the stage of “acceptance” seems to have the connotation of capitulation or giving up. This
reaction is rarely the case with injured athletes, however, because the final stage of their
reaction involves a readiness to engage in physical activity again.
Although this five-stage theory seems plausible, it has been criticised on the grounds
of poor methodology (e.g., Kübler-Ross’s recording of data was unsystematic and there
are no independent empirical data to validate it) and for unreliable findings (e.g., see
Aronoff and Spilka, 1984–1985). In addition, Doka (1995) argues that the alleged
reactions of terminally ill patients to bad news are not typical of people facing death in
other situations. Despite such criticisms of loss theory, Kübler-Ross’s work has exerted a
major influence on sport psychologists’ understanding of how athletes react to injuries
(Brewer, 2001a). Thus according to this grief stages theory, athletes who experience a
significant injury or a career-threatening illness tend to go through a predictable sequence
of stages as part of their recovery process. At first glance, however, this claim seems
fanciful because illness and injury are not the same as death and also because there are
many differences between the worlds of terminal illness and sport. Nevertheless, there is
no doubt that injury generates doubt and loss in athletes. Thus sports performers who
suffer serious injury are not only precluded from engaging in the activity that they love
but are also vulnerable to significant losses of income, mobility, independence and social
status.
In general, Kübler-Ross’s five stages may be translated into the sporting domain as
follows. In the first stage, an injured athlete’s denial is captured by such statements as
“I’ll be fine—it can’t be very serious”. The next stage (“anger”) may begin when athletes
realise the amount of time they will miss as a result of the injury. After that, some
bargaining may occur in which the athlete may offer to make compromises to his or her
lifestyle in an attempt to regain lost fitness. Next, depression may arise when the afflicted
athlete makes pessimistic predictions about his or her future in sport. This feeling is
epitomised by such expressions as ‘This is hopeless—I’ll never be as good as I was in the
past”. Finally, acceptance should arrive as the athlete comes to terms with the adverse
circumstances which s/he has encountered. For example, s/he may say, “It’s no use
moaning—I’ll just have to work myself back to fitness”. Interestingly, Heil (1993)
proposed a sport-related modification of Kübler-Ross’s five-stage model. Briefly, his
affective cycle model suggested that athletes go through three broad stages on the way to
recovery. First, they are held to experience “distress” (e.g., shock, anger, depression).
Then, they are believed to engage in denial and finally, in determined coping (whereby
realism sets in and athletes accept their responsibility in the rehabilitation process).
Typically, stage theories of injury reaction have been tested in two ways (Brewer,
2001b). On the one hand, quantitative studies have used questionnaires and standardised
psychological tests to assess athletes’ emotional responses to injury and to compare them
with the normal emotional fluctuations experienced by matched participants in control
groups. In this regard, the “Profile of Mood States” (POMS; McNair et al., 1992) has
been used extensively to measure six affective states in athletes: tension/anxiety;
depression/dejection; anger/hostility; vigour; fatigue; and confusion/bewilderment In this
test, a total mood disturbance score may be calculated by adding the negative mood scale
scores (tension, depression, anger, fatigue and confusion) and subtracting the positive
mood scale (vigour). An abbreviated, sport-specific version of this instrument has been
developed by Grove and Prapavessis (1992). The second approach in this field uses
Sport and exercise psychology: A critical introduction 252