Do athletes with perfectionism seek help when they develop emotional problems? Longitudinal investigation of dimensions of perfectionism and help seeking in college athletes
Young people are generally reluctant to seek mental health care, and perfectionism is one of the factors that prevents help seeking. The purpose of this article is to investigate whether perfectionistic athletes seek help when they develop emotional and performance problems, and what types of help and support they look for, if they do seek help.
Design and Method
Study 1 employed a longitudinal design to test if perfectionistic athletes sought help, and 132 college athletes were asked to complete a questionnaire that included two forms of perfectionism (self-oriented perfectionism and socially prescribed perfectionism), help seeking, depression, stigma, and attitude toward seeking help. Study 2 asked 109 college athletes what types of help and support they would seek.
The results of Study 1 suggest that, even after controlling for other factors that may affect help seeking, self-oriented perfectionism was positively associated with help seeking for both emotional and performance problems, while socially prescribed perfectionism was negatively associated with help seeking only for emotional problems. The results of Study 2 suggest that college athletes with self-oriented perfectionism would ask their coach and teammates for emotional support and problem solving support. Moreover, they think that seeking help may contribute to a better relationship within the team. However, college athletes with socially prescribed perfectionism would only ask friends and family for information about mental health.
The present findings suggest that some perfectionistic athletes seek help in order to cope with emotional and performance problems.
Keywords: Perfectionism; help seeking; athletes; stigma; longitudinal study.
Barriers to help seeking in youth and athletes
A wide range of studies attests to young people’s reluctance to seek professional mental health care. For example, a school-based survey of 11,154 Norwegian youth aged 15–16 years reported that, even at the highest symptom levels for anxiety and depression, only a third had sought professional help. Similarly, the most recent national survey data for Australia show that only 29% of children and adolescents with a mental health problem had been in contact with a professional service of any type in a 12-month period (Andrews, Teesson, & Henderson, 1999). Gulliver, Griffiths, and Christensen (2010) reviewed perceived barriers to mental health help seeking in young people. The barriers firstly include poor mental health literacy, such as feeling unsure about where to seek help, not being able to distinguish between ‘real distress’ and ‘normal distress,’ and being uninformed about available services. Secondly, they identified attitudes and personal characteristics that may prevent them from seeking help, such as male gender, ethnicity, low emotional competence, negative attitudes to professional help-seeking, the belief that the problem would go away or could be solved without help, lack of confidence in the professional opinion of the specialist or doctor, a culture of self-reliance especially in rural areas, not wishing to admit to having a disorder, accessing help making it ‘real’, and not selecting GPs as a source of help. Following that, stigma including embarrassment, privacy and confidentiality concerns particularly amongst those living in a small town, and negative self-perceptions may discourage young people from seeking help. Finally, practical barriers such as lack of transport to access help, difficulty obtaining help, inadequate time, and financial cost could also be barriers to help seeking.
As elite athletes tend to fall within this high-risk age group, Gulliver, Griffiths, and Christensen (2012) qualitatively investigated what young elite athletes perceive as the barriers and facilitators to help seeking for common mental health problems. Participants’ written and verbal data suggested that stigma was the most important perceived barrier to seeking help for young elite athletes. Other notable barriers were a lack of mental health literacy and negative past experiences of help seeking. Facilitators to help seeking were encouragement from others, having an established relationship with a provider, pleasant previous interactions with providers, the positive attitudes of others, especially their coach, and access to the Internet (Gulliver et al., 2012).
The Multidimensional Nature of Perfectionism
Perfectionism is a personality trait characterized by striving for flawlessness and setting exceedingly high standards of performance accompanied by overly critical evaluations of one’s behaviour (Hewitt & Flett, 1991; Frost, Marten, Lahart, & Rosenblate, 1990). Over the past 20 years, research has produced converging evidence that perfectionism has different aspects and is best conceptualized as a multidimensional characteristic (Enns & Cox, 2002; Lo & Abbott, 2013). In particular, two main dimensions have been differentiated: perfectionistic strivings, i.e. setting high standards and a self-oriented striving for perfection, and perfectionistic concerns, i.e. concerns about making mistakes, feelings of discrepancy between one’s standards and performance, and fears of negative evaluation and rejection by others if one fails to be perfect (see Stoeber & Otto, 2006, for a review).
The multidimensional nature of perfectionism and its linkages to both maladaptive traits and negative outcomes, and less frequently, adaptive traits and positive outcomes has generated much research during the past two decades. Hewitt and Flett (1991) proposed three dimensions of perfectionism and developed a self-report measure of the different components. Self-oriented perfectionism characterizes those individuals who are assumed to create excessively high standards for themselves and engage in intense self-criticism. Socially prescribed perfectionism characterizes those individuals who perceive that significant others are imposing excessively high standards on them and that they must meet these standards in order to please others. Other-oriented perfectionism characterizes those individuals who impose excessively high standards on other individuals in their lives. A number of publications have demonstrated a link between components of perfectionism and maladjustment. For example, socially prescribed perfectionism has been linked to submissive behaviour and shame-proneness, depression, diminished self-esteem, irrational fears, maladaptive thinking patterns and coping, and other indices of maladaptive symptomatology or maladjustment including suicide ideation (e.g. Dunkley & Blankstein, 2000; Blankstein, Flett, Hewitt & Eng, 1993; Flett, Hewitt, Blankstein & O’Brien, 1991; Hewitt & Flett, 1991; Wyatt & Gilbert, 1998).
The Impact of Perfectionism on The Treatment Process
There is also some evidence that perfectionism may have an impact on outcome, being associated with poorer prognosis and treatment drop-out (Bizeul, Sadowsky & Rigaud, 2001; Sutandar‐Pinnock, Woodside, Carter, Olmsted & Kaplan, 2003), with OCPD traits including perfectionism and rigidity found to be potential mediators of treatment outcome (Crane, Roberts & Treasure, 2007). Although the means by which perfectionism impacts outcome are not clear, it has been suggested that the all or nothing thinking style and perceived failures associated with perfectionism may make the setting of appropriate treatment goals difficult and that perfectionistic traits may prevent the self-disclosure needed to establish a strong therapeutic alliance (Goldner, Cockell & Srikameswaran, 2002). Some support for this theory comes from a study conducted by Zuroff et al. (2000) regarding the outcome of depression following treatment, where it was found that the relationship between perfectionism and poorer treatment response was mediated by the impact of perfectionism upon the therapeutic alliance. Finally, Blatt and Zuroff (2005) found that higher levels of perfectionism at both pre- and post-treatment predicted poorer ability to cope with life stress 18 months after treatment.
Moreover, perfectionism may affect individuals’ willingness to seek treatment. Hewitt et al. (2003) maintain that perfectionists differ in terms of their need to appear perfect to other people and not display or disclose imperfections in public. Several studies support the notion that perfectionistic individuals conceal negative personal information to maintain a flawless appearance and avoid negative evaluation by others. For example, Frost et al. (1995, 1997) found that perfectionistic individuals feared that others would think negatively of them because of their mistakes, and therefore, preferred to keep them secret. For perfectionists, the short-term benefit of self-concealment appears to be the avoidance of evaluative threat, but unfortunately, the long-term consequence of self-concealment may be higher levels of psychological distress.
This unwillingness of perfectionistic individuals to admit to others when they are having personal difficulties may affect help seeking in youth and athletes, because help seeking may be perceived, particularly by athletes, as a powerful indication of weakness. Attitudes about seeking help from others are related to both perfectionism (Kelly & Achter, 1995) and self-concealment (Cepeda-Benito & Short, 1998; Hinson & Swanson, 1993). Mills and Blankstein (2000) found that perfectionists exhibited a fear that others would evaluate them negatively for poor academic performance and feared asking for academic assistance. Regarding self-concealment and help-seeking attitudes, Cepeda-Benito and Short (1998) found that high self-concealers were most likely to avoid seeking needed psychological services. Finally, Hewitt, Flett, and Wekerle (2012) found that self-oriented perfectionism is associated with internalized emotion-oriented coping responses and self-reliant problem-solving, suggesting that perfectionists would keep the problem to themselves rather than disclosing it to other people.
Purpose of this study
Flett and Hewitt (2014) point out that, if perfectionistic athletes are indeed particularly susceptible to distress and tend to have difficulties coping with stress, it is essential to study their willingness to seek help. Those athletes who are high in perfectionistic self-presentation should be especially unlikely to seek help if they are prone to self-stigma and endorse beliefs that seeking help is an admission of being weak and imperfect. This issue is vitally important to evaluate and the lack of help seeking points to the need for proactive, preventive interventions. On the other hand, some perfectionists, at least individuals with perfectionistic strivings, might seek help. A number of studies have examined links between perfectionism and coping-strategy utilization in sport and non-sport settings. In general, these studies have found significant positive relationships between active, task-oriented, and problem-oriented coping styles and subscales that measure sub-dimensions of perfectionistic strivings (Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000; Gaudreau & Antl, 2008), self-oriented perfectionism (Hill, Hall, & Appleton, 2010; Kobori, Yoshie, Kudo, & Otsuki, 2011), and striving for perfection (Stoeber & Childs, 2010; Stoeber & Rennert, 2008). Moreover, self-oriented perfectionism is associated with adaptive social skills (Flett, Hewitt, & DeRosa, 1996). These results suggest that individuals with positive/adaptive forms of perfectionism can be good at seeking the help and support of other people. However, it remains unknown as to what support perfectionistic athletes seek and the way they want other people to help them. For example, they may look for practical advice from their coach, want close friends to listen to, or only want someone to do something with them for distraction, without disclosing the detail of their problems.
So far, no studies have investigated the relationship between dimensions of perfectionism and help seeking. The purpose of Study 1 was to investigate whether perfectionism prevents athletes from seeking help. Regarding the problems they seek help for, we included both emotional problems, and problems about athletic performance. We hypothesized that only the facets of perfectionistic concerns, not perfectionistic strivings, would prevent athletes from seeking help, even after controlling for the stigma about mental health, attitudes toward professional psychological help (e.g. how effective one thinks psychological help is), and current level of depression, because these variables may affect the motivations to seek help. Moreover, Study 1 employed a longitudinal design in order that participants indicate whether they actually sought help over a specific period of time (help seeking behaviour), as well as how likely they would be to seek help (help seeking intention).
As athletes with perfectionistic strivings might seek help as an active coping strategy, Study 2 explored further the way athletes utilize help and support from other people, and its relationship to both perfectionistic strivings and perfectionistic concerns. In other words, we examined what type of help perfectionistic athletes may want from the other person. We also asked athletes whether they see any secondary benefits of help seeking (i.e. benefits other than resolving their problems). For example, perfectionistic athletes may see seeking help as an opportunity to establish a trustful relationship with other people, which can eventually enhance their performance. These investigations will inform us of the person who can be the first contact when athletes with perfectionism seek help, but also shed light on how we respond to athletes with perfectionism when they seek help.
A longitudinal design was employed to measure both help seeking intentions and help seeking behaviours. All the measures except for Actual Help Seeking Questionnaire were administered to 132 participants. In 12 weeks, 96 participants completed the Actual Help Seeking Questionnaire.
At the end of a psychology lecture, college athletes were asked to complete the questionnaire. A total of 132 college athletes were recruited to participate in this study. The participants consisted of 48 men and 84 women with a mean age of 18.22 years (SD=0.584), and 91% identified their ethnicity as Japanese; the remaining 9% were Asian or Mixed. Their average practice hours per week was 13.09 hours (SD=7.589), and average career history as an athlete was 11.34 years (SD=3.684). They competed in different sports including football, tennis, dancing, swimming, basketball, badminton, volleyball, handball, lacross, gymnastics, kendo, aikido, table tennis, judo, softball, baseball, rugby, and track and field.
Multidimensional Perfectionism Scale (MPS: Hewitt & Flett, 1991). In order to measure the different facets of perfectionism traits, the Japanese version of the MPS (Ohtani & Sakurai, 1995) was employed. This scale is a Japanese translation of the MPS (Hewitt & Flett, 1991) that also consists of 3 dimensions (i.e. self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism). The psychometric properties of the Japanese version of the MPS have been confirmed by Ohtani and Sakurai (1995), who reported good construct validity, internal consistency (alpha = .65–.83), and test-retest reliability (r = .61–.73). Items related to self-oriented perfectionism and socially prescribed perfectionism from the Japanese version of the MPS were administered. Participants rated these questions on a 7-point Likert scale ranging from ‘disagree’ to ‘agree’.
Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001). The PHQ-9 was employed to assess participant’s general wellbeing; it is a 9-item self-report questionnaire originally measuring depressive symptoms. Items are scored on a 4-point scale from 0 (not at all) to 3 (nearly every day) with total scores ranging from 0 to 27. The questions are based on the DSM-IV diagnostic criteria, and thus, can provide both a diagnosis as well as a measurement of depression severity (Kroenke & Spitzer, 2002). A cut off score of 10 or greater has a sensitivity and specificity of 88% and a drop of at least 5 points is considered a clinically significant response (Kroenke & Spitzer, 2002). The internal consistency of the scale ranges from .86 to .89 (Kroenke et al., 2001). The Japanese version (Inagaki et al., 2013) was employed for this study.
Discrimination-Devaluation Scale (Link, 1987; Link, Cullen, Struening, Shrout, & Dohrenwend, 1989). The Japanese version of the D-D scale (Shimotsu et al., 2006) was employed to measure public stigma. The D-D scale asks people how much they agree with each of 12 statements that begin with ‘Most people believe . . .’, ‘Most people think . . . ’, or ‘Most people would . . .’ followed by a stereotype, example of discrimination, or the opposite (an accepting view or behaviour). The original D-D scale refers to a ‘patient with mental health problems’, a ‘former patient with mental health problem’, or a person ‘who has been hospitalized for mental illness’. We adapted the wording to refer instead to ‘a person who has received mental health treatment’ because our objective was to measure perceived stigma regarding a broader concept of mental health treatment (rather than institutional treatment for severe mental illness per se). As in the original D-D scale, the answer choices were on a 6-point Likert scale from strongly agree to strongly disagree. As in the original use of the scale, we constructed an index of perceived stigma by coding each response as 0, 1, 2, 3, 4, or 5 (with higher numbers referring to answers indicating higher perceived stigma) and calculating the average across the 12 items for each individual.
Attitude toward Seeking Professional Psychological Help-Short Scale (ATSPPH-S: Fischer & Farina, 1995). The Attitude Towards Seeking Professional Psychological Help-Short Scale (ATSPPH-S) (Fischer & Farina, 1995) measures willingness to seek help from mental health professionals when psychological problems are encountered in general. It is a 10-item short scale based on the original 29-item version developed by Fischer and Turner (1970). Items on the scale include ‘I would want to get psychological help if I were worried or upset for a long period of time’. Responses are on a 5-point scale ranging from ‘strongly disagree (1)’ to ‘strongly agree (5)’. High scores indicate more positive attitude towards seeking professional psychological help. Fischer and Farina (1995) report an internal coefficient alpha of .84 and a test-retest reliability of .80 over one month. They also report significant point biserial correlations between individuals’ scores on the ATSPPH-S and psychological help-seeking behaviour, an indication of a good construct validity. Elhai, Schweinle, and Anderson (2008) also reported an internal consistency of .87 for the scale, and a moderate correlation with the mental health care utilization scale. The Japanese version of the ATSPPH-S was employed for this study (Takamura, Oshima, Yoshida & Motonaga, 2008).
General Help-Seeking Questionnaire (GHSQ; Wilson, Deane, Ciarroch & Rickwood, 2005). GHSQ assesses future help-seeking intentions. The athlete’s intentions to seek help were measured by listing a number of potential help sources and asking participants to indicate how likely it is that they would seek help from that source for (1) emotional and personal problems, and (2) problems with athletic performance, on a 7-point scale ranging from (1) extremely unlikely to seek help to (7) extremely likely to seek help. In this study, the potential help sources included the coach, teammates or supporting staff, partner, friends, family, college counsellor, physicians, and mental health professionals. These sources were grouped into three higher categories: ‘Athletic Networks’ (average of coach and teammates or supporting staff), ‘Social Networks’ (average of partner, friends, and family), and ‘Professionals’ (average of college counsellor, physicians, and mental health professionals).
Actual Help-Seeking Questionnaire (AHSQ; Rickwood & Braithwaite, 1994). The AHSQ was derived from an earlier measure used by Rickwood and Braithwaite (1994) and developed to measure recent actual help-seeking behaviour. Listing the same sources of help as the GHSQ, participants indicate, over the past 12 weeks, whether they sought help from that source for (1) emotional and interpersonal problems, and (2) problems with athletic performance, by choosing either ‘yes’ or ‘no’. These sources were grouped into three higher categories: ‘Athletic Networks’, ‘Social Networks’, and ‘Professionals’. For computing the score, if the participant sought help from one or more sources in the category, the score of the category was ‘1’, whereas if the participant did not seek help from any sources, the score of the category was ‘0’.
Table 1 presents means and standard deviations of standard measures and help seeking intentions from Athletic Networks, Social Networks, and Professionals, for emotional and interpersonal problems, and performance problems. Scores on help seeking intentions suggest that athletes would seek help for emotional problems from social networks more than athletic networks and professionals, and seek help for performance problems from athletic networks more than social networks and professionals.
Tables 1 and 2
Table 2 presents the number and percentage of athletes who actually sought help for emotional and personal problems and performance problems from any source(s) in each category (Athletic Network, Social Networks, and Professionals). Scores on help seeking behaviours suggest that athletes sought help for emotional problems from social networks more than athletic networks, and sought help for performance problems from athletic networks more than social networks. However, few athletes sought help from professionals for both problems.
Hierarchical and logistic regression analysis
Tables 3 and 4 are the result of hierarchical regression analyses that tested whether perfectionism affects help seeking intentions after controlling for the current level of depression, stigma related to mental health, and attitude toward seeking professional psychological help.
The analysis of factors that predict help seeking intentions for emotional and interpersonal problems (Table 2) revealed that positive attitude towards seeking professional psychological help predicted help seeking intentions not only from professionals but also from athletic and social networks. Self-oriented perfectionism positively predicted help seeking from athletic and social networks, but socially prescribed perfectionism negatively predicted help seeking from athletic and social networks. Help seeking from professionals was not predicted by perfectionism.
The analysis of factors that predict help seeking intentions for performance problems (Table 4) revealed that positive attitude towards seeking professional psychological help predicted help seeking intentions only from social networks. Self-oriented perfectionism positively predicted help seeking from athletic and social networks, but social prescribed perfectionism did not predict help seeking from any resources.
The analysis of factors that predict help seeking behaviours for emotional and interpersonal problems (Table 5) revealed that positive attitude towards seeking professional psychological help predicted help seeking behaviours from social networks. The analysis of factors that predict help seeking behaviours for performance problems (Table 6) revealed that self-oriented perfectionism positively predicted help seeking behaviours from athletic networks. Help seeking behaviours from professionals for both problems were not analysed due to the small number of participants who sought help.
The sample consisted of 119 Japanese college athletes (women, n=34; men, n=85), majoring in sport and exercise studies at the University of Tsukuba, Japan. The mean age of participants was 18.40 (SD=1.145) years, the mean hours of training per week was 17.39 hours (SD=7.116), and the mean years in training was 8.71 years (SD=3.887).
Multidimensional Perfectionism Scale (MPS: Hewitt & Flett, 1991). The same scale was used as Study 1.
Help Seeking Utilization Questionnaire. This questionnaire was developed specifically for this study. Participants were asked what kind of help and support they would look for if they seek help for emotional and interpersonal problems from athletic networks (coaches and teammates) and from social networks (partner, friends, and family). The types of support were categorized according to the broad classification of coping strategies, which include the individual’s attempts to (a) deal with resultant emotions, (b) approach or alter the task/problem, and (c) avoid/disengage from the stressor entirely (see Nicholls & Polman, 2007). Participants were asked to rate the following items from strongly disagree (1) to strongly agree (7).
- Emotional Support: ‘I would seek emotional support (e.g. being listened to, receiving empathy, listening to other people’s experiences) by talking my problems in detail’
- Problem-Solving Support: ‘I would seek support for problem solving (e.g. asking for advice about what to do, asking the person to resolve interpersonal problems) by talking my problems in detail’
- Information Seeking: ‘I would seek information about mental health such as where to find mental health professionals’
- Distraction Seeking: ‘I would ask the person to have a chat or to do something together to freshen up’
In addition, participants were asked if they see any secondary benefits of help seeking from athletic networks (coaches and teammates) and from social networks (partner, friends, and family), apart from solving emotional and interpersonal problems. They were asked to rate the following items from strongly disagree (1) to strongly agree (7).
- Relationship Building: ‘I can develop a more trustful relationship with a person by seeking help for emotional and personal problems’
- Performance Enhancement: ‘I can improve my performance by seeking help for emotional and personal problems’
- Participants were also asked to briefly write down their ideas of any other benefits of seeking help for emotional and personal problems
Table 7 presents the means and standard deviations of the perfectionism scales and the type of help athletes seek from both athletic and social networks, and potential benefits of seeking help from these networks. The score for Information Seeking was lower than for other types of help, and participants moderately agreed that seeking help has secondary benefits. Self-oriented perfectionism was correlated to two types of help sought from Athletic Networks, while socially prescribed perfectionism was correlated only to Information Seeking from Social Network. Self-oriented perfectionism was positively correlated with secondary benefits of seeking help, while socially prescribed perfectionism was negatively correlated to one of the potential benefits of seeking help from Athletic Network.
Some participants wrote down their comments about other secondary benefits of seeking help. The benefits of seeking help from Athletic Network include:
‘It gives you a sense of comfort that somebody is on your side’
‘The teammate may also tell you his or her problems’
‘The person will swiftly notice when I am starting to develop a similar condition again’
‘The team can develop better communication between members’
‘As people understand me more, they may discover a position that suits me more‘
The benefits of seeking help from Social Network include:
‘The person thinks that I am strong enough to disclose my weaknesses’
‘You can re-discover the good relationships you have outside the team’
‘It may help the person to seek help from you so that you can support each other’
The purpose of this article was to investigate whether perfectionistic athletes seek help when they have emotional and performance problems, and what types of help and support they look for, if they do seek help. Study 1 hypothesized that only the facets of perfectionistic concerns, not perfectionistic strivings, would prevent athletes from seeking help even after controlling for the stigma about mental health, attitudes toward professional psychological help (e.g. how effective one thinks psychological help is), and current level of depression. The analyses of help seeking intentions (how likely they would seek help if they have problems) showed that self-oriented perfectionism and socially prescribed perfectionism have different patterns of relationships for help seeking intentions. While self-oriented perfectionism is positively associated with help seeking intentions for both emotional and performance problems from both athletic and social networks, socially prescribed perfectionism is negatively associated with help seeking intentions only for emotional problems both from athletic and social networks. Only the attitude towards seeking professional psychological help but neither type of perfectionism was associated with help seeking from professionals. The analyses of help seeking behaviour (whether they actually sought help over the past 12 weeks) revealed that self-oriented perfectionism was positively associated with help seeking behaviours only for performance problems from athletic networks, but socially prescribed perfectionism was not associated with any help seeking behaviours. Study 2 then explored what kind of help and support athletes with perfectionism would seek. The results suggest that self-oriented perfectionism is associated with two types of help (emotional support and problem solving support) from athletic networks, while socially prescribed perfectionism is associated only with information seeking from social network. Moreover, self-oriented perfectionism is positively associated with the secondary benefits of seeking help such as relationship building, while socially prescribed perfectionism is negatively associated with such secondary benefits.
These findings elucidate some important theoretical implications for perfectionism and help seeking in athletes. Firstly, our findings consistently suggest that college athletes with self-oriented perfectionism would seek help from informal sources such as their coach, teammates, family, and friends. This is consistent with the finding that ‘healthy’ perfectionists view teammates as important sources of support and motivation (Gotwals, Spencer, & Cavaliere, 2014). It is also suggested that these athletes look for both emotional support and problem solving support when they seek help, and they may think that seeking help can contribute to building a more trustful relationship with a person. Flett et al. (1996) found that self-oriented perfectionism was associated with emotional-sensitivity and social expressiveness as measured by the Social Skills Inventory (Riggio, 1986), suggesting that individuals with such perfectionism have a perceived ability to decode social messages and engage others in conversation. This perceived skill may help athletes with self-oriented perfectionism to effectively seek help and support from other people. These results contrast with the assumption of Hewitt et al. (2003) that perfectionists try to look perfect and flawless, and conceal their mistakes and weaknesses. For college athletes with self-oriented perfectionism, it would be more important to achieve their goals (e.g. winning the match) with help and support from other people, rather than worrying too much about what they think of them if they disclose their problems. Alternatively, they may have good interpersonal skills that allows them to keep other people on their side, as suggested by Flett et al. (1996).
On the other hand, college athletes with socially prescribed perfectionism may hesitate to seek help from those sources when they develop emotional problems. They may seek relevant information (e.g. where to find mental health professionals) when they seek help from family and friends, and would not think that seeking help can contribute to building more trustful relationships with their coach and teammates. These findings are consistent with Gotwals et al. (2014), who found that some ‘unhealthy’ perfectionists felt significant pressure to perform to avoid criticism and angry reactions from the coach. They also felt pressure in not wanting to let the teammates down. This may be why some perfectionists try to conceal their mistakes and weaknesses (Hewitt et al., 2003), which is a possible mediator in the relationship between perfectionism and distress (Kawamura and Frost, 2004). Gulliver et al. (2012) discovered that athletes would be worried about others finding out if they were seeking help for a mental health problem, because their coach and teammates would think they were not coping effectively or were ‘weak’. This may explain the present finding that college athletes with socially prescribed perfectionism would not seek help when they develop emotional problems, and they would not think that seeking help could contribute to relationship building with the coach and teammates.
Clinical implications, limitations, and future directions
Our findings also have practical or clinical implications for the facilitation of athletes’ help seeking. Both perfectionistic strivings and concerns do not affect athletes’ help seeking from formal sources such as mental health professionals when they develop emotional problems, and only attitudes toward professional psychological help (e.g. how effective one thinks psychological help is) can affect such help seeking. This is consistent with the view that athletes do not believe that a general practitioner was an appropriate source for seeking help for mental health problems (Gulliver et al., 2012; Boyd, Francis, Aisbett, Newnham, Sewell, Dawes, & Nurse, 2007; Biddle, Donovan, Gunnell, & Sharp, 2006). Athletes may not view mental health professionals as a good source of help when they have developed emotional problems as a result of performance problems. Alternatively, they may believe such professionals would not understand the nature of interpersonal relationship in sports (e.g. the coach-athlete relationship), although they suffer because of such relationships. Thus, in order to facilitate help seeking, it would be important to provide relevant psychoeducation to athletes at an early stage in their career, such as how mental health professionals help athletes’ emotional and interpersonal problems, as well as how effective the psychological therapies are and where to find the relevant professionals.
While few adolescents seek professional psychological help, most will seek help from a variety of other sources, such as family members, friends, and teachers (Boldero & Fallon, 1995; Offer, Howard, Schonert, & Ostrov, 1991). Our findings also suggest that college athletes would seek help from a range of sources such as the coach, teammates, family, and friends. However, college athletes with socially prescribed perfectionism may hesitate to seek help for emotional problems from such sources. The comments that participants provided in Study 2 may help such athletes to understand the positive aspects of help seeking, such as (1) enhancing relationships with other people, (2) giving opportunities for other people to tell their problems to you in order that you support each other, and (3) helping other people to notice when you develop similar problems again. This can be surprising as well as helpful to those with socially prescribed perfectionism, who may fear criticism and rejection if they disclose their problems.
However, such athletes may not know ‘how to start’ help seeking, even if they understand that seeking help does not necessarily result in criticism and rejection. Our clinical experiences suggest that athletes with negative perfectionism are likely to keep emotional problems to themselves until they can no longer practice and somebody else notices it. Moreover, most of them do not know what to do when they can no longer practice. Thus, coaches or other staff may need to help them to identify the person who is the easiest to seek help from, and what kind of help and support they would like, in order that they can start help seeking before the problems become too difficult to manage. The coaches and staff can also stipulate a procedure for athletes who have developed emotional problems that need support from mental health professionals. For example, athletes may want to know who to report to first, the forms to fill in order that they know what to report, where to find the mental health professionals that other teammates have sought help from, and how often they need to give an update on their condition to the relevant staff. This will help the athletes to stop worrying about what to do, but also enhance their awareness of mental health issues and services.
The present study has some limitations. First, the study
investigated college athletes. Consequently, future studies need to explore if
the present findings generalize to professional athletes and youth athletes who
may have different problems and different people who they seek help from. For
example, one of our clients (semi-professional athlete) had trouble with her
coach, and she sought help from her line manager at work, who resolved the
interpersonal problem. Further, the majority of the participants was Asian, and
cross-cultural differences might have affected the result. A survey by the
National Institute of Mental Health (Matsuoka, Breaux, & Ryujin, 1997)
reported that for all types of services (e.g. inpatients or outpatients etc.)
across all types of facilities (e.g. hospitals psychiatric services, mental
clinics, community services, etc.), Asian American/Pacific Islanders are much
less likely than their Euro-American counterparts to make use of mental health
services. A variety of research studies have examined the beliefs of Asians
toward mental illness. Following that, this study employed a longitudinal
design, but followed up the participants only for 12 weeks. Hence, future
studies need to include participants with other ethnic backgrounds, and employ
a longer follow-up period. Finally, it remains unknown what kind of intervention
can effectively facilitate athletes’ help seeking. One study has conducted a
randomized controlled trial of an Internet-based mental health help seeking
intervention for young elite athletes (Gulliver et al., 2012). Their results
suggest that brief mental health literacy and destigmatization improves
knowledge and may decrease stigma but does not increase help-seeking. The
interventions consisted of a mental health literacy and destigmatization
condition, a feedback condition providing symptom levels, and a minimal content
condition comprising a list of help-seeking resources, compared with a control
condition (Gulliver et al., 2012). Thus, future interventions may need to
include psychoeducation about how to start help seeking, and how to modify
negative perfectionism, which can prevent athletes from seeking help.
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Table 1. Means and standard deviations of standard measures, and help seeking intentions for emotional and interpersonal problems, and performance problems
Table 2. Proportion of athletes who sought help from any sources in each category
Table 3. Hierarchical regression analysis for help seeking intention for emotional and interpersonal problems
Table 4. Hierarchical regression analysis for help seeking intention for performance problems
Table 5. Logistic regression analysis of help seeking behaviours for emotional and interpersonal problems, predicted by demographics, depression, stigma, attitude towards seeking professional psychological help, and perfectionism with the block-entry model.
Table 6. Logistic regression analysis of help seeking behaviours for performance problems, predicted by demographics, depression, stigma, attitude towards seeking professional psychological help, and perfectionism with the block-entry model.
Table 7. Means and standard deviations of multidimensional perfectionism scales, help seeking utilization questionnaire, and their interrelationships.
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