We are constantly bombarded by information. Therefore, during every waking moment of our lives, we face decisions about which stimuli to prioritize and which ones to ignore. To complicate matters, the information that clamors for our attention includes not only events that occur in the world around us but also experiences that originate in the subjective domain of our own thoughts and feelings. The end result is that our minds can consciously attend to only a fraction of the rich kaleidoscope of information and experiences available to us from our senses, thoughts, memories, and imagination. Attentional processes such as “concentration,” or the ability to focus on the task at hand while ignoring distractions, are crucial for success in sport and other domains of skilled performance. To illustrate, Venus Williams, one of the greatest tennis players of all time, proclaimed that “for the players it is complete and pure focus. You don’t see anything or hear anything except the ball and what’s going on in your head.” For psychological scientists, concentration resembles a mental spotlight (like the head-mounted torch that miners and divers wear in dark environments) that illuminates targets located either in the external world around us or in the internal world of our subjective experiences. A major advantage of this spotlight metaphor is that it shows us that concentration is never “lost”—although it can be diverted to targets (whether in the external world or inside our heads) that are irrelevant to the task at hand. Research on attentional processes in sport and performance has been conducted in cognitive psychology (the study of how the mind works), cognitive sport psychology (the study of mental processes in athletes), and cognitive neuroscience (the study of how brain systems give rise to mental processes). From this research, advances have been made both in measuring attentional processes and in understanding their significance in sport and performance settings. For example, pupillometry, or the study of changes in pupil diameter as a function of cognitive processing, has been used as an objective index of attentional effort among skilled performers such as musicians and equestrian athletes. Next, research suggests that a heightened state of concentration (i.e., total absorption in the task at hand) is crucial to the genesis of “flow” states (i.e., rare and elusive moments when everything seems to come together for the performer) and optimal performance in athletes. More recently, studies have shown that brief mindfulness intervention programs, where people are trained to attend non-judgmentally to their own thoughts, feelings, and sensations, offer promise in the quest to enhance attentional skills in elite athletes. By contrast, anxiety has been shown to divert skilled performers’ attention to task-irrelevant information—sometimes triggering “choking” behavior or the sudden and significant deterioration of skilled performance. Finally, concentration strategies such as “trigger words” (i.e., the use of short, vivid, and positively phrased verbal reminders such as “this ball now”) are known to improve athletes’ ability to focus on a specific target or to execute skilled actions successfully.
Aidan Moran and John Toner
Simona C. Kaplan, Michaela B. Swee, and Richard G. Heimberg
Social anxiety disorder (SAD) is characterized by fear of being negatively evaluated by others in social situations. Multiple psychological interventions have been developed to treat SAD. The most widely studied of these interventions stem from cognitive-behavioral, acceptance-based, interpersonal, and psychodynamic conceptualizations of SAD. In cognitive-behavioral therapy (CBT), patients learn to identify and question maladaptive thoughts and engage in exposures to feared situations to test the accuracy of biased beliefs. Mindfulness and acceptance-based approaches to treating SAD focus on mindful awareness and acceptance of distressing internal experiences (i.e., psychological and physiological symptoms) with the ultimate goal of behavior change and living a meaningful life based on identified values. Interpersonal psychotherapy links SAD to interpersonal problem areas and aims to reduce symptoms by targeting interpersonal difficulties. Psychodynamic psychotherapy for SAD focuses on identifying unresolved conflicts that lead to SAD symptoms, fostering insight and expressiveness, and forming a secure helping alliance. Generally, CBT is the most well-studied of the psychological treatments for SAD, and research demonstrates greater reductions in social anxiety than pill placebo and waitlist controls. Results from randomized controlled trials (RCTs) suggest that mindfulness—and acceptance-based therapies may be as efficacious as CBT, although the body of research remains small; four of five RCTs comparing these approaches to CBT found no differences. RCTs comparing CBT to IPT suggest that CBT is the more efficacious treatment. Two RCTs comparing CBT to psychodynamic psychotherapy suggest that psychodynamic psychotherapy may have efficacy similar to CBT, but that it takes longer to achieve similar outcomes. RCTs examining CBT and pharmacotherapy suggest that the medications phenelzine and clonazepam are as efficacious as CBT for treating SAD and are faster acting, but that patients receiving these medications may be more likely to relapse after treatment is discontinued than patients who received CBT. Research generally does not indicate added benefit of combining psychotherapy with pharmacotherapy above each monotherapy alone, although this body of research is quite variable. Effectiveness studies indicate that CBT is equally effective in community clinics and controlled research trials, but studies of this nature are lacking for other psychological approaches.
Shauna Shapiro and Elli Weisbaum
Mindfulness practice and protocols—often referred to as mindfulness-based interventions (MBIs)—have become increasingly popular in every sector of society, including healthcare, education, business, and government. Due to this exponential growth, thoughtful reflection is needed to understand the implications of, and interactions between, the historical context of mindfulness (insights and traditions that have been cultivated over the past 25 centuries) and its recent history (the adaptation and applications within healthcare, therapeutic and modern culture, primarily since the 1980s). Research has shown that MBIs have significant health benefits including decreased stress, insomnia, anxiety, and panic, along with enhancing personal well-being, perceptual sensitivity, processing speed, empathy, concentration, reaction time, motor skills, and cognitive performance including short- and long-term memory recall and academic performance. As with any adaptation, skillful decisions have to be made about what is included and excluded. Concerns and critiques have been raised by clinicians, researchers, and Buddhist scholars about the potential impact that the decontextualization of mindfulness from its original roots may have on the efficacy, content, focus, and delivery of MBIs. By honoring and reflecting on the insights, intentions, and work from both historical and contemporary perspectives of mindfulness, the field can support the continued development of effective, applicable, and accessible interventions and programs.