By Timothy Neal, MS, ATC, AT

The athletic trainer is putting in long days at their place of employment. Along with the long daily hours, the AT has had few days off in the past three months. Add in the pressures from patients/athletes, coaches, parents and administrators relative to expectations of their job outcomes, and a “perfect storm” of potential mental health challenges is developing for the AT. To top it off, given the hours worked and the stressors of the position, the AT has little time, opportunity or inclination for a life outside of their job. This type of scenario is common in the athletic training profession. What can the AT do to prevent this “perfect storm” of potential mental health issues from affecting them?

As chair of two NATA consensus statements on psychological concerns in athletes (collegiate in 2013, secondary school in 2015), a member of the NCAA Task Force on Student Athlete Mental Health and Wellness and NATA liaison to Mental Health America, I have extensively studied and worked with outstanding mental health care professionals, and have been very involved in forwarding athlete mental health wellness. The time has come to address the mental health of those caring for the physically active, the athletic trainer.

The AT provides health care for their patient/athlete in various settings, many of which are fraught with pressure, like those found in competitive athletics. ATs are expected to be selfless, put other’s needs first, work long hours and perform at high levels to help their patient/athlete recover. These expectations result in work-related stress. Stress is the impact of external job demands on a worker’s internal experience, and the subsequent outcomes of this process.

Stress impacts the worker’s performance by reducing the worker’s cognitive function and capacity to perform complex skills. As stress continues to develop, and if measures aren’t taken to reduce that growing stress, ATs whose work settings experience high demands with low resources to address that stress run the risk of burnout.

The three hallmarks of burnout are overwhelming mental and physical exhaustion; feelings of frustration, anger and cynicism; and a sense of failure or ineffectiveness. This sense of burnout, as a result of a prolonged response to chronic interpersonal stressors on the job, impairs social and personal functioning. Many ATs feels less than “professional” with these negative feelings, and question their ability and commitment to a great profession, with some leaving athletic training to pursue other careers. Certainly, stress is felt differently for each individual. However, when an individual stress experience is trying to function in a complex work environment and relationships, it may negatively affect the individual’s concept of themselves and others.

The three core components of burnout are:

Emotional exhaustion as a result of being overextended and depleted of emotional resources. The AT feels drained and all used up, barely able to face another day, practice, game or patient/athlete with a problem.

Reduced personal accomplishments at work. The AT feels frustrated or inadequate about their ability to help their patient/athlete, and to enhance their work circumstances.

Depersonalized attitude toward others. The AT adopts a callous or emotionally detached response to others. In extreme cases, depersonalization may devolve into dehumanizing of others.

Whenever the dynamic of burnout is present, the specter of mental health disorders lurks for the AT. Being a health care professional doesn’t provide immunity from developing a mental health disorder. Rather, the inability to effectively deal with stress which leads to burnout may put the AT at risk for developing a mental health disorder, or exacerbating a present mental health disorder that is under control.

Much of today’s preparation of ATs is via training of skills. Unfortunately, the AT does not receive sufficient preparation for the emotional reality of their responsibilities and its impact on their personal functioning and self-fulfillment. The AT can’t always control their work setting stressors. In reality, very few people, in whatever profession or job, can control their work-related demands that are stressful.

Here are some considerations for the AT to “take care of yourself”:

Workout, meditate or practice yoga on a regular basis.

Try to establish a daily routine, even if it is busy. Disruptions of routine may cause stress.

Talk to others you trust about your feelings in a safe and productive way.

It is OK to have a bad moment or day. It is normal to react to abnormal events such as an argument with a coach or a treatment plan that is not making progress. Remember, no one goes through life undefeated. There will be bad days and weeks. Look toward the next day or opportunity to make something positive happen.

Take time for yourself. Make time for a hobby or relaxation daily, even if for a short period of time. If you have a family, spend as much time as you can with them; they are your greatest support unit.

Take control. If you feel as if you are being affected by a stressful event, or being overtaken by stress, step away from the situation to regroup, refocus and recharge. Feeling are normal, it is the behavior as a result of a negative feelings that may exacerbate a situation.

Try not to dwell on a fleeting negative emotion. Ruminating about a negative feeling or situation gives it momentum to take over your day in a bad way.

Practice good nutrition. Be sure to eat; don’t skip meals. Be well hydrated.

Get enough sleep. Take breaks; leave the building to run an errand or just take a walk around the building or outside.

Don’t abuse alcohol or drugs.

For departmental managers and leaders, encourage a culture of “living your life.” Certainly, ATs work long and hard. Don’t make your staff feel compelled to be at work when not needed just to “be around”; let them know it is OK to leave for a period of the day or go home early, if possible, to enjoy a life outside of athletic training. Also, when possible, schedule mornings and days off, or reduced work hours for your staff during the competitive season on team off-days.

Know your resources. If an AT feels the signs and symptoms of burnout or a mental health disorder, seek professional assistance through your place of employment.

A good resource for learning about mental health and wellness, and steps to address stress to prevent mental health disorders can be found at Mental Health America’s website.

The AT is a caring health care professional who is exposed to stressful events on a daily basis. Knowing how to recognize how stress may affect them and learning about prevention and management of stress strategies is important. “Athletic trainers, take care of yourself” is good advice for the AT so they can do what they do so well, taking care of the physically active.

In next week's blog post, Randy Cohen, ATC, DPT, will address the importance of knowing your athletes at a personal level and having an official mental health management plan.

Timothy Neal, MS, ATC, AT, is the clinical education coordinator and an assistant professor in the Athletic Training Education Program at Concordia University Ann Arbor.