4

Introduction

Concussions are one of the most common injuries for athletes to experience. It is a traumatic brain injury that results from your brain rapidly shaking back and forth. This can be caused in many ways such as getting whiplash in a car accident or something as simple as falling and hitting your head. A common misconception is that concussions are minor injuries, but in actuality it is an injury that should not be taken lightly. The side effects of a concussion vary based on the area of the brain that received the impact. If a concussion goes untreated, an individual could suffer from severe headaches and fatigue, sometimes for years. Additionally, concussions could have serious consequences on an individual’s cognition. Cognition is a broad term for anything created by the mind. This includes “mental processes, such as perception, attention, and memory” (Goldstein, 2019, p. 6). It is essential to first explore the basics of cognition in order to fully understand the true impact a concussion may have on an individual. There are many complex components to cognition that are much easier understood by focusing in-depth on a select few at a time. The basic background of cognition, its neuroscience, and perception are deeply involved in the analysis of the impacts of concussive injuries on cognition.

Through our paper we discuss cognition and how concussions can impact many of the mental processes of cognition. Then we describe a wise intervention that can be used to help athletes stop negative self talk and negative self schemas formed because athletes can’t compete/practice anymore.

What is cognition?

In its simplest form, cognition is the way our mind works. Therefore, cognitive psychology would be the study of our mind’s characteristics and how it operates. The mind can be described as our mental process that creates mental representations of sounds, feelings, and images. Cognition is extremely important to study as it provides a handful of answers as to why we think certain thoughts or act certain ways. Cognitive psychology dates all the way back to 1868 when Franciscus Donders ran one of the first cognitive psychology experiments (Goldstein, 2019, p. 6). Since then, cognitive psychology has been understood and interpreted in many different ways. The latest approach to cognition is looking at it as if the mind operated similar to that of a computer. This spawned the information-processing approach, an explanation to highlight the “sequences of mental operations involved in cognition. According to the information-processing approach, the operation of the mind can be described as occurring in a number of stages” (Goldstein, 2019, p. 14).

What is NOT Cognition?

Concussions directly have an effect on cognition, but the actual impact and initial force of the concussion may be related more to physics. With concussions, a cognitive psychologist would look more closely at the way the mental processes have been altered and disturbed. Although physics is extremely important to study, cognition is more concerned with the internal impacts of a concussion.

How are Concussion and Cognition related?

Plain and simple, concussions have a direct effect on concentration, attention, perception, memory and more, which are all components of cognition. Although usually inflicted through physical impact, concussions are more of a functional disturbance than an injury to the physical structure of the head. This means that concussions are a unique injury as it requires more than just a physical examination. Encoding, which is what happens as you learn material, and retrieval, which is what happens as you remember material, are two components of cognition that are most commonly damaged as a result of a concussion. However, other areas include attention and concentration, verbal fluency, and cognitive processing efficiency. Many of these cognitive impairments are resolved within a week but may take longer and have more serious consequences if not treated properly (Covassin & Elbin, 2010). Today’s constant and rapid technological advancement has allowed brain imaging technology to thrive. This opens up the opportunity to look at neuroscience on a deeper scale.

The Science of Cognition: What is our brain made of and how does it work? 

Cognition is the process where neural networks are activated and transmit signals throughout the brain causing one to complete a mental process. Mental processes are created by the mind and include memory, attention, perception, and attribution (Goldstein, 2019, p.6). Along with performing mental processes, cognition can also influence how our mind/self operates including how we behave, react and make decisions (Goldstein, 2019, p.6). The brain is a delightfully dense structure composed of many million neural networks that allow information to be stored, processed, and retrieved. Each neuron contains a cell body, an axon and multiple dendrites that interact with other neurons to send signals (Goldstein, 2019, p.29). The small space between neurons is called the synapse which is where chemical messengers float across to continue or halt the message that is trying to be expressed. Each neuron is only connected to a few other neurons through neural circuits (Goldstein, 2019, p.29). Damage to one neuron can have a big impact on the neural network that it is a part of.

What happens to the brain when athletes get concussions?

Initially when athletes get concussions, the impact that their brain undergoes by hitting their skull can cause there to be torn blood vessels or axons (Graham et al., 2014). The torn blood vessels and axons lead to a change in the blood flow in the brain or differences in the neurotransmitters released (Graham et al., 2014). The axons are essential to the transmission of a signal in a neuron. Signals flow from the cell body through the axon and then into the dendrites. If an axon is torn then this can cause a signal to not be able to make it through a neuron. When a signal can’t move through a neuron then it can’t get to its target area. The localization of function idea states that neurons’ location plays a role in the information they transmit. Therefore damage to one area can impact certain functions for instance damage to the following lobes affects the:

• Occipital Lobe: Visual interpretation
• Parietal Lobe: Perception (pressure, touch, pain)
• Temporal Lobe: Recognizing faces and seeing complex shapes
• Frontal Lobe: Coordination of senses

The results of a concussion on the neural tissue, including the damage of axons, can impact our cognition by not allowing neurons to send their signals. When neurons don’t send their signals neural networks are not activated and this can negatively impact the distributed processing of the brain. Distributed processing is the idea that certain functions are activated in different areas of the brain (Goldstein, 2019, p.44). If certain functions fail to activate then we are missing information for our overall cognition.

Symptoms of a Concussion

Let’s say you are playing a feisty game of basketball when you go to shoot a spectacular shot. Then an ornery opponent side slams into you, causing you to hit the front of your forehead on the firm gym floor. If the impact was hard enough the cerebral cortex of your brain will crash into the location where it was hit and the location opposite to it. Your brain would then have large amounts of neuronal damage on the frontal and occipital lobes of the brain. The frontal lobe is involved in coordination of senses and higher level thinking (Goldstein, 2019, p.39). The occipital lobe is where the visual cortex is located and it is involved with visual processing (Goldstein, 2019, p.39). You would then have damage to the neural networks that aid in your perception of vision and higher level thinking which would alter your cognition.

Neural Code: How do concussions affect neural code?

Concussions are found to damage the neurons in the brain more specifically the axon (Brewer & Redmond 2017). Signals can have a harder time or they can not be transmitted through damaged neurons. If neural networks can’t send the signal between them then there would be no spreading activation across the cortex. Hebb’s rule says that neurons that fire together, wire together. Neurons that are not able to fire together or activate other cells through spreading activation would cause there to be no sent signal which would negatively impact cognition.

Multiple Codes: How are they involved in cognition? 

Neural representation refers to the idea that experience is based on representations in people’s nervous systems rather than direct contact with a stimuli. This means that people’s experiences are based on their cognition.

Additionally, even simple experiences involve the activation of a combination of various codes, making these neurons multidimensional. This concept is known as distributed representation. There are multiple ways that neurons can be activated and form codes through different ways one interprets a sensation. A sensation can then lead to population coding where multiple neurons fire at the same time depending on the stimulus or sparse coding when a few neurons are activated. Multiple stimuli activate neurons in different areas of the brain (as seen below) which is then all added together to make up our cognition. It is important to stimulate multiple routes in your brain due to the idea of encoding variability that says that increasing the routes in your brain increases the retrieval so that you can remember that information better (Kleinknecht, Feb. 10 2020).

Example:  when athletes act out improvements to their performance that was instructed to them, they are increasing their ability to remember what they learned. The athletes would have spreading activation in multiple areas of their brains due to the movement and auditory stimulation. Then when the athletes are trying to recall what they learned, they are more likely to remember due to the multiple neural networks that were activated upon initial learning.

Concussions and Encoding

Encoding is the process of getting information from working memory into long term memory (Goldstein, 2019, p.193). The retrieval of the stored information depends largely on the way it was encoded according to the Levels of Processing Theory.

According to this theory, the quality of memories is dependent on the depth of processing for the memory in question. Memory processing can be shallow, which is where the person does not give much attention to the meaning of what they are remembering. This is the type of processing that happens when you try to remember a phone number using repetition. Items are better remembered, however, when they go through deep processing. Deep processing requires attention and elaborative rehearsal, so that the item has meaning or a relationship to something else (Goldstein, 2019, p.193).

In a 2015 study, researchers found that former athletes who suffered two or more concussions before the age of 18 had a subtle deficit in memory encoding (Terry, D.P.; Adams, T.E.; Ferrara,M.S.; Miller, L.S.). They tend to have less recruitment of areas used in the Levels of Processing Theory such as regions in the left hemisphere. While this long-term deficit is subtle, it highlights the importance of practicing the wise interventions previously mentioned (self-talk, relating new information to old information, imagery, etc).

Perception & Concussions

Perception is described as “experiences that result from stimulation of the senses” (Goldstein, 2019, p.60). These can be influenced by a concussion or can influence the likelihood that athletes become concussed. A change in perception can be the first indicator that athletes are injured, which can later be confirmed by objective testing (Brewer & Redmond 2017). Athletes also have a perceived risk of injury, wherein they analyze the likelihood that they will become injured. Athletes who have been injured before have a higher perceived risk of injury, and act with less confidence and greater worry (Reuter & Short 2005). Their perceptions can lead to them being a predisposed or susceptible athlete, where they become injured after an inciting event (Brewer & Redmond 2017). Perceptions that lead to injury often occur in a top-down processing manner. Athlete’s thoughts influence their perceived environment and cause them to act with excessive caution.

Perception for Action

Perception is made more complex when movement is taken into account; however, movement also makes the perceptions of objects more accurate. Movement allows for multiple viewpoints of one object and therefore, more information surrounding the object (Goldstein, 2019, p.80).

Perception and action occur simultaneously, feeding off each other as well as movement. Actions such as picking up a full cup of coffee and picking up an empty cup of coffee are done slightly differently based on one’s perceptions of the cup. Similarly, running on a clear path versus one with many obstacles are different actions because there is increased perceptual complexity. Perceptions relating to actions can be divided into two pathways: the ventral (what) and dorsal (where) streams. This is because the temporal lobe is responsible for determining what an object is and the parietal lobe is responsible for determining where the object is in space. These pathways can also be called the perception and action pathways because they are involved in how a person orients themselves and how they act on these orientations respectively (Goldstein, 2019, p.82-85).

Concussions & Emotion’s effect on Memory

Concussions can be severely traumatic to athletes. The trauma can come from the high impact to the head and then the realization that the athlete’s performance might be put on halt or altered. Athletes identify with their sports and this might cause them to feel intense emotion including sadness, loss, and anger after getting a concussion. The intense emotion can enhance their memory of the experience.

Emotion is found to be correlated to memory. The pairing of a memory with a strong emotion will increase the memory consolidation (Goldstein, 2019, p.231). Memory consolidation is the process that allows for the strengthening of memories  so that they can be remembered again (Goldstein, 2019, p.226). Memories are fragile when they are first in the brain and through consolidation they are made into a more stable form where they can more likely be retrieved. When something traumatic happens where one experiences a lot of emotion, hormones are released to allow the body to respond to that emotion (Goldstein, 2019, p.231). The hormones released increase the memory consolidation which increases the ability to remember that event. The main structure in the brain that deals with emotion is the amygdala (Goldstein, 2019, p.231). The hippocampus is involved in the forming of memories in the brain (Goldstein, 2019, p.210). The amygdala and the hippocampus work together to form new memories including the memory of getting a concussion.

High emotional events can cause the formation of flashbulb memory. When someone gets a concussion they might form flashbulb memories about those experiences due to the large emotions they felt due to the large impact and change in consciousness. Flashbulb memories are formed when people experience extremely emotional events and that causes them to remember how they formed that memory (Goldstein, 2019, p.232). After a concussion, someone might remember how they formed the memory of that confusion including who was around them when it happened, where they were at, how they felt right before and after the concussion due to the high amount of emotions athletes might have felt.

Flashbulb memories can change and redevelop over time so they are less “true” to the original memory. For example, if an athlete continually thinks about the negative memory associated with becoming concussed, it can impact their reconsolidation. Reconsolidation is when memories that are stored in the long term memory are remembered and then consolidated again (Goldstein, 2019, p.216). However, when memories are remembered they are more susceptible to alterations (Goldstein, 2019, p.216). When memories are consolidated there are two major ways that they can be including synaptic consolidation (short term) and system consolidation (Long term) (Goldstein, 2019, p.208). Synaptic consolidation takes place over the short term scale and involves changes in the synapse between the neurons (Goldstein, 2019, p.208). Systems consolidation is the long term change of neural circuits in the brain and occurs over months to years (Goldstein, 2019, p.208). Continuous reconsolidation of the memory can cause athletes to have changes in the neural circuits in their brain. These neural circuits can then highlight some of the emotion the athletes might feel about concussion.

It is important to know that athletes might feel heavy emotion when they get concussions which will lead to flashbulb memories of that event and an increased amount of memory of that event. The long term effect of continuous rehearsal of a negative flashbulb memory can have bad effects on an athletes self schema. The continuation of thinking about that event due to the high memory can cause synaptic consolidation and system consolidation which can change the flow of the neural circuits in the brian over the long run and make the athlete think more negatively.

Long Term Memory (LTM)

Long term memory is our memory system responsible for storing information for extended periods of time (Goldstein, 2019, p.162). This memory system has a virtually unlimited capacity and is divided into semantic, episodic, and procedural memories. Semantic memory is for remembering facts, episodic is for lived experiences, and procedural is for learned skills.

The different divisions of long term memory are all important for an athlete that is in the recovery process. Semantic memory is useful for remembering rehabilitation information. For many injuries, this may include knowledge of the strengthening exercises done in physical therapy, but for concussions this will more likely include knowledge of what to avoid doing (such as staring at screens for extended periods, being in bright light, or engaging in contact sports before full recovery). Episodic memories may involve knowledge of game play that lead up to their injury. Procedural memories are especially important for an athlete, even before an injury. These allow them to learn the skills necessary for their sport and allow them to continue to be skilled after taking some time away from their sport. These are also important when engaging in the self-talk intervention mentioned later. When an injured athlete learns to use self-talk to regulate their mindset, they gain a sense of control. This learning is only possible through procedural memory.

Attention & Working Memory after Concussions

Attention and working memory are both aspects of the working memory model. Working memory is a system of memory that deals with the manipulation of information while serving as a place for temporarily stored information to be able to do complete complex tasks (Goldstein, 2019, p.143). Working memory was proposed in the working memory model by Baddeley and Hitch to describe the idea that short term memory has a function to process information and to manipulate it (Goldstein, 2019, p.144). In the working memory model there are three components the phonological loop which processes verbal and auditory information, the visuospatial sketch pad which processes visual and spatial information, the episodic buffer which can store information and bring in information from the long term memory, and the central executive which pulls in information from the phonological loop, visuospatial sketchpad and episodic buffer to determine where attention should be going (Goldstein, 2019, p.144-145). Attention is the “ability to focus on specific stimuli or locations” (Goldstein, 2019, p. 95). The central executive can make attention limited and can be selective, divided, or captured by outside stimuli. When attention is selective, someone is able to tune out tasks outside the one they are focused on. If someone were to focus on multiple things at once, their attention would be considered divided. If something outside the task they are working on grabs their attention, this is called attentional capture. Overall, working memory is the short term memory that aids in the perception and attention of stimuli to be able to guide decisions and actions.

Working memory is important for athletes to be able to pay attention and observe their environment and interpret what is around them so that they can adequately respond to it. However, when athletes get concussions they might have brain damage in the areas that deal with working memory and this can influence their ability to pay attention to certain things. The main area in the brain that deals with working memory includes the prefrontal cortex (Goldstein, 2019, p.150). If athletes get concussions that damage the prefrontal cortex then they might not be able to hold information from their environment or pay attention to their environment as well as they normally would be able to. Athletes would have a harder time responding and processing the environment around them and this would lessen their ability to compete or live their day to day lives.

Working memory allows a person to bring long term memories to their consciousness and form the idea of themselves. Working memory allows people to tie in their past, present and future to allow people to form a sense of self. However when someone’s attention gets drawn to their inability to do things they want to do this can lead to negative self talk. Constant negative self talk can lead to a negative self schema. Attention can be used to influence self-talk and mindset intervention to help an injured athlete regain a sense of control and break down the negative self schema. A study by Kross et al., showed that how you engage in self-talk matters when using it as a regulatory mechanism (2014).

To make self-talk effective, one must make small changes in the language they use when approaching challenges. By focusing on limiting the use of first-person pronouns and one’s own name when facing challenges, subjects were better able to regulate their thoughts, feelings, and behaviors. This ability to regulate their mindset would give subjects a greater sense of control. By selectively attending to this change in language, athletes would likely recover in a shorter time frame based on the self determination theory (Brewer & Redmond 2017).

What is a Wise Intervention?

The way people act or perceive a social situation can depend on many factors, including the schemas their brain has created for certain situations. As people grow up, their experiences influence how they perceive and react to certain situations. However, sometimes these viewpoints can cause people to act in a less advantageous way. Psychologists are able to change how people think or feel in order to help them grow into a better and more productive person by using wise interventions. Wise interventions directly target the things in people’s lives that hold them back from their greater potential. By doing this, wise interventions can also lead to a larger positive effect on the individual over time. For instance, a wise intervention may allow an individual to think more positively in a specific situation, which leads to more positive thinking about more general situations, and then a more positive outlook on life as a whole. In order to be effective, wise interventions must change a specific psychological process such as the way things are worded, how orderly a place is, how much control someone perceives in their life, etc. Through wise intervention, people can also be shown how to interpret their actions in social situations in a better and more positive way.

Putting a wise intervention in place involves determining someone’s psychological reality. To develop an applicable wise intervention, one must place themselves in the targeted person or group and imagine their social surroundings. In order to make an effective wise intervention, one must find the root of the problem as to why another person is struggling and then target that problem to allow that person to reach a greater potential. A wise intervention must also begin with a psychological theory that they are attempting to target. Without this, the intervention cannot be precise and will not be very effective. By targeting a psychological theory, researchers are allowing subjects to feel control over the intervention, rather than be passive recipients of the intervention. If the subject is merely passive, the intervention will not have long lasting effects.

What is NOT a Wise Intervention?

Things to avoid in a wise intervention include expecting the intervention to always lead to the goal outcome despite the fact that it may have worked in different ways depending on the individual or group subjects. Wise interventions tend to be specific to certain people or groups and are tailored to fit that group or persons situation. If the same wise intervention that was successful in one person or group is applied to another group then it might not be as effective because not all the factors could be taken into consideration. Wise interventions also don’t address why people do what they do. Wise interventions are used to help change situations versus describing why those situations are the way they are. Wise interventions are not always specific to a certain situation, but rather, are driven by context.

Wise Interventions in relation to Concussions

Wise interventions can be used with athletes suffering from an injury, like a concussion. During recovery periods, athletes can develop negative self talk where their internal voice brings them into a more negative mindset when they think about their concussion. When athletes think about the negative symptoms of concussions, they might feel a loss of sense of self and a sense of control. Athletes might also think in a fixed mindset where they continue thinking negatively about their situation which creates negative self schemas for themselves.

Since sports are a large part of an athlete’s identity, they often experience grief when they are unable to participate. When athletes also learn about how their future performance might be affected they might think very negatively about their situation and themselves.

A wise intervention that may be effective with injured athletes is helping them regain a sense of control to stop the negative self talk. A wise intervention can also allow a person to focus their working memory on a positive perspective (positive self talk) which will then lead to the formation of positive long term memories that they can use to function optimally. Our wise intervention stems from two examples of wise interventions. In a study on residents of a nursing home, participants reported better health outcomes after gaining a sense of control (Langer & Rodin, 1976; Rodin & Langer, 1977; see also Schulz, 1976; Schulz & Hanusa, 1978). In order to achieve this, residents were given responsibilities that they were in charge of managing, rather than having a staff member being responsible for them. Athletes are likely to benefit from similar interventions where they gain a sense of control. The self-determination theory, combined with theory of planned behavior exemplifies this (Brewer & Redmond 2017). For example, athletes with a positive outlook on rehab are more likely to recover in a shorter amount of time. Athletes who are excited to get back to their sport recover in a shorter amount of time than athletes who do not like their sport, team, coach, etc. Reframing is another technique similar to wise interventions. This involves posing questions to athletes to direct them to a more positive state of mind (Brewer & Redmond 2017). Reframing is more explicit than wise interventions, but produces similar positive effects since they ask athletes to think with a positive mindset and through a mindset in which they think they are going to get better. When athletes think in a more positive way about their situation they are breaking down their negative self talk and negative self schemas.

We can then frame the idea of positive outcomes from sport injury as a wise intervention. Using what we already know about wise interventions, self control, self talk, self schemas, self-determination theory, and reframing, we were able to create a wise intervention logic model. Essentially, we are assuming that giving athletes a sense of self control post-injury and positive outlook on getting better will allow them to have a more positive mindset which, in turn, could help them recover quicker.

Wise interventions to enhance working memory?

Everyone has different limits to their working capacities. However, there are some things that athletes can do to strengthen their working memory to stop them from having negative self talk and negative self schemas (Goldstein, 2019, p.154). These things include:

• When learning new things athletes should think elaborately by trying to pair the new information learned with old information or past memories. For instance when learning about the wise intervention stated above athletes can try to pair how they should think to other people or situations that have resembled the same thinking way. For instance, if athletes have a teammate who thought positively about rehab and didn’t think their situation was negative they might use them as a way to remember to not think negatively about themselves. The relation of themselves to their teammate will make them be able to remember and implement the positive mindset better and in an easier way.
• Athletes can use more imagery to try to remember things better. For instance, athletes can imagine themselves being a great player again and also imagine themselves being super positive about their situation. The use of imagery enhances working memory and it enhances the chances that memory goes into the long term memory.

Damage to working memory can be very disadvantageous to athletes due to the fact that many athletes need to constantly respond to their environment and in a quick way. Damage to working memory could lead to less interpretation and processing of the environment.

This program can be used to help athletes gain more sense of control over their mind and allow them to stop the negative self talk and self schema they might feel after getting a concussion. We hope that our program helps athletes mentally recover faster from their concussion. Wise interventions for concussed athletes extend beyond self-talk. Anything that would be advantageous and help an athlete’s productivity or thought processes would improve athletes mental states.

References 

Brewer, B., & Redmond, C. (2017) Psychology of Sport Injury. Human Kinetics Publishers.

Covassin, T., & Elbin, R. J. (2010). The cognitive effects and decrements following concussion. Open access journal of sports medicine, 1, 55–61. https://doi.org/10.2147/oajsm.s6919

Graham R, Rivara FP, Ford MA, et al. (2014). Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Washington (DC): National Academies Press.

Kleinknecht, E. (Feb. 10 2020). Psy206 Week 3 Sp2020. Retrieved from https://moodle.pacificu.edu/mod/resource/view.php?id=543748

Langer, E. J., & Rodin, J. (1976). The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. Journal of Personality and Social Psychology, 34, 191–198. https://doi.org/10.1037/0022-3514.34.2.191

Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239 –245. http://dx .doi.org/10.1037/0022-006X.56.2.239

Terry, D.P.; Adams, T.E.; Ferrara,M.S.; Miller, L.S., (2014). FMRI Hypoactivation During Verbal Learning and Memory in Former High School Football Players with Multiple Concussions, Archives of Clinical Neuropsychology, 30 (4), 341–355, https://doi.org/10.1093/arclin/acv020

Schulz, R. (1976). Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. Journal of Personality and Social Psychology, 33, 563–573. https://doi.org/10.1037/0022-3514.33.5.563

Schulz, R., & Hanusa, B. H. (1978). Long-term effects of control and predictability-enhancing interventions: Findings and ethical issues. Journal of Personality and Social Psychology, 36, 1194–1201. https://doi.org/10.1037/0022-3514.36.11.1194

Walton, G. M. (2014). The new science of wise psychological interventions. Current Directions in Psychological Science, 23, 73 – 82. Doi: 10.1177/0963721413512856

Walton, G.M. & Wilson, T.D. (2018). Wise interventions: Psychological remedies for social and personal problems. Psychological Review, 125, 617 – 655. https://doi.org/10.1037/rev0000115