












































MANUSCRIPT TYPE


EVIDENCE-TO-PRACTICE REVIEW  

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                    Volume 6 – Issue 2 – September 2023 
 

Interventions for the Mind, Body, and Spirit of NCAA Student-Athletes: 
An Evidence to Practice Review  
Molly M. Osborn, MS, LAT, ATC*; Victoria A. Williams, MS, SCAT ATC‡; Allison B. Smith, PhD. LAT, ATC†; Zachary K. Winkelmann, 
PhD, SCAT, ATC, CHSE§ 
*Florida International University, Miami, FL; ‡Lexington High School, Lexington, SC; †Otterbein University, Westerville, OH; 
§University of South Carolina, Columbia, SC 
 

 
ABSTRACT 
Life as an athlete in the National Collegiate Athletic Association (NCAA) can enrich and play an integral part in a young student-
athlete's development. Consequently, this lifestyle comes with its own stressors that affect one’s physical, spiritual, and psychosocial 
well-being. These issues can affect various aspects of a student-athlete’s life, including their performance in sports, school, and social 
settings. Recent studies have begun connecting these domains directly to the health and well-being of NCAA student-athletes, leading 
to new evidence focused on the best intervention protocols for the biopsychosocial-spiritual (BPSS) model of health. A systematic 
review was conducted using five electronic databases. Twenty studies were included in this review, each assessing how effective 
existing interventions were at helping the health outcomes of BPSS factors in NCAA student-athletes specifically. The most used 
interventions in the reviewed literature included cognitive behavioral therapy, cognitive dissonance, and mindfulness. Results 
suggested that the interventions had positive BPSS effects on student-athlete stressors. This data can be especially beneficial for 
healthcare providers, such as athletic trainers, who work directly with them daily. The overall health of NCAA student-athletes should 
be considered when creating treatment protocols and BPSS-based programs should be incorporated due to their demonstrated 
positive effects.  
Content Focus: Health Information Technology  
 
Correspondence 
Dr. Zachary Winkelmann, 1300 Wheat Street, Columbia, SC 29208. 
E-mail: winkelz@mailbox.sc.edu   
Twitter: @zachwinkelmann 
 
Full Citation 
Osborn MM, Williams VA, Smith AB, Winkelmann ZK. Interventions for the mind, body, and spirit of NCAA student-athletes: 
An evidence to practice review. Clin Pract Athl Train. 2023;6(2): 15-20. https://doi.org/10.31622/2023/0006.02.2.   
 

 
ORIGINAL REFERENCE 
Brown BJ, Jensen JF, Hodgson JL, Brown RE, Rappleyea DL, Schoemann AM. Mind, body, spirit, and 
sport: A systematic review examining the effectiveness of interventions targeting the biopsychosocial-
spiritual health of NCAA student-athletes. J Study Sports Athl Educ. 2020;14(3):235-261. 

SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 
The National Collegiate Athletic Association (NCAA) has about 500,000 participants yearly.1 Sports can be 
an experience that helps athletes grow in confidence, maturity, social skills, work ethic, problem-solving, 
acceptance, and much more.1 But for others, the addition of sports to college lives can prove to be too much 
when balancing social, spiritual, psychological, and biological stressors.2 In recent years, researchers have 
begun studying these stressors of NCAA student-athletes and their connection to risky behaviors, mental 
health problems, and spirituality.3 Data gathered from the National College Health Assessment identified 
that half of male NCAA athletes and almost three out of four female NCAA athletes described experiencing 
overwhelming anxiety in the last year.4 Furthermore, over 5% of student-athletes have experienced suicidal 
ideation, and 30% of sudden deaths have come from suicide and drug-related activities.4-6 It has been 
hypothesized that these behaviors are based on an inability to cope with the pressure from sports and 
school.7 With this type of data surfacing, the NCAA acknowledged mental health as being the top health 

mailto:winkelz@mailbox.sc.edu
https://doi.org/10.31622/2023/0006.02.2


Interventions for the Mind, Body, and Spirit of NCAA Student-Athletes: An Evidence to Practice Review 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                    Volume 6 – Issue 1 – September 2023 
  

concern for student-athletes.8 Athletic trainers in the collegiate setting work directly with this population daily; 
knowing what afflicts them physically is equally important as knowing what afflicts them mentally. The athletic 
trainer must aid in preventing, educating, and referring issues involving the patient’s mental, social, and 
spiritual health and well-being. Therefore, this evidence-to-practice review aims to explore successful 
interventions managing the biopsychosocial-spiritual (BPSS) health of NCAA student-athletes.  

SUMMARY OF LITERATURE 

To identify studies that highlighted interventional effects on the BPSS model, the authors of the guiding 
systematic review searched CINAHL, PsycINFO, PubMed, ERIC, and SPORTDiscus for articles. The search 
terms included many words related to “intercollegiate athletes,” “depression,” “stress,” “body image,” 
“treatment,” and “spirituality.” Those search terms revealed 420 unique articles, which, after a review of 
titles and abstracts, yielded 75 studies for a full review. For the full text to be reviewed, the study had an 
intervention to affect the BPSS model, be peer-reviewed, be published in English, and study NCAA student-
athletes. If the reported outcome was biological, the study also had to report a psychological, social, or 
spiritual outcome. A double review system provided inter-rater consistency to the full-text review inclusions 
and exclusions. Once studies were deemed relevant, researchers used the Cochrane collaboration tools and 
the Quality Assessment Tool for Quantitative Studies (QATSQ) to assess bias, study design, methods, and 
other factors that affect the quality of the study. The scores from these quality assessments were used to rate 
the studies as either weak, moderate, or strong; the strong research was kept, and the weak and moderate 
articles were not included. Of these reviews, eighteen articles remained and were included, and two 
additional articles were selected after hand-searching the reference lists of the chosen articles.  

SUMMARY OF INTERVENTIONS  

These studies used various psychological, mindfulness, educational, and social interventions. Most interventions 
were single administration education or intervention, 7 to 14 sessions of therapy or group intervention, or 
season-long interventions. Four studies used forms of cognitive behavioral therapy (CBT) administered by a 
therapist or a sports psychologist, while another study used normative therapy techniques via interactive 
computer programs. Six studies focused on mindfulness training related to performance measures, anxiety, 
stress, and heart rate. These techniques were either self-guided or conducted by a trained meditation 
instructor. The three studies aimed to investigate if cognitive dissonance and healthy weight education 
programs implemented by psychologists impacted body image and disordered eating habits. Six studies 
had at least one group given an educational intervention focused on stress, substance abuse, or health. Only 
one study looked at social support from the athletic training staff and its impact on the BPSS model of health. 
Several studies used more than one of the interventions mentioned earlier and a control group to compare 
3 or 4 levels of an independent variable.    

SUMMARY OF OUTCOMES 

Because the BPSS model encompasses many aspects of a person, the outcomes needed to study it should be 
equally encompassing. These studies researched objective and subjective biological, psychological, social, 
and spiritual wellness measures. Each study chose its unique biological measures, including body fat 
percentage, resting heart rate, illness/injury days, and several visits to a health center. Psychological 
outcomes examined body dissatisfaction, thinness idealization, self-esteem, sports anxiety, bulimic pathology, 
and anxiety symptoms. To assess the social impacts of the interventions, they measured alcohol use, alcohol-
related consequences, levels of social cohesion, and team leadership skills. Mindfulness scores and overall 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                    Volume 6 – Issue 1 – September 2023 
  

life satisfaction appraised improvements in spirituality. A few studies in the systematic review also viewed 
qualitative outcomes in addition to the quantitative measures collected. These included patients’ preferences 
of intervention types and their subjective beliefs of the effectiveness of the treatments. They collected 
coaches’ performance, leadership skills, and coping skills ratings of players who received the interventions 
compared to the control groups. In addition, studies qualitatively assessed how team group activities, like 
campouts and meetings, compared to more formal interventions in affecting the BPSS outcomes.  

FINDINGS AND CLINICAL IMPLICATIONS 

Results from the guiding systematic review identified improvements in BPSS health outcomes when 
interventions based on mindfulness and cognitive-behavioral approaches were implemented (Table 1). 
Mindfulness involves specific meditative actions (yoga, deep breathing exercises, etc.) that help to decrease 
a patient’s reactivity to stressful internal problems and help them develop skills to better self-reflect.9 
Cognitive-behavioral approaches involve treatments that help patients focus on maladaptive thoughts and 
behaviors to better understand and work through their emotions during high-stress situations.10 Research from 
one study found that these intervention types showed significant decreases in the number of injured days, 
sick days, and visits to the health center,11 and another study showed improvements in sports performance, 
concentration, and anxiety.12 Additional research revealed in-person programs focusing on cognitive-
behavioral and motivational interviewing techniques positively affected student-athlete substance use and 
abuse.13 The participants had decreases in the frequency and amount of alcohol use and alcohol-related 
penalties, as well as increased protective behaviors. Athletic trainers could incorporate mindfulness and/or 
cognitive-behavioral type activities by starting with guided awareness of their body in space, their breath, 
and their thoughts while in a relaxed state and leading into self-guided meditative control over these same 
factors when in stressful situations.14 

Table 1. Definition of Cognitive Therapies  
Intervention Type  Definition  
Cognitive Behavioral Therapy  A treatment method that focuses on maladaptive behaviors and 

thoughts of individuals. It enhances the individual’s attentiveness 
and understanding of their emotions, heightens their cognitive 
flexibility, and increases their ability to work through anxious, 
negative, and avoidant behaviors and thoughts.10  

Mindfulness  A treatment method that uses exercises such as yoga, seated 
meditation, and deep breathing to help an individual decrease 
their reactivity to negative internal issues and increase their ability 
to self-reflect by focusing on the orientation of their bodies in that 
present moment.9  

Cognitive Dissonance  A theory that states an individual’s preferences are modulated by 
the act of choosing between two alternatives. This can cause 
psychological tension and stress and can be reduced by 
reevaluating the alternatives post-decision-making.21  

 

Several studies showed positive outcomes related to body positivity and disordered eating. One study found 
that dissonance prevention and healthy weight education decreased restrictive eating habits, bulimic 
pathologies, weight concerns, and thinness ideals.15 Another study showed that those interventions also 
decreased dietary restraint in those with dietary restraint issues.16 Health education intervention focusing on 
positive health behaviors was also linked to decreased body dissatisfaction and thinness idealization.17 Data 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                    Volume 6 – Issue 1 – September 2023 
  

from multiple studies determined that biopsychosocial-spiritual interventions also helped with depressive 
symptoms. One of these studies used a 10-week individual/group psychological training program focused 
on relaxation, positive self-talk, and the use of imagery, which demonstrated positive adjustments to self-
confidence.18 Another study found that implementation of a 7-week stress management program decreased 
anxiety and increased psychological abilities, sports performance, and educational performance.13  

Implementing mindfulness and meditation programs showed increased awareness, mindfulness, and focus on 
the present and individual goals.19,20 In one study, it led to greater goal-directed energy.16 The results 
discussed can heavily influence clinical practice in the collegiate setting. For athletic trainers working with 
NCAA athletes, many of the patients they work with will experience some of the issues described above 
(substance abuse, loss of concentration, anxiety, low self-confidence, depression, etc.). Athletic trainers must 
know how to recognize these concerns and which interventions to seek out for their patients. Athletic trainers 
possessing the ability to help with matters outside of just sport-related issues can be critical in increasing their 
patients' overall quality of life.  

This review showed great support for CBT techniques. Athletic trainers may not have the necessary training 
to employ this on their own; therefore, enlisting the help of a psychologist, social worker, or counselor trained 
in CBT may be beneficial. Referring athletes to the appropriate mental health specialist when they are 
experiencing difficulties in rehab, school, and social situations may help their overall wellness and improve 
their sports performance. The research presented in this article has shown how interconnected the mind, body, 
and spirit are; if one aspect fails, it can adversely affect the others. Conversely, addressing one of those 
aspects can result in healing the whole person. This can lead to safer behaviors, better health-related 
outcomes, and increased sports performance. Having the capability to help a patient or seek help on behalf 
of a patient in all four of these areas should be the standard of care for every athletic trainer, especially in 
the collegiate setting. 

CLINICAL BOTTOM LINE 

Being an NCAA student-athlete can have adverse effects on the BPSS aspects of one’s daily life. Those 
working directly with this population, especially athletic trainers, need to address and help manage these 
patients' specific social, spiritual, biological, and psychological issues. Athletic trainers play a significant role 
in the physical health of a student-athlete, and by extension, they have considerable influence over mental 
health. Recognition is one of the first skills athletic trainers need when dealing with BPSS issues. To do this, 
proper training and education need to be available and tailored to athletic training on issues like anxiety, 
depression, and substance use/abuse. Once recognized, the athletic trainer can implement the appropriate 
plan of care. Regarding NCAA student-athletes, there is no set intervention that guarantees positive results 
for all facets of the patient’s BPSS character. So, it is particularly important that athletic trainers continue to 
learn about various interventions that have proved successful in similar populations. 

These studies outline major ways athletic trainers can affect the BPSS well-being of their athletes. The most 
prominent way is through educational interventions. Athletic trainers can implement whole team or individual 
educational programs, which, as discussed previously, can be especially effective for disordered eating and 
substance abuse. Pre-emptive educational programs could help those at risk for serious issues and improve 
the overall well-being of the team unit. The comprehensive health of NCAA student-athletes is constantly 
challenged by life and sports stressors, and this should be a priority for everyone involved in their healthcare 
team. 



Interventions for the Mind, Body, and Spirit of NCAA Student-Athletes: An Evidence to Practice Review 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                    Volume 6 – Issue 1 – September 2023 
  

Another method to address the patient's well-being is by athletic trainers incorporating mindfulness 
techniques into the daily plan of care and rehabilitation programs. Adding breathing techniques, stress 
management, visualization, and/or yoga into a patient’s rehabilitation plan could improve both their mental 
and physical health. Successful interventions mentioned in this review include but are not limited to mindfulness 
meditations, motivational interviewing, life skills training, breathing techniques, individual and group sessions, 
substance use prevention programs, managing cognitive-behavioral stress techniques, and more. Different 
sports have various obstacles that can negatively impact a student-athlete’s BPSS model. Athletic trainers 
benefit from researching what has worked well for common BPSS issues in the sports in which they work. This 
article represents a great starting point to see what the data indicates are the most effective interventions 
for collegiate student-athletes in one sport compared to another. Further research should be conducted on 
the BPSS model and related intervention strategies.  

 

REFERENCES   

1. Chen S, Snyder S, Magner M. The effects of sport participation on student-athletes and non-athlete 
students' social life and identity. J Issues Intercoll Athl. 2010:176-193. 

2. Malinauskas R. The associations among social support, stress, and life satisfaction as perceived by injured 
college athletes. Soc Behav Pers. 2010;38(6):741-752. 
http://dx.doi.org/10.2224/sbp.2010.38.6.741.  

3. Kimball A, Freysinger VJ. Leisure, stress, and coping: the sport participation of collegiate student-
athletes. Leis Sci. 2003;25(2/3):115. https://psycnet.apa.org/doi/10.1080/01490400306569.  

4. American College Health Association. American College Health Association-National College Health 
Assessment II: Reference Group Executive Summary Spring 2019. Silver Spring, MD: American College 
Health Association; 2019.  

5. Miller KE, Hoffman JH. Mental well-being and sport-related identities in college students. Sociol Sport J. 
2009;26(2):335-356. https://doi.org/10.1123%2Fssj.26.2.335.  

6. Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S. Incidence and causes of sudden death in 
U.S. college athletes. J Am Coll Cardiol. 2014;63(16):1636-1643. 
https://doi.org/10.1016/j.jacc.2014.01.041.  

7. DeFreese JD, Smith AL. Teammate social support, burnout, and self-determined motivation in collegiate 
athletes. Psychol Sport Exerc. 2013;14(2):258-265. 
https://doi.org/10.1016/j.psychsport.2012.10.009.  

8. Burnsed B. NATA, NCAA, and others announce mental health recommendations. 2013. Published 
September 25th, 2013. 

9. Hofmann SG, Gómez AF. Mindfulness-based interventions for anxiety and depression. Psychiatr Clin 
2017;40(4):739-749. https://doi.org/10.1016%2Fj.psc.2017.08.008.  

10. Oar EL, Johnco C, Ollendick TH. Cognitive behavioral therapy for anxiety and depression in children 
and adolescents. Psychiatr Clin North Am. 2017. https://doi.org/10.1016/j.psc.2017.08.002.  

11. Perna FM, Antoni MH, Baum A, Gordon P, Schneiderman N. Cognitive behavioral stress management 
effects on injury and illness among competitive athletes: a randomized clinical trial. Ann Behav Med. 
2003;25(1):66-73. https://doi.org/10.1207/s15324796abm2501_09.  

12. Holm JE, Beckwith BE, Ehde DM, Tinius TP. Cognitive-behavioral interventions for improving performance 
in competitive athletes: a controlled treatment outcome study. Int J Sport Psychol. 1996;27(4):463-475. 

13. Cimini MD, Monserrat JM, Sokolowski KL, Dewitt-Parker JY, Rivero EM, McElroy LA. Reducing high-risk 
drinking among student-athletes: the effects of a targeted athlete-specific brief intervention. J Am Coll 
Health. 2015;63(6):343-352. https://doi.org/10.1080/07448481.2015.1031236.  

14. Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in Mindfulness-Based Cognitive 
Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' 

http://dx.doi.org/10.2224/sbp.2010.38.6.741
https://psycnet.apa.org/doi/10.1080/01490400306569
https://doi.org/10.1123%2Fssj.26.2.335
https://doi.org/10.1016/j.jacc.2014.01.041
https://doi.org/10.1016/j.psychsport.2012.10.009
https://doi.org/10.1016%2Fj.psc.2017.08.008
https://doi.org/10.1016/j.psc.2017.08.002
https://doi.org/10.1207/s15324796abm2501_09
https://doi.org/10.1080/07448481.2015.1031236


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mindfulness practice and its association with outcomes. Behav Res Ther. 2017;95:29-41. 
https://doi.org/10.1016/j.brat.2017.05.004.  

15. Becker CB, McDaniel L, Bull S, Powell M, McIntyre K. Can we reduce eating disorder risk factors in female 
college athletes? A randomized exploratory investigation of two peer-led interventions. Body Image. 
2012;9(1):31-42. https://doi.org/10.1016/j.bodyim.2011.09.005.  

16. Smith A, Petrie T. Reducing the risk of disordered eating among female athletes: a test of alternative 
interventions. J Appl Sport Psychol. 2008;20(4):392-407. 
https://psycnet.apa.org/doi/10.1080/10413200802241832.  

17. Abood DA, Black DR. Health education prevention for eating disorders among college female athletes. 
Am J Health Behav. 2000;24(3):209-219. https://doi.org/10.5993/AJHB.24.3.6  

18. Savoy C, Beitel P. The relative effect of a group and group/individualized program on state anxiety 
and state. J Sport Behav. 1997;20(3):364. 

19. Baltzell A, Akhtar VL. Mindfulness meditation training for sport (MMTS) intervention: impact of MMTS 
with division I female athletes. J Happiness & Well-Being. 2014;2(2):160-173. 

20. Goodman FR, Kashdan TB, Mallard TT, Schumann M. A brief mindfulness and yoga intervention with an 
entire NCAA Division I athletic team: An initial investigation. Psychol Conscious. 2014;1(4):339. 
https://psycnet.apa.org/doi/10.1037/cns0000022.  

21. Colosio M, Shestakova A, Nikulin VV, Blagovechtchenski E, Klucharev V. Neural mechanisms of cognitive 
dissonance (revised): An EEG study. J Neurosci. 2017;37(20):5074-5083. 
https://doi.org/10.1523/JNEUROSCI.3209-16.2017.  
 

https://doi.org/10.1016/j.brat.2017.05.004
https://doi.org/10.1016/j.bodyim.2011.09.005
https://psycnet.apa.org/doi/10.1080/10413200802241832
https://doi.org/10.5993/AJHB.24.3.6
https://psycnet.apa.org/doi/10.1037/cns0000022
https://doi.org/10.1523/JNEUROSCI.3209-16.2017

	ABSTRACT

