The Integrated Model of Religiosity and Psychological Response to the Sport Injury and Rehabilitation Process: A Christian Illustration
Diane M. Wiese-Bjornstal, PhD, CMPC
Professor, University of Minnesota Twin Cities
Abstract: Research in psychology and medicine supports that religiosity functions as a protective and resilience factor among people facing diverse health challenges. Athletes risking and responding to health challenges associated with sport injuries likely benefit from religiosity and religious ways of coping, and yet associated mechanisms of influence are largely unexplored within sport psychology. This paper introduces a religiosity-adapted version of the integrated model of psychological response to the sport injury and rehabilitation process as a conceptual framework for research examining religiosity within sport injury prevention and care. Examples from the Christian faith illustrate model predictions. Psychological antecedents expected to influence vulnerability to sport injuries include personality (e.g., positive values), life stress (e.g., lower stress perceptions), and coping resources (e.g., utilizing prayer). Once injury happens, personal (e.g., religious commitment) and situational (e.g., support of faith community) factors are hypothesized to affect athletes’ health and well-being (e.g., spiritual health), and in turn their psychological responses to sport injuries. These responses include cognitive appraisals (e.g., God controls injury recovery) that affect feelings (e.g., gratitude for God’s work through health care providers), influence religious behaviours (e.g., church service attendance), and impact recovery outcomes (e.g., stress-related growth). Religious interventions within sport injury contexts such as referring athletes to clergy or coaches praying with athletes are predicted to benefit religious athletes. Overall, an inductive consideration of research evidence for model predictions supports that religiosity likely advantages the mental and physical health of many Christian athletes during sport injury recoveries. The integrated model of religiosity and psychological response to the sport injury and rehabilitation process provides a basis for generating more explicit research investigations into the mechanisms of influence between religiosity and health within sport injury contexts.
Keywords: Sport Psychology, Sports Medicine, Religious Coping, Athletes, Spiritual Health
Statement of Original Unpublished Work: By submitting this document to the Editor in Chief of CJSCF, I am making a Statement of Original Unpublished Work not submitted to another journal for publication.
Introduction
Research examining the psychological aspects of sport injuries is of significant relevance to the work of sport psychology consultants, sport coaches, and sports medicine providers. These professionals can benefit athletes by adopting holistic approaches to the prevention and care of sport injuries that include consideration of psychological factors. Diverse psychological factors relevant to the sport injury experiences of athletes include personality, motivation, anxiety, stress perceptions, coping mechanisms, and rehabilitation adherence behaviours. This paper proposes that religiosity – the beliefs and behaviours of athletes as influenced by specific religious faiths – be considered among the many psychological factors affecting sport injury vulnerability and recovery. It presents a conceptual model illustrating hypothesized interconnections between religiosity and the psychological aspects of sport injuries. Research on religiosity among Christian athletes is used to provide research examples lending preliminary support to model predictions (Beck and Haugen 2013; Wiese-Bjornstal 2019a).
Religiosity, as described within the psychology literature, is a complex multidisciplinary construct exhibiting intrapersonal, interpersonal, and physiological dimensions (Hill and Pargament 2003). It encompasses attitudes, beliefs, emotions, and behaviours (Hooker, Masters and Carey 2014). Religiosity involves adherence to specific, institutionalized belief systems focused on gods, deities, higher powers, or ultimate truths, characterized by explicit codes of ethics and common rituals, and encompassing social connections to others of the same faith (Hill and Pargament 2003). A key function of religiosity is connection to one’s spirituality. Psychological and health care scholars describe spirituality as an individualized, abstract, and subjective construct referring to one’s beliefs and values concerning meaning, purpose, connection, and transcendent sacredness in life (Center for Spirituality and Healing 2016; Greenstreet 2006). Religious adherents such as Christians most often identify as both religious and spiritual, but individuals who identify as spiritual do not necessarily report being religious (Pew Research Center 2018).
A wealth of literature in psychology and medicine supports that religiosity is largely positive in protecting mental and physical health and in promoting psychological resilience among those facing health challenges (Koenig 2012; Pearce 2013; VanderWeele 2016; Wiese-Bjornstal 2019b). Yet, in spite of this relevance of religiosity to protective and resilience functions within health contexts, social science literature examining religiosity within sport in general (Gibbons and Braye 2019), and within sport injury contexts specifically (Wiese-Bjornstal, Wood, White, Wambach and Rubio 2018) is extremely limited. Thus, the purpose of this paper is to present and describe the integrated model of religiosity and psychological response to the sport injury and rehabilitation process as one means of stimulating research that explores intersections between religiosity and sport injury. This model was developed as an adaptation of the integrated model of psychological response to the sport injury and rehabilitation process (Wiese-Bjornstal, Smith, Shaffer and Morrey 1998), which is frequently adopted in the sport psychology literature as a conceptual framework for research examining the psychological aspects of sport injuries (Wiese-Bjornstal, 2019b). The purposes for presenting this adapted model are to (a) establish predictions upon which to base research examining the protective and resilience influences of athlete religiosity within the contexts of sport injury prevention and care, and to (b) operationalize expected pathways through which sport, medical, and psychology professionals could intervene to tap into the benefits of religiosity to athletes within these experiences. Examples are derived from literature review and incorporate consideration of Koenig’s (2012) theoretical models illustrating the ways in which adherence to Western monotheistic religions (i.e., Christianity, Judaism, Islam) influences mental and physical health. Research findings regarding the psychological and social aspects of sport injuries integrated with medical literature showing connections between religiosity and health provide preliminary support for the adapted model predictions. However, many of these predictions are speculative within the context of sport injuries and future research testing of these predictions is essential to determining the viability of the model.
In order to accomplish these purposes, the first section of this paper provides a visual schematic and general narrative overview of the model. This model captures a broad perspective about ways in which religiosity across multiple faith traditions connect to the psychological aspects of sport injury experiences. It is not exclusive to Christianity. In section two, however, examples drawn from the Christian faith tradition illustrate specific model components. The third section provides conclusions and future directions for research and professional practice connected to religiosity and its contributions to physical and mental health within sport injury contexts.
Integrated Model of Religiosity and Psychological Response to the Sport Injury and Rehabilitation Process
The integrated model of psychological response to the sport injury and rehabilitation process (Wiese-Bjornstal et al. 1998) has been widely used as a conceptual framework driving research on the psychological responses of athletes to sport injuries (Wiese-Bjornstal 2019b). Research generally has supported its basic premises, and thus it provides a relevant starting point for predicting how religious beliefs, behaviours, and relationships might serve as health protective, resilience, and intervention factors within sport injury contexts (Wiese-Bjornstal 2019a). Figure 1 displays the newly adapted integrated model of religiosity and psychological response to the sport injury and rehabilitation process. In the top segment of Figure 1, the flow begins with pre-injury psychological elements derived from the stress and injury model (Williams and Andersen 1998) that are predicted to continue to exert influence on post-injury psychological sequelae. Examples of religious constructs are integrated into these psychological elements in the religiosity-adapted model. Psychological antecedents (e.g., personality, history of stressors, coping resources) and pre-injury interventions independently and conjunctively affect the stress responses of athletes, as manifested in stress reactivity, attentional, and physiological effects. Antecedent psychological and intervention factors that promote and protect mental and physical health, such as religious faith and coping resources, are predicted to reduce the stress response, which lessens vulnerability to sport injuries (Ivarsson et al. 2017).
Figure 1. Integrated Model of Religiosity and Psychological Response to the Sport Injury and Rehabilitation Process
Source: Adapted from Wiese-Bjornstal et al. (1998). Reprinted by permission of the author.
Once a sport injury occurs, the psychological response and rehabilitation process segment of the model becomes relevant. The middle segment of Figure 1 shows that personal and situational factors frame an interactional approach to understanding the dynamic field of influences affecting holistic health and well-being. Personal factors such as religious values, beliefs, and behaviours interact with situational factors, such as the support of religious teammates and family, to influence dimensions of health and well-being. One of these dimensions, spiritual health, is of particular relevance to this paper, as it describes one’s relationship with God and sense of life purpose that affect health-related quality of life (Dhar, Chaturvedi and Nandan 2011). These global dimensions of health and well-being may influence sport injury-specific cognitive appraisals, affective responses, and behaviours, as depicted in the bi-directional cycles of Figure 1. Appraising sport injury as part of God’s plan, for example, may lead to feelings of calmness and comfort about care and support, which may lead to behaviours associated with diligence and commitment to a rehabilitation plan. Physical and psychological recovery outcomes shown at the center of Figure 1, such as return to sport and stress-related growth, are affected by these dynamic cycles of cognition, affect, and behaviour over time.
The bottom segment of Figure 1 represents religiosity-specific ideas about aspects of post-sport injury psychological care related to assessments, providers of psychological care, and types of interventions that may prove useful. The predictions based on this model would be that assessments could gather information about the religiosity-based health and well-being of the athlete, which in turn inform the selection of appropriate religious interventions used by mental and physical health care providers. It is essential that these health care providers demonstrate cultural competence through their recognition that religiosity may be an important priority for individual athletes, and through their willingness to cultivate and accommodate religiosity within their use of interventions and provision of health care.
Thus, the integrated model of religiosity and psychological response to the sport injury and rehabilitation process shown in Figure 1 provides an overarching framework of religiosity influences within the sport injury context, and sets the scene for the next section of the paper. This upcoming section illustrates specific examples of evidence-based support for predictions about how Christian beliefs, behaviours, and relationships might function as health protective, resilience, and intervention influences on injured athletes.
Model Components and Christian Illustrations
While an overarching model of religiosity within sport injury contexts is a useful starting point, it is unrealistic to suggest that it accurately depicts the mechanisms of influence within all religious faith traditions. As presently drawn, it admittedly depicts pathways consistent with Western monotheistic traditions. Thus, this section of the paper provides illustrations of model components drawn primarily from one specific monotheistic tradition (i.e., Christianity).
Pre-Sport Injury Psychology
Returning to Figure 1, the uppermost pre-injury segment of the model identifies psychological antecedents that exert their influence on the stress response and sport injury vulnerability before injuries happen. The premise of this paper would be that it would be beneficial to tap into the psychologically protective effects that religiosity offers as a means of reducing vulnerability to sport injuries through the stress response pathway. Faith-related antecedents, such as religious beliefs, may influence stress responses through direct or indirect pathways. For example, athletes with a strong Christian faith may simply not perceive potentially stressful sports events as worrying (thus, religiosity exerts direct influence on reducing stress perceptions). Alternatively, athletes may use internal and external religious resources such as prayer and social support to buffer the effects of negative life events and maintain an attentional focus on meaning and purpose in sports competition rather than on fear or anxiety (thus, religiosity exerts indirect influence on reducing stress perceptions). By either perceiving less stress, or by better managing perceived stress, Christian athletes are less likely to display high levels of stress reactivity such as increased muscle tension, elevated heart rate, or distracted attentional focus. In turn, then, the avoidance of these high stress manifestations is associated with a reduced vulnerability to sport injuries (Ivarsson et al. 2017).
Other potential benefits may accrue via the personality antecedent, such as through the influences of religious identities (Watson 2011), virtues, and goal orientations. Proios (2017), for example, found a relationship between religious and athletic identities among adult athletes. This requires further exploration to find out what this means, because athletic identity is a construct that encompasses important aspects of social identity and affect and has demonstrated relationships to sport injury risks and responses in prior research (Wiese-Bjornstal 2019b). So, the question is, does religious identity promote or protect health, or can it compromise health such as by feeling that one must sacrifice health in order to fulfill one’s God-given potential (Lee Sinden 2013)? Kretschmann and Benz (2012) examined the moral thoughts and actions of Christian athletes relative to their own health and well-being and that of their opponents. With respect to religious orientation, for example, they cited evidence showing that athletes with traditional Christian beliefs evidenced greater emphasis on goal/mastery rather than competitive/ego orientations, the latter of which is more strongly tied to a willingness to do whatever it takes, including injuring others, in order to achieve victory. One Christian athlete, when talking about moral limits of body contact and hurting someone on purpose, said the following:
[Winning] is not so important to me that I would risk an injury or something like that in this case. I wouldn’t do that. Or to get an advantage through such ways, I personally probably could not be happy about it. (Kretschmann and Benz 2012, 513)
Kretschmann and Benz (2012) reported evidence showing that Christian athletes rated honesty and integrity as high priority values, compared with nonreligious athletes who rated values such as perfectionism higher. Honesty is an important and beneficial Christian value, and in a secular sense is a health protective virtue or asset within a positive psychology view of character strengths. Perfectionism, particularly perfectionistic concerns, associates with increased risks of sport injuries (Madigan, Stoeber, Forsdyke, Dayson and Passfield 2018). Other examples of strengths or virtues associated with religiosity and a positive psychology view would be hope, compassion, and gratitude; again, with the prediction that these would protect, rather than harm, health and well-being (Worthington et al. 2014).
Pre-injury coping resources reflect the use of internal and external coping resources as a means of controlling the stress response. Reducing anxiety and preparing for competitions, such as via the use of pre-game religious rituals and practices such as prayer, are evident among many athletes. Their reasons for using these often include safety and protection from harm or injury in the coming contest (Jirásek 2018; Watson and Czech 2005). For example, in their interview study about the role of sports chaplains within English professional soccer clubs, Gamble, Hill and Parker (2013) reported that the chaplains noted player pre-game prayers often focused on preventing injury and playing well. The chaplains facilitated these team and individual prayers. One athlete working with a sports chaplain attributed his improved play to the adoption of a pre-game prayer ritual. The ritual provided him with the capacity to manage better his in-match emotions due to a sense of peace about his purpose and preparation. This example illustrates a potential protective effect of religious interventions in that by feeling peaceful and less anxious pre-game thanks to prayer rituals, the stress response lessens and risk of injury decreases based on the stress and injury model predictions (Wiese-Bjornstal 2019a).
Although religious rituals and practices are sometimes included in sport psychology and sociology studies describing “superstitions” in sport, thus relegating them to the realm of irrationality and chance control, several authors articulate the importance of distinguishing superstition from religious ritual and practices. Religious ritual and practices have specific rational and controllable meanings and serve functions beyond relying on luck (Hoven 2019; Hoven and Kuchera 2016; Maranise 2013). Maranise (2013, 84) contended, “Religious rituals practiced by athletes or integrated into sporting lifestyles promote greater holistic (mental, emotional, physical, and spiritual) well-being and add significant meaning to life in a way that superstitions cannot.” As such, it is logical to presume that religious rituals would serve not only a performance enhancing function (by focusing effort and promoting confidence), but also health protective (by promoting well-being) (Hoven 2019), and spiritual (by promoting meaning) functions.
Having explored some possible predictions relative to the role of religiosity as a health protective factor pre-injury, it is apparent that research on this topic is quite limited. In the context of health in general and allied literature, however, the evidence generally would support the predictions of the religiosity-adapted model and provide researchers with ideas for examining religiosity as psychologically influential during the pre-injury phase. Next, it is important to consider how religiosity influences psychological responses to sport injuries once they occur.
Post-Sport Injury Psychology
Based on the integrated model of religiosity and psychological response to the sport injury and rehabilitation process, personal factors such as religious commitment, religious schemas, and locus of health control would comprise factors predicted to influence the spiritual well-being of athletes. Among Christians, for example, spiritual well-being involves living by faith in proper relationship with God and trusting in God’s steadfast love and mercy through Jesus Christ as the purposes for one’s life (Evangelical Lutheran Church in America 2019). This spiritual well-being may influence athletes’ cognitive appraisals when sport injury occurs; for example, by interpreting sport injury as serving some larger purpose in one’s life. A few studies illustrate promising results regarding the generally positive influences of religiosity on spiritual well-being and coping with sport injuries. For example, in their qualitative study of religious well-being in intercollegiate sport, within one of their resulting coded data themes, Cope With Injury, Seitz, Sagas and Connaughton (2014) reported that some athletes used religious coping strategies indicative of positive religious well-being. One Christian athlete, Leslie, stated the following with respect to coping with a season-ending injury:
I think if most other people went through the same thing, injury-wise, they probably wouldn’t have stuck it out as long, and I think my faith had a lot to do with that. It made dealing with injury easy in the beginning because I was able to see that something good is going to come out of this. God has a purpose for everything, and I was trying to understand what that was. (Seitz, Sagas and Connaughton 2014, 227)
Spiritual well-being and associated cognitive appraisals influence emotional and behavioural responses and coping efforts of religious individuals (Newton and McIntosh 2010). Seitz, Sagas and Connaughton (2014, 227) reported that one athlete attributed his recovery from a career-threatening injury to the power of God: ‘‘My God rescued me from a pretty significant injury my freshman year. I was able to get back out there and play and I wanted to make the most of it.’’ Research examining the effects of religious beliefs and practices on the mental health and well-being of male professional athletes prior to surgery for anterior cruciate ligament injuries showed similar relationships (Najah, Farooq and Rejeb 2017). In comparing athletes who were high versus low in religious/spiritual belief and in praying/meditation practice, Najah, Farooq and Rejeb (2017) found that higher levels of religiosity/spirituality positively influenced adaptive coping and was associated with fewer negative emotions. Athletes higher in religiosity/spirituality at pre-surgery exhibited greater use of coping strategies such as acceptance, emotional support, and self-distraction, and reported lower scores on stress, anxiety, and depression.
A recent mixed methods study by Wiese-Bjornstal et al. (2018) correspondingly illustrated the roles of religiosity in cognitive, affect, and behaviour in response to sport injuries. Their study explored religiosity/spirituality specifically within the context of coping with sport injuries, based on predictions of the integrated model of psychological response to the sport injury and rehabilitation process. The responding sample of athletes and other physically active individuals were predominantly Christian, and the findings supported religiosity and religious coping as beneficial to psychological resilience following sport injury. The results showed that athletes identifying as religious and/or spiritual utilized more active coping strategies (e.g., acceptance, planning, positive reframing) than those identifying as not religious or spiritual. Further, stronger religious commitment predicted greater reliance on a God locus of health control for sport injury. It also predicted greater use of positive religious coping strategies such as seeing the ways in which God was caring for and strengthening them in their injuries. Higher religious commitment did not predict greater use of negative religious coping. Triangulation of quantitative and qualitative data reflected primarily positive benefits of religious coping strategies such as prayer, positivity, and priorities in managing the psychological challenges presented by sport injuries (Wiese-Bjornstal et al. 2018). For example, a 21-year-old Christian female athlete who suffered a concussion playing high school basketball illustrated these positive benefits:
I grew closer to God. I prayed for my injury and was prayed for. I felt strengthened by others when they prayed over my injury and just seeing the healing process come through strengthened my trust in Him over my body. (Wiese-Bjornstal et al. 2018, 13)
Overall, the findings from this study were consistent with the predictions of the integrated model of psychological response to the sport injury and rehabilitation process. They confirmed intersections between personal/internal factors (e.g., religious commitment) and situational/external factors (e.g., others’ prayers) on cognitive, emotional, and behavioural responses to sport injuries and the psychological and physical recoveries associated with these responses.
A related study focused on athletes embracing the Christian religion explored possible differences between Catholic/Mainline Protestant and Evangelical Christians in coping with their sport injury experiences (Wiese-Bjornstal, Wood, Principe and Schwartz 2019). The purpose of this study was to examine the relationships between religious commitment, religious engagement, God locus of health control, and religious ways of coping during the sport injury recoveries of athletes from diverse Christian denominations. As part of a larger mixed methods study, physically active adults (n=88) responded to an online survey including questions about their most serious or challenging sport injuries and several religiosity factors. The results showed that religious commitment (i.e., the importance and centrality of religious beliefs, values, and practices to one’s life) predicted religious engagement (e.g., attendance at religious services) and God locus of health control for sport injuries (i.e., a belief that God controls one’s health status). Further, religious commitment fully mediated the relationship between athletes’ Christian denominations and their use of positive religious ways of coping with sport injuries. Positive religious ways of coping were used significantly more than were negative, with seeking spiritual support, active religious surrender, and benevolent religious reappraisal the most frequently used strategies. Although negative religious ways of coping were less prevalent, self-directed religious coping, marking religious boundaries, and pleading for direct intercession were most used among them. This study illustrated the centrality of religious commitment as the driver of religious coping with sport injuries, regardless of Christian denomination, and demonstrated the intersections between spiritual health and cognitions, emotions, and behaviours following sport injuries.
These research findings demonstrate preliminary evidence showing that religiosity is associated with the use of primarily positive religious coping strategies among Christian athletes dealing with the stresses of sport injuries and recoveries. Koenig’s (2012; 2013) reviews of literature in the general medicine and health care fields also document that positive religious coping exerts beneficial effects for patients dealing with a wide variety of health challenges. Knowing this, culturally competent sports, medicine, religious, and psychology professionals should consider how tapping into athletes’ religiosity could play a role in psychological interventions designed to aid in the prevention and care of sport injuries, as next discussed.
Psychological Interventions/Return to Sport
Psychological interventions generally refer to professionals intervening via the development of interpersonal relationships and the utilization of activities or strategies with the purpose of improving individual health and well-being, such as spiritual, mental, physical, social, behavioural, or emotional health and well-being. The psychological care of athletes involves the integration of psychological assessments with the work of sport, religion, and medical professionals and the interventions they use, as depicted in the bottom segment of Figure 1.
Sports medicine providers, sport psychologists, sport coaches, and sport chaplains are among the many professionals that might intervene with varied religious strategies contained within the boundaries of their expertise and ethical standards (Gamble, Hill and Parker 2013; Wiese-Bjornstal 2000). Individuals within these professional roles are expected to demonstrate cultural competence. Cultural competence in health care and rehabilitation settings such as sports medicine or sport psychology refers to being culturally knowledgeable, sensitive, and effective in working with diverse populations in order to build resilience and restore health (Buse, Burker and Bernacchio 2013; Cartwright and Shingles 2011). This would include accommodating an athlete’s religiosity in sports training and health care (Wiese-Bjornstal 2019a). With respect to support among sports medicine providers for accommodating religiosity, findings of a survey of program directors in United States athletic training education programs showed that 89% of program directors believed there to be a connection between spirituality and health/healing (McKnight and Juillerat 2011). Further, survey results with United States intercollegiate athletic trainers reported that 82% of athletic trainers agreed that addressing injured athletes’ spiritual concerns leads to more positive rehabilitation outcomes (Udermann et al. 2008). Thus, the implication is that when working with Christian athletes, the effectiveness of culturally-competent sport professional practices is improved by recognizing that religiously-committed Christian athletes engage in religious activities, believe that God exerts control over their sport injury recoveries, and benefit from utilizing primarily positive religious ways of coping when injured (Wiese-Bjornstal 2019a).
Given this evidence of the need for considering religiosity in health care, Plante’s (2014) paper “Four Steps to Improve Religious/Spiritual Cultural Competence in Professional Psychology,” provides useful guidelines for psychology professionals incorporating religiosity-based interventions. Plante (2014) identified the following four steps for psychologists: beware of biases (e.g., against religion), consider religion just as one would other types of diversity (e.g., worthy of respect and consideration), take advantage of available resources (e.g., material available in American Psychological Association journals such as Psychology of Religion), and consult colleagues, including clerics (e.g., religious clergy as professionals with whom to consult, and to whom to refer). Sport psychology consultants could incorporate religious practices such as Christian prayer and music into mental skills training (Mosley, Frierson, Cheng and Aoyagi 2015; Watson and Nesti 2005), or tap into the benefits of religious rituals, as suggested by Maranise (2013):
…the multidimensional aspects of adherence to religious rituals for athletes cannot be understated in their importance for they provide opportunities for utilization in sport psychological consulting, therapeutic techniques, and life-coaching which ultimately concretize and provide visible, experiential outcomes to what many have long-viewed as merely abstract and intangible. (Maranise 2013, 89)
Wiese-Bjornstal (2000) recommended similar strategies for use by sports medicine-related professionals, such referrals of athletes by sports medicine providers to a network of religious clergy, praying or sharing Scripture with athletes if appropriate and ethical within the specific work environment (Egli and Fisher 2017), and weaving athlete stories of faith and recovery from sport injuries into interpersonal exchanges (Wiese-Bjornstal et al. 2018). The latter provides an example of tapping into the benefits of narrative health or narrative health psychology. Narrative health psychology is a research (Sools, Murray and Westerhof 2015) and communication model (Pallai and Tran 2019) through which health care providers and patients become better listeners, care providers, and patients through the sharing of personal stories, and, by extension, on drawing from the relevance of the stories of others negotiating similar health challenges.
These examples illustrate ways in which the model of religiosity and psychological response to the sport injury and rehabilitation process might help researchers and practitioners examine how religiosity may benefit the prevention and rehabilitation of injuries among Christian athletes. The ultimate benefit of exploring religiosity is to maximize the protective and resilience benefits it may offer to athletes. In the broadest sense, this paper has focused on the development of a model reflecting the integration of social science, religious faith, and health among religious athletes relative to the risks and consequences of sport injuries. Some concluding thoughts emerging from this review may be useful in guiding future research and professional practice.
Conclusions and Future Directions
Evidence-based findings evolved into an adapted conceptual model provided nascent yet potentially compelling evidence that religiosity, and Christian faith specifically, serves as a psychologically protective and resilience factor for athletes relative to sport injury risks and consequences. As a protective factor pre-injury, reduced stress reactivity accrues through the influences of strong coping resources such as those provided by religious social networks and through personal faith and rituals. Reduced stress reactivity may lessen the vulnerability of Christian athletes to injuries. This is a fruitful future direction for sport psychology research given that the extensive body of knowledge on psychological predictors of sport injuries has largely ignored religiosity. As a resilience factor post-injury, benefits of religiosity likely include positive mindsets, emotional control, adaptive behaviours, and stress-related religious and spiritual growth (Wiese-Bjornstal et al. 2018). Since religiosity shows strong support as a beneficial psychological resilience factor for persons facing a variety of health challenges (Helmreich et al 2017), it could be an asset to sports medicine health care for researchers to find support for similar mechanisms in sport injury contexts.
Although the role of religiosity seems to be largely positive in preserving and promoting health and well-being among athletes, future work should further examine some potentially negative or harmful aspects of religiosity relative to sport injuries. These might include the role of pain in religious sacrifice and expression (Glucklich 2015), and the use of negative religious coping strategies, such as blaming God when living in chronic pain and “imprisonment” (Hunt and Day 2019, 1), or feeling abandoned and withdrawing from religious support after injury (Wiese-Bjornstal et al. 2018). Career terminations resulting from sport injuries also represent vulnerable life transitions that could negatively affect, or be affected by, religious faith (Wiese-Bjornstal et al. 2018), such as believing that one has failed to live up to their God-given potential. There is evidence of some undesirable, conflicting, or negative influences of religiosity on health and well-being within sport that must be considered and addressed by scholars and practitioners moving forward (Lee Sinden 2013; Wiese-Bjornstal 2019a).
In conclusion, the integrated model of religiosity and psychological response to the sport injury and rehabilitation process provides one way forward in generating future research on the roles of religiosity in preventing and recovering from sport injuries. As theory often drives research initiatives, the hope is that the presentation of this model serves toward that purpose. However, the model derives largely from a psychological, medical, and positivist science view of religiosity, and thus would greatly benefit from elucidation by scholars and professionals trained in liberal arts fields such as religious studies and theology, philosophy, and sociology (Gibbons, Watson and Mierzwinski 2019; Sullivan 2019). These individuals may better articulate some of the less scientifically tangible sacred and spiritual aspects involved when considering religiosity’s role in sport psychology and sports medicine, such as a deeper capacity to tap into the spiritual dimensions of coping that may benefit athlete health and recovery (Pargament 2009).
Bibliography
Beck, Richard, and Andrea Haugen. 2013. “The Christian Religion: A Theological and Psychological Review.” In APA Handbook of Psychology, Religion, and Spirituality (Vol. 1): Context, Theory, and Research, edited by Kenneth Pargament, 697–711. Washington, DC: American Psychological Association.
Buse, Natalie, Eileen Burker, and Charles Bernacchio. 2013. “Cultural Variation in Resilience as a Response to Traumatic Experience.” Journal of Rehabilitation 79, no. 2: 15–23.
Cartwright, Lorin, and Rene Shingles. 2011. Cultural Competence in Sports Medicine. Champaign, IL: Human Kinetics.
Center for Spirituality and Healing. 2016. “What is Spirituality?” Accessed May 25, 2016.
https://www.takingcharge.csh.umn.edu/enhance-your-wellbeing/purpose/spirituality/what-spirituality.
Dhar, Neera, S. K. Chaturvedi, and Deoki Nandan. 2011. “Spiritual Health Scale 2011: Defining and Measuring 4th Dimension of Health.” Indian Journal of Community Medicine 36, no. 4: 275–82. https://dx.doi.org/10.4103%2F0970-0218.91329.
Egli, Trevor, and Leslee Fisher. 2017. “Christianity and Sport Psychology: One Aspect of Cultural Competence.” Journal of the Christian Society for Kinesiology, Leisure and Sport Studies 4, no. 1: 19–27.
Evangelical Lutheran Church in America. 2019. “ELCA Teaching.” Accessed March 30, 2019. https://www.elca.org/Faith/ELCA-Teaching.
Gamble, Richard, Denise Hill, and Andrew Parker. 2013. “Revs and Psychos: Role, Impact and Interaction of Sport Chaplains and Sport Psychologists Within English Premiership Soccer.” Journal of Applied Sport Psychology 25, no. 2: 249–64. DOI 10.1080/10413200.2012.718313.
Gibbons, Tom, and Stuart Braye. 2019. “Christianity and Social Scientific Perspectives on Sport: Introduction to the Special Issue”. Sport in Society, 22, no. 2: 201–8.
https://www.tandfonline.com/action/showCitFormats?doi=10.1080/17430437.2017.1360563.
Gibbons, Tom, Nick Watson, and Mark Mierzwinski. 2019. “Christianity as Public Religion: A Justification for Using a Christian Sociological Approach for Studying the Social Scientific Aspects of Sport.” Sport in Society, 22, no. 2: 209–23. https://doi.org/10.1080/17430437.2017.1360565.
Glucklich, Ariel. 2015. “Pain and Religious Experience: Theory and Methods.” In Oxford Research Encyclopedia of Religion, 1–19. New York, NY: Oxford University Press.
DOI 10.1093/acrefore/9780199340378.013.42.
Greenstreet, Wendy. 2006. “Clarifying the Concept.” In Integrating Spirituality in Health and Social Care: Perspectives and Practical Approaches, edited by Wendy Greenstreet, 7–19. Seattle, WA: Radcliffe.
Helmreich, Isabella, Angela Kunzler, Andrea Chmitorz, Jochem König, Harald Binder, Michéle Wessa, and Klaus Lieb. 2017. “Psychological Interventions for Resilience Enhancement in Adults (Protocol).” Cochrane Database of Systematic Reviews 2017, no. 2: 1–43. DOI 10.1002/14651858.CD012527.
Hill, Peter, and Kenneth Pargament. 2003. “Advances in the Conceptualization and Measurement of Religion and Spirituality: Implications for Physical and Mental Health Research.” American Psychologist 58, no.1: 64–74. DOI 10.1037/0003-066X.58.1.64.
Hooker, Stephanie, Kevin Masters, and Kate Carey. 2014 “Multidimensional Assessment of Religiousness/Spirituality and Health Behaviors in College Students.” The International Journal for the Psychology of Religion 24, no. 3: 228–40. https://doi.org/10.1080/10508619.2013.808870.
Hoven, Matt. 2019. “Re-Characterizing Confidence Because of Religious and Personal Rituals in Sport: Findings From a Qualitative Study of 15 Year Old Student-Athletes.” Sport in Society 22, no. 2: 296–310. https://doi.org/10.1080/17430437.2017.1360582.
Hoven, Matt, and Samantha Kuchera. 2016. “Beyond Tebowing and Superstitions: Religious Practices of 15-Year-Old Competitive Athletes.” International Journal of Children’s Spirituality 21, no. 1: 52–65. https://dx.doi.org/10.1080/1364436X.2016.1150814.
Hunt, Emily, and Melissa Day. 2019. “Narratives of Chronic Pain in Sport.” Journal of Clinical Sport Psychology 13, no. 1: 1–16. https://doi.org/10.1123/jcsp.2017-0003.
Ivarsson, Andreas, Urban Johnson, Mark Andersen, Ulrika Tranaeus, Andreas Stenling, and Magnus Lindwall. 2017. “Psychosocial Factors and Sport Injuries: Meta-Analyses for Prediction and Prevention.” Sports Medicine 47, no. 2: 353–65. DOI 10.1007/s40279-016-0578-x.
Jirásek, Ivo. (2018). “Religion and Spirituality in Sport.” Oxford Research Encyclopedia of Psychology, 1–21. New York: Oxford University Press. DOI 10.1093/acrefore/9780190236557.013.149
Koenig, Harold. 2012. “Religion, Spirituality, and Health: The Research and Clinical Implications.” International Scholarly Research Network, ISRN Psychiatry Article ID 278730: 1–33. DOI 10.5402/2012/278730.
Koenig, Harold. 2013. “Religion and Spirituality in Coping with Acute and Chronic Illness.” In APA Handbook of Psychology, Religion, and Spirituality (Vol 2): An Applied Psychology of Religion and Spirituality, edited by Kenneth Pargament, 275–95. Washington, DC: American Psychological Association.
Kretschmann, Rolf, and Caroline Benz. 2012. “God has a Plan: Moral Values and Beliefs of Christian Athletes in Competitive Sports.” Journal of Human Sport and Exercise 7, no. 2: 495–519.
DOI 10.4100/jhse.2012.72.14.
Lee Sinden, Jane. 2013. “The Elite Sport and Christianity Debate: Shifting Focus From Normative Values to the Conscious Disregard for Health.” Journal of Religion and Health 52, no. 1: 335–49. DOI 10.1007/s10943-012-9595-8.
Madigan, Daniel, Joachim Stoeber, Dale Forsdyke, Marcus Dayson, and Louis Passfield. 2018. “Perfectionism Predicts Injury in Junior Athletes: Preliminary Evidence From a Prospective Study.” Journal of Sports Sciences 36, no. 5:545–550. https://doi.org/10.1080/02640414.2017.1322709.
Maranise, Anthony. 2013. “Superstition & Religious Ritual: An Examination of Their Effects and Utilization in Sport.” The Sport Psychologist 27, no. 1: 83–91. https://doi.org/10.1123/tsp.27.1.83.
McKnight, Cynthia, and Stephanie Juillerat. 2011. “Perceptions of Clinical Athletic Trainers on the Spiritual Care of Injured Athletes.” Journal of Athletic Training 46, no. 3: 303–11.
https://www.ncbi.nlm.nih.gov/pubmed/21669101.
Mosley, Michael, Desiree Frierson, Yihan Cheng, and Mark Aoyagi. 2015. “Spirituality & Sport: Consulting the Christian Athlete.” The Sport Psychologist 29, no. 4: 371–86. https://dx.doi.org/10.1123/tsp.2013-0123.
Najah, Amira, Abdulaziz Farooq, and Riadh Ben Rejeb. 2017. “Role of Religious Beliefs and Practices on the Mental Health of Athletes with Anterior Cruciate Ligament Injury.” Advances in Physical Education 7, no. 2: 181–90. https://doi.org/10.4236/ape.2017.72016.
Newton, A. Taylor, and Daniel McIntosh. 2010. “Specific Religious Beliefs in a Cognitive Appraisal Model of Stress and Coping.” The International Journal for the Psychology of Religion 20, no. 1: 39–58.
DOI 10.1080/10508610903418129.
Pallai, EmmaLee, and Kim Tran. 2019. “Narrative Health: Using Story to Explore Definitions of Health and Address Bias in Health Care.” Permanente Journal 23: 1-7. https://doi.org/10.7812/TPP/18-052.
Pargament, Kenneth. 2009. “The Spiritual Dimension of Coping: Theoretical and Practical Considerations.” In International Handbook of Education for Spirituality, Care and Wellbeing, edited by Marian de Souza, Leslie Francis, James O’Higgins-Normal, and Daniel Scott, 209–30. Dordrecht, NL: Springer.
Pearce, Michelle. 2013. “Addressing Religion and Spirituality in Health Care Systems.” In APA Handbook of Psychology, Religion, and Spirituality (Vol. 2): An Applied Psychology of Religion and Spirituality, edited by Kenneth Pargament, 527–41. Washington, DC: American Psychological Association.
Pew Research Center. 2018. “Attitudes Toward Spirituality and Religion.” Accessed March 30, 2019. https://www.pewforum.org/2018/05/29/attitudes-toward-spirituality-and-religion.
Plante, Thomas. 2014. “Four Steps to Improve Religious/Spiritual Cultural Competence in Professional Psychology.” Spirituality in Clinical Practice 1, no. 4: 288–92.
https://psycnet.apa.org/doiLanding?doi=10.1037%2Fscp0000047.
Proios, Militiadis. 2017. “Exploring the Relationship between Athletic and Religious Identities.” Trends in Sport Sciences 24, no. 3: 117–22. DOI 10.23829/TSS.2017.24.3-4.
Seitz, Matthew, Michael Sagas, and Daniel Connaughton. 2014. “Religion and College Athletics: Antecedents and Consequences of Student-Athletes’ Perceived Religious Well-Being.” Journal for the Study of Sports and Athletes in Education 8, no. 3: 213–34. DOI 10.1179/1935739714Z.00000000031.
Sools, Aneke, Michael Murray, and Gerben Westerhof. 2015. “Narrative Health Psychology: Once More Unto the Breach.” Journal of Health Psychology 20, no. 3: 239–45. DOI 10.1177/1359105314566616.
Sullivan, Sean. 2019. “Single, Separate or Unified? Exploring Christian Academicians’ Views of the Body, Sport and Religious Experience.” Sport in Society 22, no. 2: 311–25.
https://doi.org/10.1080/17430437.2018.1360584.
Udermann, Brian, Greta Schutte, David Reineke, William Pitney, Mark Gibson, and Steven Murray. 2008. “Spirituality in the Curricula of Accredited Athletic Training Education Programs.” Athletic Training Education Journal 3, no. 1: 21–7. https://natajournals.org/doi/abs/10.4085/1947-380X-3.1.21.
VanderWeele, Tyler. 2016. “Religion and Health: A Synthesis.” In Spirituality and Religion Within the Culture of Medicine: From Evidence to Practice, edited by Michael Petter and John Balboni, 1–39. New York, NY: Oxford University Press.
Watson, Nick. 2011. “Theological and Psychological Reflections on Identity in Sport.” Journal of Religion and Popular Culture 23, no. 2: 182–202. https://dx.doi.org.ezp3.lib.umn.edu/10.3138/jrpc.23.2.182.
Watson, Nick, and Daniel Czech. 2005. “The Use of Prayer in Sport: Implications for Sport Psychology Consulting.” Athletic Insight: The Online Journal of Sport Psychology, 7, no. 4: 26–31.
https://www.athleticinsight.com/Vol7Iss4/PrayerinSports.htm.
Watson, Nick, and Mark Nesti. 2005. “The Role of Spirituality in Sport Psychology Consulting: An Analysis and Integrative Review of Literature.” Journal of Applied Sport Psychology 17, no. 3: 228–39.
DOI 10.1080/10413200591010102.
Wiese-Bjornstal, Diane. 2000. “Spirit, Mind, and Body.” Athletic Therapy Today 5, no. 1: 41–2. https://doi.org/10.1123/att.5.1.41.
Wiese-Bjornstal, Diane. 2018. “Sociocultural Aspects of Sport Injury and Recovery.” In Oxford Research Encyclopedia of Psychology, 1–29. New York: Oxford University Press.
DOI 10.1093/acrefore/9780190236557.013.174.
Wiese-Bjornstal, Diane. 2019a. “Christian Beliefs and Behaviours as Health Protective, Resilience, and Intervention Factors in the Context of Sport Injuries.” In Sport Psychology and Christianity: Welfare, Performance and Consultancy, edited by Brian Hemmings, Nick Watson, and Andrew Parker, 54–70. London, UK: Routledge.
Wiese-Bjornstal, Diane. 2019b. “Psychological Predictors and Consequences of Injuries in Sport Settings.” In APA Handbook of Sport and Exercise Psychology (2nd ed., Vol. 1): Sport Psychology, edited by Mark Anshel, 697–726. Washington, DC: American Psychological Association.
Wiese-Bjornstal, Diane, Aynsley Smith, Shelly Shaffer, and Michael Morrey. 1998. “An Integrated Model of Response to Sport Injury: Psychological and Sociological Dynamics.” Journal of Applied Sport Psychology 10, no. 1: 46–69. https://www.tandfonline.com/doi/abs/10.1080/10413209808406377.
Wiese-Bjornstal, Diane, Kristin Wood, Francesca Principe, and Emma Schwartz. 2019. “Religiosity and the Use of Religious Ways of Coping Among Christian Athletes During Sport Injury Recoveries.” Paper presented at the 15th European Congress of Sport and Exercise Psychology, Münster, Germany.
Wiese-Bjornstal, Diane, Kristin Wood, Andrew White, Amanda Wambach, and Victor Rubio. 2018. “Exploring Religiosity and Spirituality in Coping With Sport Injuries.” Journal of Clinical Sport Psychology. Advance online publication, 1–35. https://doi.org/10.1123/jcsp.2018-0009.
Williams, Jean, and Mark Andersen. 1998. “Psychosocial Antecedents of Sport Injury: Review and Critique of the Stress and Injury Model.” Journal of Applied Sport Psychology 10, no. 1: 5–25.
https://doi.org/10.1080/10413209808406375.
Worthington, Everett Jr., Caroline Lavelock, Darryl Van Tongeren, Charlotte van OyenWitvliet, Brandon Griffin, Chelsea Greer, David Jennings II, Yin Lin, Kayla Jordan, and Man Yee Ho. 2014. “The Contributions of Christian Perspectives and Practices to Positive Psychology.” In Religion and Spirituality Across Cultures: Cross-Cultural Advancements in Positive Psychology (Vol. 9), edited by C. Kim-Prieto, 47–70. Dordrecht, NL: Springer.
Author Bio: Diane M. Wiese-Bjornstal (PhD) is a Professor of Sport and Exercise Psychology, Associate Director of the School of Kinesiology, and Director of the Sports Medicine Psychology Laboratory at the University of Minnesota Twin Cities, USA. She is a Certified Mental Performance Consultant (CMPC) and a Fellow in the National Academy of Kinesiology, the Association for Applied Sport Psychology, and the Society of Health and Physical Educators. Her research focuses on sports medicine psychology, which encompasses multidisciplinary theory, research, and practice in the social, psychological, and behavioural aspects of injury prevention and rehabilitation among physically active participants across the lifespan. Recent publication venues include the Journal of Clinical Sport Psychology, Kinesiology Review, and the Scandinavian Journal of Medicine and Science in Sports. Dr. Wiese-Bjornstal’s professional service encompasses election as a member of the Science Board of the United States President’s Council on Fitness, Sports and Nutrition and Associate Editor responsibilities for Elevate Health, Research Quarterly for Exercise and Sport, and the Journal of Applied Sport Psychology. A former youth and collegiate volleyball and softball coach, she serves as an Affiliated Scholar with the Tucker Center for Research on Girls & Women in Sport at the University of Minnesota.