Empowering Student-Athletes: The Intersection of Human Flourishing and Preventative Medicine
Student-athletes have two full-time jobs. They are expected to commit hours a day towards their athletic development so they can perform at a high level representing an institution, and they are held to a high standard academically in order to be eligible to play. Although, these standards may look very different across National Collegiate Athletic Association (NCAA) divisions, I will be focusing on division I student-athletes. The median time spent for a division I student-athlete in athletic related activities is 32 hours per week and 38.5 hours per week spent on academics (NCAA, 2016). Totaling just over 70 hours a week of time demands over the course of four years. One can only imagine the pressure that these time demands place on the student-athletes psyche.
There is an excerpt from a chapter titled The Student-Athlete Experience published by Navarro and colleagues (2020) that encompasses the life of a student-athlete:
“Many student-athletes start their day before dawn to attend workouts, treatment sessions, with athletic trainers, team and solo practice, meetings with coaches, in travel between a competition the night before in another city or state, or due to any number of other possible actions. Moreover, long after the traditional school day is complete, student-athletes may be asked or required to join coaches or school administrators for a range of university functions that further encroach upon their time. By the time student-athletes attend classes or turn toward their social responsibilities, they might be exhausted for a number of reasons. These remarkable students are always ‘on’ in the public eye, representing the university in every aspect of their lives” (p. 31).
According to evidence provided in the same book, institutions and administrators are aware of the challenges and barriers student-athletes face over the course of their time in higher education. Additionally, the NCAA has been aware of similar concerns pertaining to the psychological well-being of student-athletes. In a seminal position document (NCAA, 2014), the NCAA outlined areas of concern regarding psychological disorders student-athletes may experience: (1) eating disorders, (2) anxiety disorders, (3) mood disorders and depression, (4) substance use and abuse, (5) gambling, (6) sleeping disorders, and (7) suicidal tendencies. Additionally, outlining three important concerns that are just as important (a) how being injured affects mental health, (b) post-concussion syndrome, and (c) student-athletes in transition.
It is not a surprise that this document discussed above was titled Mind, Body, and Sport: Understanding and Supporting Student-Athlete Mental Wellness (NCAA, 2014), where the focus is on the mental well-being and psychology of the student-athlete. This may be due to the already well-established physical well-being protocol put in place by athletic trainers and sports medicine disciplines within athletic departments. Along this thread, examining the career trends from 2012 to 2014 (when the NCAA piece was published) the athletic training occupation reflected an increase of 10.9% in employment opportunities (U.S. Department of Labor’s Occupational Outlook Handbook, 2015). Today, one cannot walk through an NCAA Division I athletic department and not see at least one athletic trainer devoted to each team. Conversely, on the mental health side, research has shown that 70% of athletic departments have only one individual delivering services, with a ratio of provider to clients ranging from anywhere between 1:200 and 1:800 (Jones et al., 2022). Reflecting on one person’s abilities to service anywhere between 200 and 800 student-athletes is beyond this article. However, that seems like a recipe for burnout to provide mental health support to so many individuals on one person’s caseload.
Therefore, taking into consideration the time demands of student-athletes, and lack of mental health practitioners in athletic departments, I want to propose a preventative medicine intervention framed through the lens of human flourishing to tackle the growing mental health concerns that are faced by student-athletes at NCAA Division I athletic departments. I believe that an intervention program will allow breadth of impact in the lack of human resources athletic departments provide mental health services. Furthermore, the motivation is to provide student-athletes with appropriate skills to manage the challenges they face with the time demands they are put through from a posture of prevention rather than reacting in crisis. The goal is to empower student-athletes and allow them to develop resources themselves throughout their time at an institution and beyond.
Preventative Medicine and Human Flourishing
The concept of human flourishing in the context of preventative medicine is not a thoroughly examined relationship in the literature. Firstly, human flourishing has been defined as a state in which all aspects of a person’s life are good (VanderWeele, 2017) and as a state where people experience positive emotions, positive psychological functioning, and positive social functioning, most of the time (Mental Health Foundation of New Zealand, 2010). Secondly, preventative medicine is “the practice of promoting preventative health care to improve patient well-being…the goal is to ultimately prevent disease, disability, and death” (ACPM, 2022). The American College of Preventative Medicine (ACPM, 2022) states that preventative medicine should focus on the health of individuals and communities. Using the ACPM lens, I will frame the individual from a student-athlete perspective and the community as the athletic department.
A few years ago, Levin (2021) published a commentary marrying the two areas and stated that human flourishing matters for preventative medicine potentially impacting it in four ways: (1) research, (2) preventative health policy, (3) public health training, and (4) preventative interventions. I plan on focusing on the fourth point, the intervention piece.
The concept of human flourishing is rooted in the positive psychology movement (Seligman, 2011). Other terms that may relate to human flourishing are eudaimonia or thriving (Bundick et al., 2010; Ryff, 2014). However, the Positive Psychology Center at the University of Pennsylvania define it as, “the scientific study of the strengths that enable individuals and communities to thrive” (https://ppc.sas.upenn.edu/). Additionally, a course titled, The Art and Science of Human Flourishing taught at the University of Virginia shares that there are three main ideas of human flourishing that act as the foundation: (1) the idea that human beings have an intrinsic potential for positive change; (2) the role of practice and community in the process of positive change; and (3) the interdependence between positive personal and social change.
Using the three foundational concepts, I believe that an NCAA athletic department has the potential to act as the community and the student-athletes to act as change makers in their own life. Ultimately, through their own positive change influencing the change in their community. The purpose for taking a human flourishing perspective is due to VanderWeele’s (2020) work outlining activities for flourishing that tackle some psychological concerns summarized by the NCAA (2014) Mind, Body, and Sport document. Thus, speaking to the applicability of human flourishing in the context of preventative medicine (Levin, 2021) within the environment of an athletic department. The ultimate goal would simply be an invitation to athletic departments and administrators to deliver this type of intervention with the goal of cultivating healthy habits of mind in the community.
An Intervention Idea
A potential Student-Athlete Flourishing Program could consist of six experiential workshops (Table 2). Importantly, each workshop will have autonomy and peer-learning as fundamental pedagogical principles, a theme consistent with self-determination theory (Deci et al., 2017). During each session, participants will have a chance to reflect and express their individual perceptions about the experiential activities, and subsequently, discuss their insights and feelings with other student-athletes (i.e., think, pair, share model). The sessions will be aimed at cultivating (1) human flourishing and (2) decreasing psychological distress and increasing a sense of well-being.
Each individual intervention found in Table 2 are all taken from empirically supported concepts.
Table 2
Imagining Your Best Possible Self. During this workshop, student-athletes would be instructed to write for 30 minutes about imagining themselves in the future. The prompt they will be given is from King’s (2001) work stating, “Imagine that everything has gone as well as it possibly could. You have worked hard and succeeded at accomplishing all of your life goals. Think of this as the realization of all of your life dreams. Now, write about what you imagined” (p. 801).
King (2001) had 81 undergraduate students write for 20 minutes a day for four days. The researcher had the students split up into four groups with one of them focusing on their best possible selves. The results revealed health benefits from writing, and concluded with a significance in feeling less upset, more perceived happiness, and even getting less sick (Kings, 2001).
Savoring/Gratitude. The concept of savoring is defined as the capacity to notice and appreciate positive experiences in one’s life (Smith et al., 2014). This intervention is based on the Three Good Things approach by Seligman and colleagues (2005) where student-athletes would be encouraged to become mindful of good things that have happened to them that day.
Student-athletes will write down three good things that occurred to them and be provided with space to share them with their teammates. Participants will be asked to repeat this exercise for a full week with their teammates. Evidence shows when considering three good things that happen every day, it has the capacity to increase savoring of these events and boosts happiness, both long-term and short-term (Carlton, 2009; Seligman et al., 2005).
Use of Character Strengths. The purpose of this workshop is to make student-athletes aware of their signature character strengths and encourage them to engage their strengths in their daily lives. Based on Seligman and colleagues (2005) work, participants will complete a self-report measure on their character strengths (survey), share with their fellow teammates what their strengths are and be given feedback (reflect), and lastly be encouraged to exercise them in their daily lives (actions). A meta-analysis (Schutte & Malouff, 2019) concluded that engaging in such an intervention has a significant impact on positive affect, happiness, and flourishing.
Identity Exploration. The following workshop focuses on providing a space for facilitating conversations with student-athletes around diversity and inclusivity. This workshop is based on the work done by (Mac Intosh & Martin, 2018). The focus of this workshop is fourfold, to (1) raise student-athletes’ awareness of their identities and those of others, (2) increase student-athletes’ knowledge of racial ideologies and how these can create differential access to opportunities throughout society, (3) discussing the role that sport plays to bring about change in society, particularly in fostering diversity, and (5) teaching students skills that will allow them to have constructive conversations. The results of such a workshop have shown to improve attitudes in relation to their interest in participating in diverse social and cultural activities and show leadership around diversity and equality (Mac Intosh & Martin, 2018).
Volunteering/Acts of Kindness. This portion of the intervention would not be considered a workshop. However, it does consist of student-athletes coming together and spending time in their immediate communities at a local elementary school. The student-athletes would be provided with an opportunity to teach the sport they play to fifth graders. A meta-analysis suggests that across 11 studies, volunteering in the community appeared to reduce mortality risk by 25% in adults (Okun et al., 2014). Furthermore, a randomized control trial with adolescents who volunteered changed risk markers for cardiovascular disease, reducing inflammation, total cholesterol levels, and obesity (Schreier et al., 2013). Although, the student-athletes in the proposed study will be volunteering only once, rather than on a more consistent basis, I believe this could still be a beneficial activity.
Work and Job Crafting. This last workshop will focus on providing student-athletes with space to discuss transitioning out of NCAA competitive sport play. It will focus what work may look like outside of higher education and exploring skills that they have developed throughout their time as a student-athlete. Additionally, student-athletes will be educated on the concept of job crafting, which is defined as a way a person can “craft” their job by providing them with a sense of autonomy (Frederick & VanderWeele, 2020). This can be done in three ways Frederick and Vanderweele (2020) explain, (1) structurally i.e., changing the order of tasks you need to complete on a given day; (2) socially, i.e., changing how one interacts with others at work by being friendly and personable; and (3) cognitively, i.e., by seeing what you are doing from a larger perspective that may cultivate more meaning in your job. Therefore, the students will be given a list of skills they may have learned over the course of being a undergraduate student and athlete. They will be provided with time to reflect on their own and share with their teammates. The workshop will conclude with providing them with psychoeducation on job crafting.
Final Thoughts
The idea of focusing on what is good in one’s life and working toward a strength-based approach is an approach that resinates with the approaches I strive to implement professionally. The more time I spend in the profession of performance psychology, the more I recognize that although performance outcomes are important, the flourishing and well-being of individuals transcends optimal performance. Additionally, I see it as a dual relationship. If an individual is flourishing outside of their performance domain, that can have a drastic impact on their performance and vice versa.
Lastly, why wait for situations, whether that is at the individual, group, or organizational level to meet criteria for crisis to intervene. A system working towards implementing preventative approaches will most likely experience crisis less frequently. However, what must be understood is that it cannot come from one discipline of sport science, such as psychology. All sport science disciplines (i.e., strength and conditioning, athletic training, nutrition) need to be integrated working from a trans-disciplinary approach. Where each discipline supports one another serving the performers within the organization. Much like a comprehensive integration model of performance (Rimer et al., 2023). Ultimately striving for administrators and executives working alongside you and supporting you in preventative approaches towards human flourishing.
References
ACPM (2022). Retrieved from https://www.acpm.org/about-acpm/what-is-preventive-medicine/.
Bundick, M. J., Yeager, D. S., King, P. E., & Damon, W. (2010). Thriving across the life span.
In W. F. Overton & R. M. Lerner (Eds.), The handbook of life-span development, Vol. 1. Cognition, biology, and methods (pp. 882–923). John Wiley & Sons, Inc. https://doi.org/10.1002/9780470880166.hlsd001024
Carlton, E. L. (2009). Happiness at work: Using positive psychology interventions to increase worker well-being. Unpublished master’s thesis: St. Mary’s University, Halifax, NS.
Deci, E. L., Olafsen, A. H., & Ryan, R. M. (2017). Self-determination theory in work organizations: The state of a science. Annual review of organizational psychology and organizational behavior, 4, 19-43.
Frederick, D. E., & VanderWeele, T. J. (2020). Longitudinal meta-analysis of job crafting shows positive association with work engagement. Cogent Psychology, 7(1), 1746733. https://doi.org/10.1080/23311908.2020.1746733
Jones, M., Zakrajsek, R., & Eckenrod, M. (2022). Mental Performance and Mental Health Services in NCAA DI Athletic Departments. Journal for Advancing Sport Psychology in Research, 2(1), 4-18.
King, L. A. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27(7), 798-807. https://doi.org/10.1177/0146167201277003
Levin, J. (2021). Human flourishing: A new concept for preventive medicine. American Journal of Preventive Medicine, 61(5), 761-764.
Okun, M. A., Yeung, E. W., & Brown, S. (2013). Volunteering by older adults and risk of mortality: A meta-analysis. Psychology and Aging, 28(2), 564–577. https://doi.org/10.1037/a0031519
Mac Intosh, A. M., & Martin, E. M. (2018). Creating athlete activists: Using sport as a vehicle to combat racism. Journal of Sport Psychology in Action, 9(3), 159-171. https://doi.org/10.1080/21520704.2018.1434582
Mental Health Foundation of New Zealand (2010). Flourishing, Positive Mental Health and Wellbeing: How can they be increased? Retrieved at: https://www.mentalhealth.org.nz/assets/Flourishing/ Flourishing-and-Positive-Mental-Health-Dec- 2010.pdf
Navarro, K. M., Rubin, L. M., & Mamerow, G. (2019). Implementing student-athlete programming: A guide for supporting college athletes. Routledge.
NCAA (2016). Division I Time Demands Survey. Retrieved from https://www.ncaa.org/sports/2016/1/27/division-i-research.aspx.
NCAA (2014). Mind, Body, Sport: Understanding and Supporting Student-Athlete Mental Wellness. Retrieved from http://www.ncaapublications.com/p-4375-mind-body-and-sport-understanding-and-supporting-student-athlete-mental-wellness.aspx?CategoryID=0&SectionID=0&ManufacturerID=0&DistributorID=0&GenreID=0&VectorID=0
Rimer, E., Petway, A., Jones, P., Schultz, R., Hayes, B., Suchomel, T., Daily, J., Nichols, K., LeBlanc, B., Antle, B., Ivey, P. (2023). Building Comprehensive Integration of Health and Performance Support Through Sport Science. Strength and Conditioning Journal. DOI: 10.1519/SSC.0000000000000794
Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and psychosomatics, 83(1), 10-28.
Schutte, N.S., Malouff, J.M. The Impact of Signature Character Strengths Interventions: A Meta-analysis. J Happiness Stud 20, 1179–1196 (2019). https://doi.org/10.1007/s10902-018-9990-2
Schreier, H. M., Schonert-Reichl, K. A., & Chen, E. (2013). Effect of volunteering on risk factors for cardiovascular disease in adolescents: A randomized controlled trial. JAMA pediatrics, 167(4), 327-332. doi:10.1001/jamapediatrics.2013.1100
Seligman, M. E. (2011). Flourish: A visionary new understanding of happiness and well-being. Simon and Schuster.
Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: empirical validation of interventions. American Psychologist, 60,410–421.
Smith, J. L., Harrison, P. R., Kurtz, J. L., & Bryant, F. B. (2014). Nurturing the capacity to savor: Interventions to enhance the enjoyment of positive experiences. The Wiley Blackwell handbook of positive psychological interventions, 42-65.
U.S. Department of Labor’s Occupational Outlook Handbook (2015). Retrieved fromhttps://www.bls.gov/ooh/.
VanderWeele, T. J. (2020). Activities for flourishing: An evidence-based guide. Journal of Positive School Psychology, 4(1), 79-91.