Sport And Exercise Psychology: A Critical Introduction

How do athletes react to injury? Contrasting theoretical models

Within research on the psychology of injury, two main theories have been postulated to
explain the way in which sport performers react to physical setbacks. The first of these
approaches is the grief stages model which focuses mainly on the emotional
consequences of injury for the afflicted athlete. The second approach concentrates on
cognitive aspects of the injury experience and is influenced by studies of the way in
which people perceive and cope with stress. This latter approach is called the “cognitive
appraisal” model. One advantage of this approach over the grief stages model is that it
tries to take into account personal and situational factors that determine athletes’
emotional reactions to injuries. A second advantage is that it addresses the extent and
quality of coping resources available to the injured athlete.

“Grief stages” models

Grief stages models (e.g., Rotella, 1985) are based on the assumption that injury is
experienced as a form of symbolic loss by athletes. As a result of such loss, injured
athletes are assumed to go through a predictable sequence of emotional changes on their
way to recovery. As Cashmore (2002) put it, “not only do they lose a physical capability,
they also lose a salient part of their self’ (sic, p. 141). But how valid is this assumption of
injury as a form of loss? More generally, what are the consequences of this loss for the
rehabilitation of the athlete?
“Loss” is a common experience in sport. Thus Lavallee, Grove, Gordon and Ford
(1998) analysed the various forms of loss that athletes encounter in sport, ranging from
competitive defeat to the loss of self-esteem that is often associated with physical injury.
Indeed, according to Ford and Gordon (1999), injured athletes may experience losses
affecting factors such as mobility, independence, sense of control, virility, social
relationships, income and financial rewards. Among the earliest proponents of the grief
response theory of athletes’ reactions to injury was P. Pedersen (1986) who suggested
that sport performers may display a form of grief similar to that exhibited by people who
suffer the loss of a loved one. This theory was based on the seminal work of Kübler-Ross
(1969), a Swiss psychiatrist who had witnessed much death and suffering in the Second
World War as a young adult and who had subsequently worked as a physician with
cancer patients in the Unites States (Gill, 1980). Based on interviews with these patients,
and observations of the way in which they dealt with their terminal illness, Kübler-Ross
proposed that people go through five hypothetical stages of emotional response after they
have been told of their impending death. These stages are denial, anger, bargaining,
depression and acceptance. Denial occurs when patients refuse to accept the diagnosis
offered to them or deny its implications. Anger results from an attempt to address the
apparent unfairness of the situation by asking the question “Why me?” In the third stage
of the grief response, “bargaining” happens when patients say prayers or offer to make
changes in their lifestyle in an exchange for a postponement of their death. Depression
occurs when patients start to grieve deeply. Finally, but not always, acceptance emerges
when the patients resign themselves with dignity to their fate. The interpretation of this
latter stage is somewhat controversial, however. Thus Hardy, Jones and Gould (1996)
pointed out that acceptance does not mean resignation. Indeed in Kübler-Ross’s model,

Helping athletes to cope with injury: from theory to practice 251