Psychology/counseling: A universal competency in athletic training

Objective: To present the rationale that certified athletic trainers (ATCs) may require structured educational training in the psychological aspects of athletic injury. Data Sources: We searched MEDLINE, Psych Lit, Psyc-INFO, First Search, and SPORT Discus databases for the years 1990 through 1999 under the search terms "psychological distress," "depression," "athletic injury," and "rehabilitation adherence." Data Synthesis: Psychological factors are significant predictors of athletic injury. Athletic injury is accompanied by significant psychological distress, which has been shown to impair rehabilitation compliance and possibly physical recovery. Although "counseling" and knowledge of psychological aspects of injury are required National Athletic Trainers' Association competencies, extant data suggest that athletic trainers may lack training in this competency. Conclusions: Evidence suggests that (1) psychological distress is prospectively associated with the incidence of athletic injury, and prolonged psychological distress, specifically depression, may occur after athletic injury; (2) psychological factors may also either hinder or facilitate rehabilitation adherence, compliance, and recovery; (3) psychological distress may persist even after physical recovery has been completed; (4) psychosocial factors related to injury occurrence and injury recovery may be overlooked by ATCs, but knowledge of these factors and appropriate use of referral sources may enhance the effectiveness of ATCs; and (5) ATCs may benefit from structured educational experiences specific to the National Athletic Trainers' Association psychology/counseling competency. Recommendations: With 75% of a national survey of ATCs indicating that they do not have access to a sport psychologist, it would be advantageous for ATCs to gain adequate training in the recognition, evaluation, and treatment of psychological factors associated with athletic injury. The literature also suggests that structured educational training with respect to psychological aspects of athletic injury would be well received by ATCs.