multimodal studies (viz.,
186 STRESS MANAGEMENT WITH SPORT PERFORMERS
Crocker, 1989a, 1989b; Gravel, Lemieux, &
Ladouceur, 1980; Haney, 2004; Hanton &
Jones, 1999b; Jones, 1993). These evaluations
are critical for identifying which treatments
have enduring effects and assessing when these
effects subside. On this point, it is believed that
interventions should be assessed after at least a
season, or 12 months, for any sustainable be-
havior change to be validly confirmed (Martin
et al., 2005).
Another issue regarding treatment efficacy
relates to the assessment of programs that were
conducted in highly “transferable” environ-
ments. It has been argued that interventions
conducted in laboratory or training settings can-
not be considered as a satisfactory evidence
base for providing treatments for athletes in
competition (Hale & Whitehouse, 1998; Martin
et al., 2005). For the most part, in this review,
the interventions failed to expose athletes to
competitive performance environments. Cer-
tainly, one of the challenges for intervention
researchers is to assess whether athletes require
exposure to stressful competitive settings to test
the likelihood of enhanced performance under
competitive pressure. Research by Holahan
and Moos (1990) has suggested that individ-
uals are more likely to strengthen their adap-
tive resources and personal growth from con-
fronting highly stressful environments.
Therefore, where logistically possible, psy-
chologists should attempt to deliver interven-
tions within a competitive sport environment
to strengthen the ecological validity of any
positive performance effects. The findings
also highlight a need to provide internal va-
lidity through strong research designs, with
the controls required to infer causality.
Moderators of Intervention Effects
In the knowledge that stronger research de-
signs will allow for inference of greater causal-
ity, there are several additional factors that may
moderate the relationship between treatment
and effect. First, the competitive level of the
athletes is important to consider when designing
and evaluating a stress management interven-
tion. To elaborate briefly, Fletcher and Hanton
(2001) suggested that stress reduction strategies
may be more appropriate when working with
non- and subelite performers. However, in con-
trast, elite and professional athletes may benefit
more from techniques that aim to positively
reappraise how they view their stress experience
(Hanton & Jones, 1999a). The results from this
review indicated that stress management inter-
ventions were most effective for collegiate sport
performers, but 21% of the total studies did not
provide information relating to performers’
competitive level. Published research should be
clear about this moderator so that consultants
can better assess which interventions are most
effective for particular clientele in various
sports.
Another important finding to emerge from
the review was that, for 59% of the studies, the
mean age ranged from 12 to 21 years old. Al-
though it appears that stress management inter-
ventions are generally effective with this age
group, it should also be noted that 27% of
studies did not provide age group data. Age is
an important consideration, as research by Warr
(1992) has identified a U-shaped curve between
age and affective well-being (e.g., anxiety)
across a wide range of occupations, whereby
individuals in their 20s and 30s report lower
well-being in comparison with younger and
older workers. In light of this research, it ap-
pears that age could moderate the outcome of
stress management interventions. Furthermore,
the present findings suggest that more interven-
tions need to be assessed with older performers
to examine the moderating effect of age.
The type of intervention used is also consid-
ered a key moderator of program effects. Re-
searchers have indicated that, for a multimodal
treatment to be implemented, the intervention
will likely require a larger period of time to be
set aside by the practitioner, athletes, and sport
organization, in comparison with a unimodal
treatment (Maynard, Hemmings, Greenlees,
Warwick-Evans, & Stanton, 1998; Prapavessis
et al., 1992). Therefore, the time taken to ad-
minister an intervention may indeed influence
how enduring any effects are for optimizing
stress and performance. Moving to review the
various components of the stress process that
were measured, we note that the results indi-
cated that the majority (75%) of studies focused
on changing anxiety levels. Therefore, other
salient aspects of the stress process should be
examined more extensively. For example, only
two studies measured competitive stressors
(viz., Kerr & Goss, 1996; Savoy, 1993). More-
over, cognitive appraisal, which is considered to
187RUMBOLD, FLETCHER, AND DANIELS
be at the core of the transactional stress process
(Fletcher et al., 2006), has also received little
intervention attention. This is an important
area for further investigation, because ap-
praisal research will provide a greater under-
standing of when competitive stress may be
facilitative rather than debilitative toward per-
formance. Undoubtedly, the component of
stress measured will affect the relationship
between program and outcome effects, as
these variables are particularly important in
determining the stress management tech-
niques and designs used. Additionally, in the
evaluation of the effectiveness of stress man-
agement on performance, it is acknowledged
that the wide variety of ways in which per-
formance was operationalized may explain
some of the differences between outcome ef-
fects for stress and performance.
Gaps in the Literature
An examination of the intervention characteris-
tics gave rise to a number of gaps in the stress
management literature in sport to date. First, it was
observed that there were relatively few elite sam-
ples in the review. Although the shortage of elite
athletes has historically been a challenging issue
for the field of sport psychology (cf. Greenspan &
Feltz, 1989), research has demonstrated that the
stress-related phenomenon is experienced by elite
and professional athletes in a variety of competi-
tive environments (Dugdale, Eklund, & Gordon,
2002; Fletcher & Hanton, 2003). Certainly, this
population may well be the most vulnerable to
experiencing stress because of the close proximity
and involvement with the sport organizations in
which they operate. It was noted in the pres-
ent review that all of the interventions mea-
sured athletes’ competitive stress experience.
In consideration of the numerous organiza-
tional-related demands that may be imposed
on individuals within the sport environment,
it is evident that interventions need to be used
to measure sport performers’ experiences of
organizational stress. This term has been de-
fined as “an ongoing transaction between an
individual and the environmental demands as-
sociated primarily and directly with the orga-
nization in which he or she is operating”
(Fletcher et al., 2006, p. 329). In recognition
of the potential effect of organizational stress
in sport, it is likely that practitioners may
need to consider broadening their competen-
cies to assist sport performers in managing
their overall stress experience (Hanton &
Fletcher, 2005). For example, within the pres-
ent review, there were few interventions that
used team building as a method of stress
management (Cogan & Petrie, 1995). Team
building could indeed be a useful technique
for practitioners to implement when attempt-
ing to optimize organizational stress-related
issues, such as poor communication channels
and team cohesion. However, to date, no in-
terventions within sport psychology have at-
tempted to manage this type of stress. It
should also be noted that athletes are individ-
uals whose personal stress experience may
affect how they manage stress in sport. For
example, an athlete who may cope ineffec-
tively when arguing with his or her parents
may also be prone to ineffective coping with
disagreeing with his or her sport coach.
Therefore, the management of athletes’ per-
sonal stress may also facilitate their manage-
ment of competitive and organizational stress
in sport.
Future Research
This review has highlighted several gaps in
the stress management literature. These gaps
provide a base to generate future research in this
area. Future interventions should attempt to ac-
count for the potential factors (e.g., research
design, stress component measured, skill level)
that may influence the effects of different treat-
ments. For example, the component of stress
measured will likely affect the relationship be-
tween the program and outcome effects, as the
variables measured should determine the treat-
ment that is implemented. However, interven-
tion research based on the tenets of the transac-
tional perspective should attempt to manage the
stress process more holistically, encompassing
the demands that performers experience, their
appraisals, emotional responses, and subsequent
coping strategies (Fletcher et al., 2006). Indeed,
Lazarus (1999) stated that stress, emotion, and
coping should exist in a part–whole relationship
and that “separation distorts the phenomena as
they appear in nature” (p. 37).
Another research endeavor that is lacking is
the assessment of interventions for other per-
formers in the sport environment (e.g.,
188 STRESS MANAGEMENT WITH SPORT PERFORMERS
coaches, parents, and support staff). The pres-
ent review has focused on stress management
in competitive athletes, but researchers have
also shown that coaches, parents, and sport
psychology practitioners are prone to various
types of competitive and organizational stress
(Fletcher, Rumbold, Tester, & Coombes,
2011; Fletcher & Scott, 2010; Harwood &
Knight, 2009). An important future research
consideration is the assessment of theoreti-
cally guided multimodal interventions. Al-
though multimodal programs appeared to be
the most effective treatments in this review,
the vast amalgamation of treatments made it
hard to establish which combinations may
lead to better outcome effects.
Limitations
Although contemporary definitions adopt a
transactional perspective of stress (Lazarus,
1999), it was evident in this systematic review
that studies were ambiguous in reporting a the-
oretical and conceptual basis for intervention.
Therefore, it was not possible to assess whether
different conceptually based programs were ef-
fective for particular components of the stress
process. To improve the theoretical credibility
for future interventions, researchers should
clearly report their conceptual underpinnings of
stress. In addition, drawbacks to the vote-
counting procedure adopted were recognized.
Namely, studies are interpreted in terms of their
reported significance rather than their effect
size. Although our systematic review has pro-
vided a comprehensive and heterogeneous num-
ber of stress management intervention effects,
meta-analyses can also focus on the overall
effect size for specific components of stress and
performance. Because this is the first systematic
review in sport psychology to report effect sizes
for stress management interventions, it was not
possible to interpret the effect sizes in “explicit,
direct comparison with the prior effect sizes in
the related literature” (Thompson, 2002, p. 28).
Therefore, in line with Thompson’s recommen-
dations for reporting effect sizes, we strongly
advocate that researchers who conduct meta-
analyses in the future should compare their ef-
fect sizes to the effects reported in the previous
literature and not by interpreting against Co-
hen’s benchmarks for “small,” “medium,” and
“large” effects. The rigid use of benchmarks for
effects can prevent readers from considering
that small effects with important outcomes may
be more noteworthy than large effects with less
important outcomes. Finally, although the chal-
lenges of obtaining unpublished studies have
been acknowledged, in the future, reviewers
should also consider contacting researchers who
have published on a particular research area to
increase the likelihood of obtaining unpublished
manuscripts.
Conclusion
In summary, stress management interven-
tions appear to be generally associated with
optimized stress in competitive sport per-
formers. This is particularly apparent when
only evaluating the interventions’ effects on
the stress process. However, the findings for
optimizing both stress and performance were
relatively weak. Although our findings could
represent a publication bias of only significant
outcomes (Egger & Davey Smith, 2001), our
approach may actually strengthen the overes-
timation of performance effects. Nonetheless,
these results suggest that psychologists need
to consider developing interventions that are
in line with athletes’ optimal activation and
emotional states for improving performance.
An important finding to emerge from the sys-
tematic review was that multimodal programs
appeared to be the most effective technique
used. However, more studies need to investi-
gate the moderating factors (e.g., type of
treatment adopted, stress component outcome
measured, age, competitive level) that affect
the relationships between interventions and
effects. Also, these moderators need to be
considered before intervention design. Fi-
nally, the systematic review indicates that
future researchers must find a better balance
between attending to athletes’ personal and
situational needs and delivering strong exper-
imental research designs, with the controls
required to infer causality.
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193RUMBOLD, FLETCHER, AND DANIELS
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