The Potential Benefits of Non-skills Training (Mental Toughness) for Elite Athletes: Coping With the Negative Psychological Effects of the COVID-19 Pandemic.

The spread of COVID-19 has had a significant impact on global sport. This is especially true at the elite level, where it has disrupted training and competition. Concomitantly, restrictions have disrupted long-term event planning. Many elite athletes remain unsure when major events will occur and worry about further interruptions. Although some athletes have successfully adapted to the demands of the COVID-19 crisis, many have experienced difficulties adjusting. This has resulted in psychological complications including increased stress, anxiety, and depression. This article critically examines the extent to which non-cognitive skills training, in the form of increased awareness of Mental Toughness, can help elite athletes inoculate against and cope with negative psychological effects arising from the COVID-19 pandemic. Non-cognitive skills encompass intrapersonal (motivations, learning strategies, and self-regulation) and interpersonal (interactions with others) domains not directly affected by intellectual capacity. Previous research indicates that enhancement of these spheres can assist performance and enhance mental well-being. Moreover, it suggests that training in the form of increased awareness of Mental Toughness, can improve the ability to cope with COVID-19 related challenges. In this context, Mental Toughness encompasses a broad set of enabling attributes (i.e., inherent and evolved values, attitudes, emotions, and cognitions). Indeed, academics commonly regard Mental Toughness as a resistance resource that protects against stress. Accordingly, this article advocates the use of the 4/6Cs model of Mental Toughness (i.e., Challenge, Commitment, Control, and Confidence) to counter negative psychological effects arising from COVID-19.

Facilitating a return to productive roles following acquired brain injury: The impact of pre-injury work level, current abilities, and neuropsychological performance.

The primary aim of this study was to examine predictors of Return to Productive Roles (RTPR) in individuals with ABI following participation in a community-based RTPR intervention. One hundred and thirty participants were inducted to an ABI-specific RTPR programme. At induction, information on clinical and social demographics, previous education and employment roles were collected. Participants underwent a comprehensive neuropsychological assessment at baseline and completed assessments of disability, mental health and community integration. Participants were followed up at the end of their programme to assess RTPR. Three out of four participants who entered the RTPR programme returned to productive roles. Despite the relatively high levels of anxiety and depression in the sample, people who returned to productive roles were not significantly less anxious or depressed than those who did not. Logistic regression suggested that participants who returned to productive roles following the programme had higher levels of pre-ABI work engagement, less disability and performed better on neuropsychological assessment in terms of their language skills. Results suggest that these factors which cut across specific prior experience, cognitive performance, and social and disability areas of functioning represent barriers to an effective return to productive roles for people with ABI accessing RTPR intervention.

The man who used to shrug - one man's lived experience of TBI.

BACKGROUND: Stress is common to the experience of TBI. Stressors challenge physical and psychological coping abilities and undermine wellbeing. Brain injury constitutes a specific chronic stressor. An issue that hinders the usefulness of a stress-based approach to brain injury is a lack of semantic clarity attaching to the term stress. A more precise conceptualisation of stress that embraces experienced uncertainty is allostasis. OBJECTIVE: An emerging body of research, collectively identifiable as 'the social cure' literature, shows that the groups that people belong to can promote adjustment, coping, and well-being amongst individuals confronted with injuries, illnesses, traumas, and stressors. The idea is deceptively simple, yet extraordinarily useful: the sense of self that individuals derive from belonging to social groups plays a key role in determining health and well-being. The objective of this research was to apply a social cure perspective to a consideration of an individual's lived experience of TBI. METHODS: In a novel application of interpretative phenomenological analysis (IPA) this research has investigated one person's lived experience in a single case study of traumatic brain injury. RESULTS: Paradox, shifting perspectives and self under stress, linked by uncertainty, were the themes identified. CONCLUSIONS: A relational approach must be key to TBI rehabilitation.

Predicting GP visits: A multinomial logistic regression investigating GP visits amongst a cohort of UK patients living with Myalgic encephalomyelitis.

BACKGROUND: Myalgic Encephalomyelitis (ME) is a chronic condition whose status within medicine is the subject of on-going debate. Some medical professionals regard it as a contentious illness. Others report a lack of confidence with diagnosis and management of the condition. The genesis of this paper was a complaint, made by an ME patient, about their treatment by a general practitioner. In response to the complaint, Healthwatch Trafford ran a patient experience-gathering project. METHOD: Data was collected from 476 participants (411 women and 65 men), living with ME from across the UK. Multinomial logistic regression investigated the predictive utility of length of time with ME; geographic location (i.e. Manchester vs. rest of UK); trust in GP; whether the patient had received a formal diagnosis; time taken to diagnosis; and gender. The outcome variable was number of GP visits per year. RESULTS: All variables, with the exception of whether the patient had received a formal diagnosis, were significant predictors. CONCLUSIONS: Relationships between ME patients and their GPs are discussed and argued to be key to the effective delivery of care to this patient cohort. Identifying potential barriers to doctor patient interactions in the context of ME is crucial.

A Thematic Analysis Investigating the Impact of Positive Behavioral Support Training on the Lives of Service Providers: "It Makes You Think Differently".

Positive behavioral support (PBS) employs applied behavioral analysis to enhance the quality of life of people who behave in challenging ways. PBS builds on the straightforward and intuitively appealing notion that if people know how to control their environments, they will have less need to behave in challenging ways. Accordingly, PBS focuses on the perspective of those who have behavioral issues, and assesses success via reduction in incidences of challenging behaviors. The qualitative research presented in this report approaches PBS from a different viewpoint and, using thematic analysis, considers the impact of PBS training on the lived experience of staff who deliver services. Thirteen support staff who work for a company supplying social care and supported living services for people with learning disabilities and complex needs in the northwest of England took part. Analysis of interviews identified five major themes. These were: (1) training: enjoyable and useful; (2) widening of perspective: different ways of thinking; (3) increased competence: better outcomes; (4) spill over into private lives: increased tolerance in relationships; and (5) reflecting on practice and moving to a holistic view: "I am aware that people…are not just being naughty." These themes evidenced personal growth on the part of service providers receiving training. Explicitly, they demonstrated that greater awareness of PBS equipped recipients with an appropriate set of values, and the technical knowledge required to realize them.

Confirmatory Factor Analysis of the Inventory of Personality Organization-Reality Testing Subscale.

The reality testing dimension of the Inventory of Personality Organization, the IPO-RT, has emerged as an important index of proneness to reality testing deficits. However, to date few studies have examined the factorial structure of the IPO-RT in isolation. This is an important and necessary development because studies use the IPO-RT as a discrete measure. Additionally, psychometric evaluation of the IPO suggests alternative factorial solutions. Specifically, recent work supports multidimensionality, whereas initial IPO assessment evinced a unidimensional structure. Accordingly, this study, using a heterogeneous sample (N = 652), tested the fit of several factorial models (one-factor, four-factor oblique, second-order, and bifactor) via maximum likelihood with bootstrapping due to multivariate non-normality. Analysis revealed superior fit for the bifactor solution (correlated errors) (CFI = 0.965, SRMR = 0.036, RMSEA = 0.042). This model comprised a general reality testing dimension alongside four subfactors (auditory and visual hallucinations, delusional thinking, social deficits, and confusion). Inter-factor correlations were in the moderate range. Item loadings and omega reliability supported the notion that the IPO-RT emphasizes a single latent construct. The model demonstrated invariance across gender and partial age invariance. Overall, from a psychometric perspective, the IPO-RT functioned effectively at both global and, to an extent, factorial levels. Findings recommend that the IPO-RT should be scored as a total scale, and rather than treat subscales independently, future studies should consider examining factor variance alongside overall scale scores.

Cognitive reserve and preinjury educational attainment: effects on outcome of community-based rehabilitation for longer-term individuals with acquired brain injury.

The cognitive reserve hypothesis has been proposed to account for the mismatch between brain pathology and its clinical expression. The aim of the current research was to explore, in a longitudinal data set, the effects of level of educational attainment before brain injury (cognitive reserve) and clinical factors on the level of rehabilitation-induced changes in disability and community integration. Participants in receipt of postacute rehabilitation were assessed at induction to the service and again at between 14 and 18 months of follow-up while still in service on changes in aspects of their abilities, adjustment and participation (Mayo Portland Adaptability Indices) and community integration (Community Integration Questionnaire). Controlling for type and severity of injury, age at onset of injury and duration of time since injury, participants with higher previous educational attainment showed significantly greater changes over the course of rehabilitation on adjustment to their injury and participation, but not on abilities, or community integration following postacute rehabilitation. Level of education would appear to be an important element of cognitive reserve in brain injury that serves to aid responses to postacute rehabilitation in terms of an individual's adjustment to disability and participation.

Changes in aspects of social functioning depend upon prior changes in neurodisability in people with acquired brain injury undergoing post-acute neurorehabilitation.

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

Affiliative and "self-as-doer" identities: Relationships between social identity, social support, and emotional status amongst survivors of acquired brain injury (ABI).

Social support is an important factor in rehabilitation following acquired brain injury (ABI). Research indicates that social identity makes social support possible and that social identity is made possible by social support. In order to further investigate the reciprocity between social identity and social support, the present research applied the concepts of affiliative and "self-as-doer" identities to an analysis of relationships between social identity, social support, and emotional status amongst a cohort of 53 adult survivors of ABI engaged in post-acute community neurorehabilitation. Path analysis was used to test a hypothesised mediated model whereby affiliative identities have a significant indirect relationship with emotional status via social support and self-as-doer identification. Results support the hypothesised model. Evidence supports an "upward spiral" between social identity and social support such that affiliative identity makes social support possible and social support drives self-as-doer identity. Our discussion emphasises the importance of identity characteristics to social support, and to emotional status, for those living with ABI.

Acquired brain injury: combining social psychological and neuropsychological perspectives.

This theoretical paper reviews an emerging literature which attempts to bring together an important area of social psychology and neuropsychology. The paper presents a rationale for the integration of the social identity and clinical neuropsychological approaches in the study of acquired brain injury (ABI). The paper begins by reviewing the social and neuropsychological perspectives of ABI. Subsequently, theoretical and empirical studies that demonstrate the social influences on neuropsychology and the inherently social nature of mind are considered. Neuropsychological understandings of social identities and their potential relationships to the variability in ABIs are also discussed. The values of these understandings to ABI rehabilitation are then examined. The paper concludes by suggesting an agenda for future research that integrates the social identity and neuropsychological paradigms so that psychology might grow in its store of applicable knowledge to enhance support and rehabilitation for those with ABI.