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The Mental Game

Psychology professor Brad Donohue strips away the stigma among athletes associated with "mental health."

Research  |  Oct 29, 2014  |  By Ched Whitney

UNLV psychology professor Brad Donohue. (R. Marsh Starks/UNLV Photo Services)

Baltimore Ravens running back Ray Rice punching his fiance in an Atlantic City, N.J., elevator. Minnesota Vikings star Adrian Peterson indicted on child abuse charges for allegedly striking his young son with a tree branch. And repeated cases of players being convicted for drunk driving with few repercussions.

The NFL has been under fire for being too slow to act and for imposing mild penalties when players show such serious behavioral issues. But, while penalties have their place, UNLV psychologist Brad Donohue said sanctions alone won't end domestic violence, substance abuse, and other conduct issues.

"They can punish those behaviors," Donohue said, "but that doesn't really address the core issues. It doesn't lead to positive behaviors."

One of the biggest obstacles, he said, lies within the tough, competitive culture of sports, where the stigma associated with mental health counseling is a major reason athletes avoid counseling programs -- to the detriment of both their athletic and personal performance. At the same time, he said, mental health professionals have failed to incorporate sports culture into their intervention programs.

That's where Donohue's innovative performance program, The Optimum Performance Program in Sports (TOPPS), comes in.

Donohue is a national expert on Family Behavior Therapy, an intervention that focuses on goal achievement, particularly in substance abuse treatment. He built TOPPS off that model and landed a four-year, $2 million grant from the National Institute on Drug Abuse to study its effectiveness among UNLV student-athletes.

"I can't tell you how hard it was to get that grant," said Donohue, a former Top-5 amateur boxer. He had to overcome another stigma to land it: "One reviewer asked, 'Why should we provide funding? Athletes already get a good portion of funds on campus.'"

Yet, previous studies show that student-athletes avoid traditional campus counseling services. As "Big Men (or Women) on Campus," they have little privacy walking into a counseling center.

So Donohue and his team of graduate students stripped away some of the stigma-laden terminology: "Performance coaches" replaced therapists, "intervention meetings" supplanted treatment sessions, and participants strived for "goal-oriented behaviors" and "mental strength."

"This program isn't about 'fixing' a problem; it's about optimizing whatever aspect of their life or sport they want to enhance," Donohue said.

Unlike typical sport psychology programs, which focus on the techniques to improve on-field performance, the TOPPS performance coaches, who are graduate psychology students, were equipped with standardized interventions to tackle stress-related behaviors -- depression, anxiety, alcohol and drug abuse, and unsafe sexual practices -- that are incompatible with optimum physical performance.

The TOPPS coaches offered team workshops and individual sessions in which student-athletes learned to make their thinking patterns more objective and to visualize themselves achieving life- and sport-specific goals. Participants also focused on life skills, such as financial management, career planning, and academic achievement.

Because teammates and coaches often are an integral part of student-athletes' family, they were invited to individual meetings. "We're showing that mental health and sport performance improve together, and coaches really bought in on that," Donohue said.

UNLV swim coach Jim Reitz considered himself a sports psychology skeptic, but Donohue opened his eyes. The most important part of TOPPS, Reitz said, is that it addresses all parts of a student's life. "I like it because it's practical," he said. "In effect, coaches are skills instructors." And positive, goal-oriented behavior is another skill to be learned.

The pilot study subjects completed twelve 60- to 90-minute meetings within four months as well as post-intervention, 1-month and 3-month follow-ups. The group reported sharp improvements in academic performance and functional thoughts in competition. Unsafe sexual practices and illicit drug use were diminished. "The performance goal student-athletes were least motivated to address was binge drinking," Donohue said, noting that most did not believe it interfered with their sports performance. That's one area that Donohue is now tweaking in the program.

The pilot study was published in the journal Clinical Case Studies and offers a number of recommendations for athletic administrators. Now, Donohue is doing what he considers the definitive follow-up study: a randomized clinical trial to directly compare TOPPS with traditional intervention programs.

Meanwhile, he is hopeful that prominent athletes will help reduce the stigma that exists. Chicago Bears wide receiver Brandon Marshall, who has been diagnosed with borderline personality disorder, has become a vocal activist for mental health. LeBron James of the Cleveland Cavaliers has talked about the correlation between his mental strength program and his physical performance.

"It would be my dream come true if we can eliminate stigma-laden terms -- mental health disorder, psychology, problems," Donohue said. "This is about achieving behaviors consistent with a state of well-being in sports and life in general."