Home⇛Psychology and Education: A Multidisciplinary Journal⇛vol. 48 no. 6 (2025)

Sports Mental Toughness and Pain Anxiety Among Injured Filipino Student-Athletes

Leanard Kim Leanard Kim | Mary Paulynne Calicdan | Jesrianne Louise Manio | Reigne Carla Pascual | Lei Khrysta Antoni Sanguir | Jade Ibhar Cuambot | Alvin Jacob

Discipline: others in psychology

 

Abstract:

Mental toughness and pain anxiety are critical psychological factors in student-athletes’ psychological health and ability to cope with the physical and emotional challenges of recovery. While mental toughness is often regarded as a protective attribute that enhances resilience, emerging evidence suggests it may also interact with pain-related anxiety in many complex ways, potentially hindering recovery when accompanied by pressure to return to play. This study investigated the relationship between mental toughness and pain anxiety using a sequential explanatory mixed-method design. Through the said method, the study first conducted a quantitative phase (Phase 1) with 124 Filipino collegiate student-athletes (18–25 years) who had sustained significant injuries. Participants completed the Sports Mental Toughness Questionnaire and the Pain Anxiety Symptoms Scale-20. Regression analysis revealed a significant model, F(1, 122) = 12.50, p < .001, with SMT accounting for 9.3% of the variance in PA (R² = 0.093). SMT was a significant positive predictor of PA (B = 0.934, β = 0.305, p < .001), contrary to the hypothesized negative association. In Phase 2, nine participants were purposively sampled and participated in semi-structured interviews, which were analyzed using Braun and Clarke’s thematic analysis. Integration was achieved by using qualitative insights to explain the quantitative trend. Four themes emerged: (1) mental toughness as a double-edged factor, (2) psychoemotional challenges during recovery, (3) post-injury adjustments and coping, and (4) adverse environmental influences. These themes clarified how high SMT could coexist with elevated PA due to internalized pressure and expectations to recover quickly. The findings highlight the paradoxical role of SMT, suggesting that while it supports resilience, it may also intensify pain and anxiety. Interventions should aim to strike a balance between mental toughness and adaptive emotional processing.



References:

  1. Abrams, M. P., Carleton, R. N., & Asmundson, G. J. (2007). An exploration of the psychometric properties of the PASS-20 with a nonclinical sample. The Journal of Pain, 8(11), 879–886. https://doi.org/10.1016/j.jpain.2007.06.004
  2. Ahlquist, S., Cash, B. M., & Hame, S. L. (2020). Associations of early sport specialization and high training volume with injury rates in National Collegiate Athletic Association Division I athletes. Orthopaedic journal of sports medicine, 8(3), 2325967120906825.
  3. Ahrendt, A., & Tao, M. (2025, March 25). How can a sports injury affect mental health?. Nebraska Medicine Omaha, NE. https://www.nebraskamed.com/health/conditions-and-services/sports-medicine/how-can-a-sports-injury-affect-mental-health
  4. Aitchison, B., Rushton, A. B., Martin, P., Barr, M., Soundy, A., & Heneghan, N. R. (2021). The experiences and perceived health benefits of individuals with a disability participating in sport: A systematic review and narrative synthesis. Disability and Health Journal, 15(1), 101164. https://doi.org/10.1016/j.dhjo.2021.101164
  5. Akbar, A., Karim, Z. A., Zakaria, J., Kurniawan, R., Dwatra, F. D., & Cahyani, F. I. (2024). Understanding Mental Toughness in Student-Athletes: Insights from Sport Psychology. Retos, 54, 1–9. https://doi.org/10.47197/retos.v54.102230
  6. Alhazmi, A. A., & Kaufmann, A. (2022). Phenomenological qualitative methods applied to the analysis of Cross-Cultural experience in novel educational social contexts. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.785134
  7. American Psychiatric Association. Anxiety Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. American Psychiatric Association; 2022: pp. 215- 231
  8. Arcangel, K. C. B. (2022). Self–Efficacy and mental toughness of Philippine National athletes: A basis for enhanced motivational program. Zenodo (CERN European Organization for Nuclear Research). https://doi.org/10.5281/zenodo.7486705
  9. Ardern, C. L., Österberg, A., Tagesson, S., Gauffin, H., Webster, K. E., & Kvist, J. (2014). The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 48(22), 1613–1619. https://doi.org/10.1136/bjsports-2014-093842
  10. Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. (2012). Fear of reinjury in people who have returned to sport following anterior cruciate ligament reconstruction surgery. Journal of Science and Medicine in Sport, 15(6), 488–495. https://doi.org/10.1016/j.jsams.2012.03.015
  11. Arora, T., Grey, I., Östlundh, L., Alamoodi, A., Omar, O. M., Lam, K. B. H., & Grandner, M. (2022). A systematic review and meta-analysis to assess the relationship between sleep duration/quality, mental toughness and resilience amongst healthy individuals. Sleep medicine reviews, 62, 101593.
  12. Bahdur, K., Pillay, L., & Dell’oca, D. (2022). Sport during the COVID-19 Bio-bubble: Wellness and opinions in South African elite football. South African Journal of Sports Medicine, 34(1). https://doi.org/10.17159/2078-516x/2022/v34i1a12528
  13. Bardel, M., Woodman, T., Perreaut-Pierre, E., & Barizien, N. (2013). The role of athletes’ pain- related anxiety in pain-related attentional processes. Anxiety, Stress, & Coping, 26(5), 573–
  14. Barrette, A., & Harman, K. (2019). Athletes play through pain—what does that mean for rehabilitation specialists?. Journal of Sport Rehabilitation, 29(5), 640-649.
  15. Beattie, S., Hardy, L., Cooke, A., & Gucciardi, D. (2020). Mental toughness training. Skill Acquisition in Sport, 255–270. https://doi.org/10.4324/9781351189750-14
  16. Bédard Thom, C., Guay, F., & Trottier, C. (2020). Mental toughness in sport: The goal- expectancy-self-control (GES) model. Journal of Applied Sport Psychology, 33(6), 627–643. https://doi.org/10.1080/10413200.2020.1808736
  17. Benjamin, L. J. M., & Wang, J. (2021). Examining the moderation and mediation effects of mental toughness on perceived stress and anxiety amongst athletes and non-athletes. Asian Journal of      Sport   and      Exercise          Psychology,     1(2–3),  89–97. https://doi.org/10.1016/j.ajsep.2021.09.001
  18. Białaszek, W., Mizak, S., Ostaszewski, P., & Bąbel, P. (2023). The role of chronic pain and pain anxiety in delay discounting of pain and monetary losses. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-46378-4
  19. Bird, M. D., Simons, E. E., & Jackman, P. C. (2021). Mental Toughness, Sport-Related Well- Being, and Mental Health stigma among National Collegiate Athletic Association Division I Student-Athletes. Journal of Clinical Sport Psychology, 15(4), 306–322. https://doi.org/10.1123/jcsp.2020-0043
  20. Brace, A. W., George, K., & Lovell, G. P. (2020). Mental toughness and self-efficacy of elite ultra- marathon runners. PloS     One, 15(11),    e0241284. https://doi.org/10.1371/journal.pone.0241284
  21. Brady-Lee, M. M. (2023). College athletes with career-ending injuries: Perceptions about using mental           health  services [Doctoral       dissertation,     ProQuest]. https://www.proquest.com/openview/579e6f2032c7c2b557c2de51cb047220/1?pq-origsite=gscholar&cbl=18750&diss=y  
  22. Brand, S., Kalak, N., Gerber, M., Clough, P. J., Lemola, S., Pühse, U., & Holsboer-Trachsler, E. (2014). During early and mid-adolescence, greater mental toughness is related to increased sleep quality and quality of life. Journal of Health Psychology, 21(6), 905–915. https://doi.org/10.1177/1359105314542816
  23. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
  24. Breazeale, S., Conley, S., Gaiser, E., & Redeker, N. S. (2021). Anxiety Symptoms After Orthopedic Injury: A Systematic Review. Journal of trauma nursing: the official journal of the Society of Trauma Nurses, 28(1), 46–55. https://doi.org/10.1097/JTN.0000000000000557
  25. Breslin, G., Shannon, S., Cummings, M., & Leavey, G. (2022). An updated systematic review of interventions to increase awareness of mental health and well-being in athletes, coaches, officials and parents. Systematic Reviews, 11(1). https://doi.org/10.1186/s13643-022-01932-5 
  26. Brown, B. J., Aller, T. B., Lyons, L. K., Jensen, J. F., & Hodgson, J. L. (2021). NCAA Student- Athlete Mental Health and Wellness: A Biopsychosocial Examination. Journal of Student Affairs Research and Practice, 252-267. https://doi.org/10.1080/19496591.2021.1902820
  27. Brown, B. J., Jensen, J. F., Hodgson, J. L., Brown, R. E., Rappleyea, D. L., & Schoemann, A. M. (2020). Mind, body, spirit, and sport: A systematic review examining the effectiveness of interventions targeting the biopsychosocial-spiritual health of NCAA student-athletes. Journal for the Study of Sports and Athletes in Education, 14(3), 235- 261. https://www.tandfonline.com/doi/abs/10.1080/19357397.2020.1774262
  28. Brown, B. J., Jensen, J. J., Hodgson, J. L., Rappleyea, D. L., & Schoemann, A. M. (2020). Beyond the Lines: Exploring the Impact of Adverse Childhood Experiences on NCAA Student- Athlete Health. Journal of Issues in Intercollegiate Athletics, 8–38.
  29. Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D., & Walker, K. (2020). Purposive sampling: Complex or simple? research case examples. Journal of Research in Nursing, 25(8), 652–661. https://doi.org/10.1177/1744987120927206
  30. Charlottetown,       Prince  Edward            Island. https://www.islandscholar.ca/islandora/object/ir%3A14702/datastream/PDF/download
  31. Cîmpean, A., & David, D. (2019). The mechanisms of pain tolerance and pain-related anxiety in acute pain. Health Psychology Open, 6(2), 205510291986516. https://doi.org/10.1177/2055102919865161
  32. Clement, D., Arvinen-Barrow, M., & Fetty, T. (2015). Psychosocial Responses during Different Phases of Sport-Injury Rehabilitation: A Qualitative study. Journal of Athletic Training, 50(1), 95–104. https://doi.org/10.4085/1062-6050-49.3.52
  33. Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic pain: an update on burden, best practices, and new advances. The Lancet, 397(10289), 2082–2097. https://doi.org/10.1016/s0140-6736(21)00393-7  
  34. Cowden, R. G. (2017). Mental toughness and success in sport: A review and Prospect. The Open Sports Sciences Journal, 10(1), 1–14. https://doi.org/10.2174/1875399x01710010001
  35. Cowee, K., & Simon, J. E. (2019). A history of previous severe injury and Health-Related quality of life among former collegiate athletes. Journal of Athletic Training, 54(1), 64–69. https://doi.org/10.4085/1062-6050-377-17
  36. Craig, K. D., & MacKenzie, N. E. (2021). What is pain: Are cognitive and social features core components? Paediatric and Neonatal Pain, 3(3), 106–118. https://doi.org/10.1002/pne2.12046
  37. Creswell, J.W., & Creswell, J.D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE Publications.
  38. Crust, L., & Swann, C. (2011). Comparing two measures of mental toughness. Personality and Individual Differences, 50(2), 217–221. https://doi.org/10.1016/j.paid.2010.09.032
  39. Dagnall, N., Drinkwater, K. G., Denovan, A., & Walsh, R. S. (2021). The potential benefits of non-skills training (mental toughness) for elite athletes: Coping with the negative psychological effects of the COVID-19 pandemic. Frontiers in Sports and Active Living, 3, 581431.
  40. David, P., Tessier, N., & Biberson, M. (2022). The paradoxical suffering of top athletes. An initial analysis. Revue CONFLUENCE: Sciences & Humanités. https://www.cairn.info/revue-confluence-2022-2-page-53.html 
  41. De Ridder, D., Adhia, D. B., & Vanneste, S. (2021). The anatomy of pain and suffering in the brain and its clinical implications. Neuroscience & Biobehavioral Reviews, 130, 125–146. https://doi.org/10.1016/j.neubiorev.2021.08.013
  42. Deci, E. L., & Ryan, R. M. (1985). Intrinsic Motivation and Self-Determination in Human Behavior. https://doi.org/10.1007/978-1-4899-2271-7
  43. Dick, R., Hertel, J., Agel, J., Grossman, J., & Marshall, S. W. (2007). Descriptive epidemiology of collegiate men’s basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. Journal of athletic training. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941286/
  44. Dixon, M., Hardie, A., & Oshiro, K. F. (2023). Transitioning Out of Sport for Collegiate Female Athletes: Individual and Organizational Implications. Journal of Issues in Intercollegiate A thletics, 16(27).
  45. Édouard, P., & Ford, K. R. (2020). Great challenges toward sports injury prevention and rehabilitation. Frontiers in Sports and Active Living, 2. https://doi.org/10.3389/fspor.2020.00080
  46. Elliott, J., Heron, N., Versteegh, T., Gilchrist, I. A., Webb, M., Archbold, P., Hart, N. D., & Peek, K. (2021). Injury reduction programs for reducing the incidence of sport-related head and neck injuries including concussion: A systematic review. Sports Medicine, 51(11), 2373– 2388. https://doi.org/10.1007/s40279-021-01501-1
  47. Escoto, D. G., & Alfarero, J. A. (2022). Winning It Both: Stories of Secondary Academic Achiever Student-Athletes. European Journal of Physical Education and Sport Science, 9(2) https://oapub.org/edu/index.php/ejep/article/view/4549
  48. Evans, J., Mabrouk, A., & Nielson, J. (2023, November 17). Anterior cruciate ligament knee injury. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499848/
  49. Everhart, J. S., DiBartola, A. C., Blough, C., Schiele, S. E., Harris, K. M., Emery, C. F., & Flanigan, D. C. (2021). Positive reframing: an important but underutilized coping strategy in youth athletes undergoing sports-related knee surgery. Journal of Athletic Training.
  50. Filbay, S. R., Ackerman, I. N., Russell, T. G., & Crossley, K. M. (2016). Return to sport matters— longer‐term quality of life after ACL reconstruction in people with knee difficulties. Scandinavian Journal of Medicine & Science in Sports, 27(5), 514–524. https://doi.org/10.1111/sms.12698
  51. Fisher, E., & Eccleston, C. (2021). Psychological aspects of pain prevention. PAIN Reports, 6(1). https://doi.org/10.1097/pr9.0000000000000926
  52. Flanigan, D. C., Everhart, J. S., DiBartola, A. C., Blough, C., Schiele, S. E., Harris, K. M., & Emery, C. F. (2021). Positive reframing: an important but underutilized coping strategy in athletes undergoing sport-related knee surgery. Journal of Athletic Training, 56(12), 1334- 1339.
  53. Foelber, K. J. (2014). Towards construct validity: Investigating the structure of the Mental Toughness in Sport Questionnaire (MTSQ-32). Master’s thesis, 212. Retrieved from https://commons.lib.jmu.edu/master201019/212
  54. Fogaca, J. L. (2021). Combining mental health and performance interventions: Coping and social support for student-athletes. Journal of Applied Sport Psychology, 33(1), 4-19.
  55. Ford, J. D., Ildefonso, K., Jones, M. L., & Arvinen-Barrow, M. (2017). Sport-related anxiety: current insights. Journal of Sports Medicine, 8, 205–212. https://doi.org/10.2147/oajsm.s125845
  56. García-Ceberino, J. M., Fuentes-García, J. P., & Villafaina, S. (2022). Impact of basketball match on the pre-competitive anxiety and HRV of Youth Female Players. International Journal of Environmental    Research    and    Public    Health, 19(13), 7894. https://doi.org/10.3390/ijerph19137894
  57. Ghasemi, M., Navidhamidi, M., Rezaei, F., Azizikia, A., & Mehranfard, N. (2022). Anxiety and hippocampal neuronal activity: Relationship and potential mechanisms. Cognitive, Affective, & Behavioral Neuroscience, 22(3), 431–449. https://doi.org/10.3758/s13415-021-00973-y
  58. Gomez-Espejo, V., Olmedilla, A., Abenza-Cano, L., Garcia-Mas, A., & Ortega, E. (2022). Psychological readiness to return to sports practice and risk of recurrence: Case studies. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.905816
  59. Gucciardi, D. F. (2016). Mental toughness as a moderator of the intention–behaviour gap in the rehabilitation of knee pain. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2015.06.010
  60. Gucciardi, D. F. (2017). Mental toughness: Progress and prospects. Current Opinion in Psychology, 16, 17–23. https://doi.org/10.1016/j.copsyc.2017.03.010
  61. Gucciardi, D. F., Hanton, S., Gordon, S., Mallett, C. J., & Temby, P. (2015). The concept of mental toughness: Tests of dimensionality, Nomological Network, and traitness. Journal of Personality, 83(1), 26–44. https://doi.org/10.1111/jopy.12079
  62. Gucciardi, D. F., Peeling, P., Ducker, K. J., & Dawson, B. (2016). When the going gets tough: Mental toughness and its relationship with behavioural perseverance. Journal of Science and Medicine in Sport, 19(1), 81–86. https://doi.org/10.1016/j.jsams.2014.12.005
  63. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? Field Methods, 18(1), 59–82. https://doi.org/10.1177/1525822x05279903
  64. Gumusdag, H. (2023). EXAMINATION OF MENTAL TOUGHNESS IN SPORTS. ASEAN Journal of Psychiatry, 24(10). https://doi.org/10.54615/2231-7805.47333
  65. Guo, J., Yang, J., Yi, H., Singichetti, B., Stavrinos, D., & Peek-Asa, C. (2020). Differences in postinjury psychological symptoms between collegiate athletes with concussions and orthopedic injuries. Clinical journal of sport medicine, 30(4), 360-365.
  66. Guszkowska, M., & Wójcik, K. (2021). Effect of mental toughness on sporting performance: review of studies. Baltic Journal of Health and Physical Activity, Supplement 1(2), 1–12. https://doi.org/10.29359/bjhpa.2021.suppl.2.01
  67. Hart, H. F., Crossley, K. M., Culvenor, A. G., Khan, M. C. M., West, T. J., Kennedy, J. B., Couch, J. L., & Whittaker, J. L. (2024). Knee confidence, fear of movement, and psychological readiness for sport in individuals with knee conditions: A systematic review and meta- analysis. Journal of Orthopaedic & Sports Physical Therapy, 54(4), 234–247. https://doi.org/10.2519/jospt.2024.12070
  68. Hasniar, Y., Abduljabar, B., & Nuryadi, N. (2017). The Correlation between Mental Toughness and Critical Thinking Ability With Indonesian Squash Pelatnas Athlete’s Anxiety. 2nd International Conference on Sports Science, Health and Physical Education. https://doi.org/10.5220/0007068507020707
  69. Hsu, C., Loecher, N., Park, A. L., & Simons, L. E. (2021). Chronic pain in young athletes: the impact of athletic identity on pain-related distress and functioning. The Clinical Journal of Pain, 37(3), 219-225.
  70. Hussain, T., Wang, D., & Li, B. (2023). Psychological resilience in athletes during the COVID-19 pandemic: A qualitative insight. Acta Psychologica, 240, 104050. https://doi.org/10.1016/j.actpsy.2023.104050
  71. Ivankova, N. V., Creswell, J. W., & Stick, S. L. (2006). Using mixed-methods sequential explanatory design: From theory to practice. Field Methods, 18(1), 3–20. https://doi.org/10.1177/1525822X05282260
  72. J. L., & Whittaker, J. L. (2024). Knee confidence, fear of movement, and psychological readiness for sport in individuals with knee conditions: A systematic review and meta- analysis. Journal of Orthopaedic & Sports Physical Therapy, 54(4), 234–247. https://doi.org/10.2519/jospt.2024.12070
  73. Jacob, M., & Jose, J. M. (2021). Consequences of injury and motivation to return to sports among athletes: a review literature. International Journal of Indian Psychology, 9(1). https://doi.org/10.25215/0901.020
  74. Jannah, M., Halimatussa’diyah, L., Nabila, N., & Widohardhono, R. (2018). Anxiety and mental toughness among athlete students. Proceedings of the 2nd International Conference on Education Innovation (ICEI 2018). https://doi.org/10.2991/icei-18.2018.119
  75. Johnson, B. (2001). Toward a new classification of nonexperimental quantitative research. Educational Researcher, 30(2), 3–13. https://doi.org/10.3102/0013189x030002003
  76. Johnson, K. L. (2020). Exploring the relationship between mental toughness and self-compassion in the context of sport injury: A mixed methods approach. HARVEST. https://harvest.usask.ca/handle/10388/12990
  77. Johnson, K. L., Cormier, D. L., Kowalski, K. C., & Mosewich, A. D. (2023). Exploring the relationship between Mental Toughness and Self-Compassion in the context of sport injury. Journal of Sport Rehabilitation, 32(3), 256–264. https://doi.org/10.1123/jsr.2022-0100
  78. Jones, E. (2020). Sports mental toughness and self-esteem in professional and amateur athletes. https://norma.ncirl.ie/4856/1/emilyjones.pdf
  79. Jones, M. I., & Parker, J. K. (2018). Mindfulness mediates the relationship between mental toughness and pain catastrophizing in cyclists. European Journal of Sport Science, 18(6), 872–881. https://doi.org/10.1080/17461391.2018.1478450
  80. Juggath, N. C., & Naidoo, N. R. (2024). The influence of psychological readiness of athletes when returning to sport after injury. South African Journal of Sports Medicine, 36(1). https://doi.org/10.17159/2078-516x/2024/v36i1a16356
  81. K. (2021). Injury reduction programs for reducing the incidence of sport-related head and neck injuries including concussion: A systematic review. Sports Medicine, 51(11), 2373– 2388. https://doi.org/10.1007/s40279-021-01501-1
  82. K. (2022). The mental health of student-athletes: a systematic scoping review. International Review of Sport and Exercise Psychology, 17(2), 848–881. https://doi.org/10.1080/1750984X.2022.2095657
  83. K. A., & Perry, J. L. (2023). Competition anxiety in combat sports and the importance of mental toughness. Behavioral Sciences, 13(9), 713. https://doi.org/10.3390/bs13090713
  84. Kadimpati, S., Zale, E. L., Hooten, W. M., Ditre, J. W., & Warner, D. O. (2015). Associations between Neuroticism and Depression in Relation to Catastrophizing and Pain-Related Anxiety in Chronic Pain Patients. PLOS ONE, 10(4), e0126351. https://doi.org/10.1371/journal.pone.0126351
  85. Kakiashvili L, Tsagareli M, Mjavanadze D, Kvachadze I. (2016) PAIN PERCEPTION IN ATHLETES: A BRIEF REVIEW. Georgian Medical News, (259):105-109. PMID: 27845297.
  86. Kalinin, R., Balázsi, R., Péntek, I., Duică, Ș., & Hanțiu, I. (2019). Relationship between competitive anxiety and mental toughness: a latent regression analysis. Health, Sport & Rehabilitation Medicine, 20(2), 70–74. https://doi.org/10.26659/pm3.2019.20.2.70
  87. Kegelaers, J., Wylleman, P., Defruyt, S., Praet, L., Stambulova, N., Torregrossa, M., De Brandt, K. (2022). The mental health of student-athletes: a systematic scoping review. International Review of Sport and Exercise Psychology, 17(2), 848–881. https://doi.org/10.1080/1750984X.2022.2095657
  88. Kristjánsdóttir, H., Erlingsdóttir, A. V., Sveinsson, G., & Saavedra, J. M. (2018). Psychological skills, mental toughness and anxiety in elite handball players. Personality and Individual Differences, 134, 125–130. https://doi.org/10.1016/j.paid.2018.06.011
  89. Kumar, D., & Mohammad, A. (2019). Prospects and challenges faced by student-athletes at university level: A study. Think India Journal, 22(14), 580–586. Retrieved from https://www.researchgate.net/publication/340819643_Prospects_and_Challenges_Faced_by_Student-Athletes_at_University_Level_A_Study 
  90. Kvist, J., & Silbernagel, K. G. (2022). Fear of movement and reinjury in Sports Medicine: Relevance for rehabilitation and return to sport. Physical Therapy, 102(2). https://doi.org/10.1093/ptj/pzab272
  91. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping (Vol. 464). Springer Publishing Company.
  92. Lee, G., Ryu, J., & Kim, T. (2023). Psychological skills training impacts autonomic nervous system responses to stress during sport-specific imagery: An exploratory study in junior elite shooters. Frontiers in Psychology, 14, 1047472.
  93. Li, C., Fan, R., Sun, J., & Li, G. (2021). Risk and Protective Factors of Generalized Anxiety Disorder of Elite Collegiate Athletes: A Cross-Sectional Study. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.607800
  94. Liew, G. C., Kuan, G., Chin, N. S., & Hashim, H. A. (2019). Mental toughness in sport. German Journal of Exercise and Sport Research, 49(4), 381–394. https://doi.org/10.1007/s12662-019-00603-3  
  95. Lin, Y., Mutz, J., Clough, P. J., & Papageorgiou, K. A. (2017). Mental toughness and individual differences in learning, educational and work performance, psychological well-being, and personality: A systematic review. Frontiers in Psychology, 8. https://doi.org/10.3389/fpsyg.2017.01345
  96. Litwic-Kaminska, K. (2020). Types of cognitive appraisal and undertaken coping strategies during sport competitions. International Journal of Environmental Research and Public Health, 17(18), 6522.
  97. Madrigal, Leilani, Katherine Wurst, and Diane L. Gill. The role of mental toughness in coping and injury response in female roller derby and rugby athletes. Journal of Clinical Sport Psychology 10.2 (2016): 137-154.
  98. Mano, J. P. M., & Schreiber, B. N. (2020, May 16). Effects of mental toughness and mood on perseverance in athletes and non-athletes. Whitman College. http://works.whitman.edu/2020018
  99. McCracken, L. M., & Dhingra, L. (2002). A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain research & management, 7(1), 45–
  100. McKay, Carly D., ed. The mental impact of sports injury. Routledge, 2021.
  101. Miçooğulları, B. O. (2017). The Sports Mental Toughness Questionnaire (SMTQ): A Psychometric Evaluation of the Turkish version. Studia sportiva. https://journals.muni.cz/studiasportiva/article/view/7778
  102. Mojtahedi, D., Dagnall, N., Denovan, A., Clough, P., Dewhurst, S. A., Hillier, M., Papageorgiou, K. A., & Perry, J. L. (2023). Competition anxiety in combat sports and the importance of mental toughness. Behavioral Sciences, 13(9), 713. https://doi.org/10.3390/bs13090713
  103. Mojtahedi, D., Dagnall, N., Denovan, A., Clough, P., Hull, S., Canning, D., Lilley, C., & Papageorgiou, K. A. (2021). The relationship between mental toughness, job loss, and mental health issues during the COVID-19 pandemic. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.607246
  104. Mosewich, A. D., Crocker, P. R., & Kowalski, K. C. (2013). Managing injury and other setbacks in sport: experiences of (and resources for) high-performance women athletes. Qualitative Research in Sport, Exercise and Health, 6(2), 182–204. https://doi.org/10.1080/2159676x.2013.766810
  105. Naden, E., Schepman, A., Bilton, G., & Rodway, P. (2023). Resilience and mental toughness as predictors of anxiety, depression, and mental well-being. Mental Wellness, 1(1). https://doi.org/10.4081/mw.2023.2
  106. Neubauer, B., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education (Print), 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2
  107. NIAMS health information on sports injuries. (2023). National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/sports-injuries
  108. Nicholls, J. G. (1984). Achievement motivation: Conceptions of ability, subjective experience, task choice, and performance. Psychological Review, 91(3), 328–346. https://doi.org/10.1037/0033-295x.91.3.328
  109. Obbarius, N., Fischer, F., Liegl, G., Obbarius, A., & Rose, M. (2021). A modified version of the transactional stress concept according to Lazarus and Folkman was confirmed in a psychosomatic inpatient sample. Frontiers in Psychology, 12, 584333. https://doi.org/10.3389/fpsyg.2021.584333
  110. Ohji, S., Aizawa, J., Hirohata, K., Ohmi, T., Koyama, K., & Nishida, Y. (2021). Psychological factors affecting return to sports after anterior cruciate ligament reconstruction. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 26, 1-7. https://doi.org/10.1016/j.asmart.2021.09.003
  111. Orchard, J. W., Meeuwisse, W., Derman, W., Hägglund, M., Soligard, T., Schwellnus, M., & Bahr, R. (2020, April 1). Sport Medicine Diagnostic Coding System (SMDCS) and the orchard sports injury and Illness Classification System (OSIICS): Revised 2020 consensus versions. British Journal of Sports Medicine. https://bjsm.bmj.com/content/54/7/397
  112. Parker, M. A., Ichikawa, J. K., Bombardier, C. H., & Hammond, F. M. (2022). Association between anxiety symptoms, depression symptoms, and life satisfaction among individuals 1 year after spinal cord injury: findings from the SCIRehab Project. Archives of Rehabilitation Research       and      Clinical Translation,     4(3),      100211. https://doi.org/10.1016/j.arrct.2022.100211
  113. Piussi, R., Berghdal, T., Sundemo, D., Grassi, A., Zaffagnini, S., Sansone, M., Samuelsson, K., & Senorski, E. H. (2022). Self-Reported Symptoms of Depression and Anxiety After ACL Injury: A Systematic review. Orthopaedic Journal of Sports Medicine, 10(1), 232596712110664. https://doi.org/10.1177/23259671211066493
  114. Ponnusamy, V., Lines, R. L., Zhang, C. Q., & Gucciardi, D. F. (2018). Latent profiles of elite Malaysian athletes’ use of psychological skills and techniques and relations with mental toughness. PeerJ, 6, e4778. https://doi.org/10.7717/peerj.4778
  115. Potter, G.  (2016). EXAMINING PAIN  ANXIETY  IN  YOUNG  ADULT  ATHLETES. Charlottetown,          Prince  Edward            Island. https://www.islandscholar.ca/islandora/object/ir%3A14702/datastream/PDF/download
  116. Putukian, M. (2016, February 1). The psychological response to injury in student athletes: A narrative review with a focus on Mental Health. British Journal of Sports Medicine. https://bjsm.bmj.com/content/50/3/145
  117. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
  118. Richardson, A. E., Derrett, S., Samaranayaka, A., & Wyeth, E. H. (2021). Prevalence and predictors of psychological distress following injury: findings from a prospective cohort study. Injury Epidemiology, 8(1). https://doi.org/10.1186/s40621-021-00337-7
  119. Ríos Garit, J., Pérez Surita, Y., Fuentes Domínguez, E., Soris Moya, Y., & Borges Castellanos, R. (2021). Anxiety and psychological variables of sports performance related to injuries in high- performance   sportsmen.   Apunts   Sports   Medicine, 56(211), 100358. https://doi.org/10.1016/j.apunsm.2021.100358
  120. Roebuck, G. S., Urquhart, D. M., Knox, L., Fitzgerald, P. B., Cicuttini, F. M., Lee, S., & Fitzgibbon, B. M. (2018). Psychological factors associated with ultramarathon runners’ supranormal pain tolerance: a pilot study. The Journal of Pain, 19(12), 1406–1415. https://doi.org/10.1016/j.jpain.2018.06.003
  121. Rogers, D. L., Tanaka, M. J., Cosgarea, A. J., Ginsburg, R. D., & Dreher, G. M. (2023). How mental health affects injury risk and outcomes in athletes. Sports Health, 16(2), 222–229. https://doi.org/10.1177/19417381231179678
  122. S., Ringkamp, M., Sluka, K. A., Song, X., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
  123. Senin, M. S., binti Bahadin, S. A., & binti Abd Rahman, S. (2021). THE INFLUENCE OF MENTAL  TOUGHNESS  AND  SKILL  UNDERGOING  THE  REHABILITATION PROGRAM. Turkish Journal of Physiotherapy and Rehabilitation, 32, 3.
  124. Sep, M. S., Joëls, M., & Geuze, E. (2020). Individual differences in the encoding of contextual details following acute stress: An explorative study. European Journal of Neuroscience, 55(9–10), 2714–2738. https://doi.org/10.1111/ejn.15067
  125. Sheard, M., Golby, J., & van Wersch, A. (2009). Progress toward construct validation of the Sports Mental Toughness Questionnaire (SMTQ). European Journal of Psychological Assessment, 25(3), 186–193. https://doi.org/10.1027/1015-5759.25.3.186
  126. Sheinbein, S. (2016). Psychological effect of injury on the athlete: a recommendation for psychological intervention. AMAA Journal, 29(3), 8-10.
  127. Soundara Pandian, P. R., Balaji Kumar, V., Kannan, M., Gurusamy, G., & Lakshmi, B. (2023). Impact of mental toughness on athlete’s performance and interventions to improve. Journal of basic and clinical physiology and pharmacology, 34(4), 409-418.
  128. St Clair-Thompson, H., & Devine, L. (2023). Mental toughness in higher education: exploring the roles of flow and feedback. Educational Psychology, 43(4), 326–343. https://doi.org/10.1080/01443410.2023.2205622
  129. St Clair-Thompson, H., & London, J. (2024). Does mental toughness predict happiness over and above resilience, self-efficacy and grit? New Ideas in Psychology, 74, 101093. https://doi.org/10.1016/j.newideapsych.2024.101093
  130. Stamatis, A., Morgan, G. B., Nyamaruze, P., & Koutakis, P. (2022). Mental toughness development via military-style training in the NCAA: A three-phase, mixed-method study of the perspectives of strength and Conditioning Coaches. Sports, 10(6), 92. https://doi.org/10.3390/sports10060092
  131. Stambulova, N. B., Ryba, T. V., & Henriksen, K. (2020). Career Development and transitions of athletes: The International Society of Sport Psychology Position Stand Revisited. International Journal of Sport and Exercise Psychology, 19(4), 524–550. https://doi.org/10.1080/1612197x.2020.1737836
  132. Stamp, E., Crust, L., Swann, C., Perry, J., Clough, P., & Marchant, D. (2015). Relationships between mental toughness and psychological well-being in undergraduate students. Personality        and      Individual         Differences,     75,      170–174. https://doi.org/10.1016/j.paid.2014.11.038
  133. Steffen, K., Soligard, T., Mountjoy, M., Dallo, I., Gessara, A. M., Giuria, H., Alamino, L. P., Rodriguez, J., Salmina, N., Veloz, D., Budgett, R., & Engebretsen, L. (2019). How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina. British Journal of Sports Medicine, 54(3), 168–175. https://doi.org/10.1136/bjsports-2019-101040
  134. Thom, C., Guay, F., & Trottier, C. (2020). Mental toughness in sport: The goal-expectancy-self- control (GES) model. Journal of Applied Sport Psychology, 33(6), 627–643. https://doi.org/10.1080/10413200.2020.1808736
  135. Tibbert, S. J., Andersen, M. B., & Morris, T. (2015). What a difference a “mentally toughening” year makes: The acculturation of a rookie. Psychology of Sport and Exercise, 17, 68–78. doi:10.1016/j.psychsport.2014.10.007
  136. Timpka, T., Jacobsson, J., Bickenbach, J., Finch, C. F., Ekberg, J., & Nordenfelt, L. (2014, January 28). What is a sports injury? - sports medicine. SpringerLink. https://link.springer.com/article/10.1007/s40279-014-0143-4
  137. Tomaka, J., Blascovich, J., Kibler, J., & Ernst, J. M. (1997). Cognitive and physiological antecedents of threat and challenge appraisal. Journal of Personality and Social Psychology, 73(1), 63–72. https://doi.org/10.1037//0022-3514.73.1.63
  138. Torma, E. P., & Balogh, L. (2021). Breakable performance - the role of mental toughness in elite sport, international outlook. Stadium - Hungarian Journal of Sport Sciences, 4(1). https://doi.org/10.36439/shjs/2021/1/9498
  139. Turick, R., Bopp, T., & Swim, N. (2021). “How do I do life?” The challenges of preparing student- athletes for professional roles. Journal for the Study of Sports and Athletes in Education, 15(1), 71-94. https://www.tandfonline.com/doi/abs/10.1080/19357397.2019.1669367
  140. Vaughan, R., Carter, G. L., Cockroft, D., & Maggiorini, L. (2018). Harder, better, faster, stronger? Mental toughness, the dark triad and physical activity. Personality and Individual Differences, 131, 206-211. https://doi.org/10.1016/j.paid.2018.05.002
  141. Vincent, H. K., Hagen, J. E., Zdziarski-Horodyski, L. A., Patrick, M., Sadasivan, K. K., Guenther, R., Vasilopoulos, T., Sharififar, S., & Horodyski, M. (2018). Patient-Reported Outcomes Measurement Information System Outcome Measures and Mental Health in orthopaedic trauma patients during early recovery. Journal of Orthopaedic Trauma, 32(9), 467–473. https://doi.org/10.1097/bot.0000000000001245
  142. Wheatley, C., Batey, M., Denovan, A., & Dagnall, N. (2023). Mental toughness in the Football Association Women’s Super League: Relationships with playing experience, perceptions of club infrastructure, support mechanisms and self-esteem. PLoS ONE, 18(5), e0285594. https://doi.org/10.1371/journal.pone.0285594   
  143. Williams, J. M., & Andersen, M. B. (1998). Psychosocial antecedents of sport injury: Review and critique of the stress and injury model’. Journal of Applied Sport Psychology, 10(1), 5–25. https://doi.org/10.1080/10413209808406375
  144. Wolanin, A., Hong, E., Marks, D., Panchoo, K., & Gross, M. (2016). Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. British journal of sports medicine, 50(3), 167–171. https://doi.org/10.1136/bjsports-2015-095756
  145. Woodgate, R. L., Tennent, P., Barriage, S., & Legras, N. (2020). The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach. Canadian Journal of Pain, 4(3), 6–18. https://doi.org/10.1080/24740527.2020.1720501
  146. Wu, C.-H., Nien, J.-T., Lin, C.-Y., Nien, Y.-H., Kuan, G., Wu, T.-Y., Ren, F.-F., & Chang, Y.-K. (2021). Relationship between mindfulness, psychological skills, and mental toughness in college athletes. International Journal of Environmental Research and Public Health, 18(13), 6802. https://doi.org/10.3390/ijerph18136802
  147. Zeiger, J. S., & Zeiger, R. S. (2018). Mental toughness latent profiles in endurance athletes. PLOS ONE, 13(2). https://doi.org/10.1371/journal.pone.0193071
  148. Zhong, Z., Jiang, H., Wang, H., & Liu, Y. (2025). The association between mindfulness and athletes’ distress tolerance: the mediating roles of cognitive reappraisal and mental toughness. Behavioral Sciences, 15(3), 298. https://doi.org/10.3390/bs15030298
  149. Zubić, I. (2021). Mental toughness as predictor of state anxiety of Serbian athletes. Exercise and Quality of Life, 13(2), 21–27. https://doi.org/10.31382/eqol.211203

Tools


Copyright © 2026  KITE Digital Educational Solutions |  Exclusively distributed by CE-Logic