1. Drew Brannon, Ph.D. Licensed Psychologist

2. Brief background Case of Madi Diagnosis and management Return to play considerations Prevention and protocol Discussion

3. Publics understanding vs. actual service delivery Variability in training has created confusion

5. Clinical Psych Sport Psych

6. Depression Anxiety Grief/loss Sexual trauma Eating disorders Anger

7. Performance Anxiety Burnout Focus Injury Confidence Role changes Career transition Goal setting Motivation

8. Collegiate student-athlete High level soccer player Key team contributor

9. Sister: diagnosed with ADHD Mother: notable symptoms of anxiety Madi: first collegiate student-athlete in family Both parents busy/successful working professionals

10. One previous ACL tear during high school (11 th grade) Extensive physical therapy Complicated rehab process Slow recovery

11. Diagnosed with ADHD @ 7 y/o Prescribed Focalin XR (20mg) History of disruptive/risk taking behaviors History of depressive episodes since age 14

12. Fall preseason camp prior to Sophomore year Three-a-day practices Day 9

13. MRI confirms tear Surgery scheduled Procedure performed

14. 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

15. (Tracey, 2003; Leddy et. al.,. 1994; Udry, 1997; Heil, 1993) Greatest mood disturbance during initial phase following injury Early recovery process greatest period of emotionality Critical point of psychological intervention occurs in first three weeks post-injury

16. Disengagement from team Perceived lack of interest from coaching staff Overly involved parents Need for attention Sense of helplessness

17. Absence of sport removes her only known coping mechanism Now has more time on her hands Peer group heavily involved in alcohol use/abuse

18. Disagreement regarding rehab Poor compliance with rehab Impatience from all parties

19. Initial consult mandated by team physician Gathering of information difficult due to lack of cooperation Was willing to discuss other things, which slowly built rapport

20. Madi becomes more willing to attend Disclosure of family dynamics clarifies nature of several problem areas Trusted information eventually shared

21. Onset of depressive symptoms Poor self-care practices Lack of regard for behavior Effects of social choices

22. Inconsistent motivation Unhappy with role on team Lack of trust toward coaches Identity confusion

23. Extensive clinical interviewing Beck Depression Inventory Collateral information Psychiatric consult

24. Weekly counseling sessions Medication management Consults with sports medicine staff

25. DenialAngerChallenged

26. Willing and motivated toward rehab Improved sleep and dietary habits Increased independence from parents More engagement with support systems

27. Clearance from sports medicine staff Psychological symptoms to benefit from return Significant anxiety necessitated controlled return Hesitation about return due to fear of regression

28. Cognitive-behavioral therapy Self-talk affirmations Guided imagery/visualization

29. Watched game tape Read old press releases Talked to high school and club coaches

30. Role of psychological services in long-term rehab Sport psychology consult protocol (pre-op, post-op, monthly follow-up, PRN) Comprehensive treatment team approach

31. Qualified team leaders Life skills programming Caring coaches

32. Power of the shared experience Knowing youre not alone Receiving ideas for getting through adversity Better use of time that other activities?

33. What could I have done differently in this case to improve the situation and/or outcome? What are critical psychological factors for sports medicine professionals to consider in athletes during long-term rehab?