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This study aimed to develop, implement and evaluate the effectiveness and feasibility of a coach-athlete relationship intervention program. The intervention targeted improvements in relationship quality and individual and team outcomes over time (i.e., thriving, basic psychological need satisfaction, and collective efficacy). Using a nonrandomized cluster-controlled trial design and mixed methods evaluation, 16 sports teams (45 coaches, 328 athletes) were assigned to an intervention or a no-training control condition. Following baseline assessments, intervention teams participated in two workshops, four weeks apart and coaches and athletes were encouraged to apply strategies taught during practice and complete bi-weekly diary logs. Follow-up assessments were completed at 4, 8 and 16 weeks post baseline. Focus groups were held after follow up to evaluate feasibility. Intervention effects were assessed using two-level growth models, with athletes nested within teams. Overall, no significant intervention effects were found over time for coaches or athletes' perceptions of relationship quality, or for athlete outcomes of thriving and collective efficacy. However, a significant decrease in relatedness was observed in athletes' basic psychological need satisfaction. Content analysis of focus group interviews highlighted participants' experiences of the intervention's relevance, delivery and implementation into sport practice. While participants emphasized the importance of the intervention's content, they also forwarded suggestions to improve delivery and transfer of skills into their daily sport practice. These insights shed light on potential reasons for the limited quantitative effects. While the current intervention did not produce significant effects, the study lays important groundwork for future research aiming to strengthen the coach-athlete relationship.

Anxiety is one of the most prevalent mental health problems in athletes, yet the inclusion of athletes with clinical mental health problems in intervention studies remains limited. Furthermore, no studies to date have investigated the mechanisms of cognitive behavioral therapy (CBT) on anxiety and positive affect in athletes. Hence, the aim of the current study was to examine the effect of CBT on moderate to severe symptoms of anxiety and positive affect in athletes, as well as to investigate the mediated effects of CBT on anxiety symptoms and positive affect through rumination and acceptance. A randomized single-case multiple-baseline design was conducted with six athletes who experienced moderate to severe anxiety. Data was collected four times daily through ecological momentary assessment, and all participants received six weekly sessions of CBT. Intervention effects were analyzed using Tau and baseline-corrected Tau, and mediated effects were analyzed using a two-step approach with Tau and cross-lagged correlations. An intervention effect on anxiety was observed for two participants, while two participants showed an increase in anxiety. An intervention effect on positive affect was observed for three participants. In terms of mediation, only one participant showed evidence consistent with a mediated process in the expected direction through rumination on anxiety. These findings highlight individual variability in treatment effects and the underlying mechanisms that may help explain how interventions exert their effects. The current study underscores the complementary role of idiographic approaches alongside group-based designs in advancing evidence on individual treatment effects and underlying mechanisms.

Athletes undergoing psychotherapy, such as cognitive behavioural therapy (CBT), is an understudied group. Therefore, the aim of this study was to examine the feasibility of combining a single-case design (SCD) with ecological momentary assessment (EMA) throughout a CBT intervention with athletes. We conducted an SCD with multiple-baselines with three athletes seeking treatment at a university sports psychology clinic. EMA was employed with six daily questionnaires measuring positive and negative affect, and momentary context and activity for 105 days. A feasibility questionnaire and semi-structured interviews were conducted post-intervention to investigate the overall experience of participation and specific features of the design. Feasibility was determined by descriptively investigating the assessment frequency, questionnaire length, compliance, potential response patterns, and perceived burden of the sampling protocol. The three participants completed an average of 455 questionnaires with response rates of 48%, 73%, and 77%, respectively. Compliance varied more over weeks than within week or day. The main reason for compliance was the quickness of completing the questionnaire. The number of daily questionnaires was perceived as more burdensome than the number of items in each questionnaire and the length of the study. The current study is the first to demonstrate the feasibility of combining SCD and EMA during CBT with athletes in a real-world clinical setting. This study contributes to evidence-based care for athletes' mental health by demonstrating a design that enables the analysis of individual processes throughout a CBT intervention. This approach can be adopted to further investigate the effectiveness and mechanisms of psychotherapeutic interventions.

The aims of this scoping review were to map the current literature on interventions for improving mental health in athletes, identify knowledge gaps, and generate future research questions. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided this review. A systematic literature search was conducted in SPORTDiscus, PsycINFO, and SCOPUS and 44 intervention studies met the inclusion criteria. Results showed that 22 studies (50%) implemented cognitive behavioural principles, and the majority of these studies were influenced by various mindfulness programmes. Most studies (93%) included healthy athlete samples, and athletes aged 15–19 were the most examined age group (43%). Only three studies used clinical criteria in their sampling of participants and mediators were examined in two studies. The scarcity of studies examining mediators and subclinical or clinical samples revealed critical knowledge gaps in the literature. Furthermore, the critical appraisal showed that regardless of study design, most studies demonstrated low internal validity. We propose the use of high-quality single-case studies with athletes who experience subclinical or clinical mental health issues, and further investigation of mechanisms of change linking intervention components to outcomes of interest.

In recent years, athletes’ mental health has gained interest among researchers, sport practitioners, and the media. However, the field of sport psychology lacks empirical evidence on the effectiveness of psychotherapeutic interventions for mental health problems and disorders in athletes. Thus far, intervention research in sport psychology has mainly focused on performance enhancement using between-subject designs and healthy athlete samples. In the current paper, we highlight three interrelated key issues in relation to treating mental health problems and disorders in athletes. (i) How are mental health and mental health problems and disorders defined in the sport psychology literature? (ii) How are prevalence rates of mental health problems and disorders in athletes determined? (iii) What is known about psychotherapeutic interventions for mental health problems and disorders in athletes? We conclude that the reliance on different definitions and assessments of mental health problems and disorders contributes to heterogeneous prevalence rates. In turn, this limits our understanding of the extent of mental health problems and disorders in athletes. Furthermore, knowledge of the effectiveness of psychotherapeutic interventions for athletes with mental health problems and disorders is scarce. Future research should include athletes with established mental health problems and disorders in intervention studies. We also propose an increased use of N-of-1 trials to enhance the knowledge of effective psychotherapeutic interventions in this population.

The correlates of coach-athlete relationship quality have been the focus of research for over a decade; however, little is known about the mediating and moderating mechanisms underlying these associations. The present study conducted a moderated mediation analysis to examine (a) the mediating role of communication strategies (via COMPASS) on the association between the quality of the coach-athlete relationship and athlete psychological needs satisfaction and (b) whether individual differences in athletes’ attachment style (secure, anxious, avoidant) moderates the mediational relationship. 350 Swedish athletes representing a range of sports and competition levels completed a multi-section questionnaire. Mediation and moderation analysis partially found that coach-athlete relationship quality and athletes basic psychological needs were associated via the COMPASS strategies of support, motivation, assurance and openness. It was also found that athletes secure attachment with their coach significantly moderated the mediated effects of motivation and support. These findings highlight the practical utility of motivation, support, openness and assurance strategies in enhancing the quality of the coach-athlete relationship. Moreover, these findings demonstrate that the attachment orientation of athletes towards their coaches play a significant role in determining what communication strategies to use to enhance both the relationship quality and an athlete’s competence, autonomy and relatedness.