Interview with Dr. Lori Freeman (Completed)

Dr. Lori Freeman of Cville Psych and Performance, my interviewee

This interview was conducted via email, on Friday, October 23rd

The email reads as follows:

Hi William, 
Thanks for sending these questions. Here are some responses. If you have follow-up questions, please let me know!

1. First, a personal question. How was your business affected by the COVID-19 pandemic? Did you simply move to an online format, or was there an adjustment period? More specifically, what methods have you recommended for your athletes with regards to dealing with COVID-19 induced stress?

When the COVID pandemic hit, I transitioned my services to telemedicine, using a HIPAA-compliant website called Doxy, to offer ongoing services. I have used this program in the past on rare occasion with clients who were unable to make it into the office for various reasons. While not as ideal as in-person sessions, this telemedicine platform has allowed me to continue treatment relatively seamlessly through the pandemic. The biggest struggle for clients in adjusting to this mode of therapy was finding private space within their own home to have the sessions. Some clients did their sessions from their car, others found quiet spaces outside, if they were unable to have privacy in their home (e.g., college students who share a dorm room with a roommate, or clients whose family was nearby or able to hear conversations through the walls).
There has been significant adjustment for all of us in the COVID-19 pandemic, but athletes have had to manage variables that have been stressful and difficult. This spring, many athletes grieved the loss of their seasons for which they had worked so hard. Others have had to deal with great uncertainty about the future of their athletic careers with the unknown of future competitive seasons. Olympic athletes have had to adjust their training, expectations, and goals with the delay of the Tokyo Olympics to 2021. I have encouraged a mindset of “controlling the controllables,” focusing on the aspects of their lives of which they have direct influence (how they sleep, eat, and take care of themselves, other projects or tasks they can do to feel productive, working on mental skills when they cannot train physically). Mindfulness has been a large part of my practice since I began this work, and I have continued to encourage athletes to use mindfulness as a strategy for managing stress on a daily basis. 

2. On your website, you mentioned helping to manage success as one of the aspects of your work. How do you typically recommend doing this and what are some easily identifiable indicators that an athlete is in need of this? Is every athlete inherently in need of this?

This concept of “managing success” may seem like an oxymoron. However for some athletes, success can be a difficult experience to cope with effectively. Whether an athlete achieves quick success (e.g., a young athlete having the “race/game of her life”, qualifying for an Olympic team at a young age) or is suddenly in the spotlight (e.g., a back-up quarterback who assumes the starting role after a teammate suffers an injury), success can be a difficult adjustment. Further, some athletes struggle with success when a sport that they had previously loved and done “for fun” suddenly becomes a “job” (e.g., an athlete becoming a professional in their sport). Not every athlete struggles with these adjustments, but some do, and it is an important part of my work with athletes as they navigate their careers. To manage success, I encourage athletes to identify and understand what their values are for their sport – why they do what they do, why they love their sport – and set goals that are aligned with those values. It is also important to normalize their experience, acknowledging the challenges associated with success, and refocusing on doing the things that got them there in the first place. For many athletes, it is a reminder that they don’t have to do anything differently just because they are amidst that success (whether on an Olympic team, playing professionally, or adjusting to a starting role). 

3. What is your personal favorite mental tool to mitigate mid-game anxiety for athletes? My favorite is conscious acceptance of the negative emotions you may feel expressed through positive self-talk, as a means of moving past those emotions. Do you find this to be a successful method of managing negative emotions?

Acceptance is a HUGE part of my work with athletes, particularly in managing “negative” emotions during competition (or practice). While years back we thought that it was best to try to “stop” negative thoughts from entering and to find and stay in an “optimal” state in which to perform at the highest level, the current research suggests that accepting our negative thoughts, letting them be there without attending to them (in essence, mindfulness), is a far more successful strategy for optimizing performance. 
In preparation for mid-game anxiety, I have athletes engage in visualizations. While it’s helpful to visualize when things go perfectly in a competition, it is just as (if not more) critical to visualize when things go wrong and, most importantly, visualize how you cope with your emotions and the situation when things don’t go as planned. Practicing these mindfulness and positive self-talk techniques during a visualization helps them become more accessible when stress is high in a competitive situation. Similarly, practicing these skills in practice is necessary for them to be utilized in competition. We can’t expect a skill to show up automatically in a game situation when we haven’t been practicing them on a regular basis. 
Just like with anxiety in non-competitive situations, our brains tend to focus on the negative or “worst-case scenario” when in a state of stress or anxiety. So, identifying those negative thoughts and reframing them to something positive (consider the “best-case scenario”, or even the “most-likely case scenario”) helps our brain think more flexibly. Just like we stretch before and after practice, using this mental skill helps build the flexibility in our brain to be able to not just think of the negative in an anxiety-provoking situation, but also catch ourselves in that process and refocus on what is positive.

4. Finally, what methods do you employ to help athletes return to their sport after recovering from an injury? How many (or what percentage of) athletes do you estimate successfully return to their sport after an injury without guidance and to what degree does that number change with guidance?

While I don’t have specific data on how many athletes seek psychological support as the rehabilitate from an injury, there is ample research suggesting the benefits of seeking support in adjusting to injury, managing rehabilitation, and returning to sport post-injury. Injury in sport can elicit a number of stressors on the athlete: to name a few, trauma related to the injury itself, change in status/role on the team, grief of loss of identity through being sidelined (or retired due to injury), and stress related to rehabilitation process. Providing group support to injured athletes can be immensely helpful, as athletes can provide and receive support to and from others that are experiencing similar difficulties. Hearing that others are facing similar challenges, and being able to share one’s experiences with fellow athletes is useful. In individual sessions, allowing space for an athlete to grieve the loss associated with an injury is important (whether missing a game, a season, or a change in career trajectory). 
During the rehabilitation process, I encourage athletes to focus on their rehabilitation and mental skills training just as they would their physical training. We know the use of visualization can strengthen muscle memory similar to actual physical movement, so using this tool is invaluable during an athlete’s physical rehabilitation. Setting goals (and adjusting goals dependent on recovery) is important for maintaining motivation for rehab. Further, finding new roles for the athlete to embody during their recovery (shifting from being a leader on the field to being a leader in the locker room, in team events, etc) can help injured athletes feel a continued sense of purpose and identity within their sport. 
Some athletes are able to employ these mental skills with minimal or no professional support, while others may need more guidance. While there is no right or wrong in seeking support, it is important for athletes to know that seeking help is a sign of strength, rather than one of weakness. Having coaches and team culture support help-seeking behaviors is important to increasing accessibility to care. 
Hope all of that is helpful. Let me know if you have additional questions or follow-up questions to any of these! 
Take care,

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