Athletes may experience trauma both within (e.g., sports-related injuries, abusive coaching dynamics) and outside of sports (e.g., adverse childhood experiences, gender-based violence). (See my post “Trauma and PTSD Among Elite Athletes” for more information.) In order to create trauma-informed sports environments, we should assume that athletes have experienced trauma and subsequently aim to create environments that are sensitive to this reality. Sports organizations have increased efforts to disseminate information about trauma symptoms and information about treatment services; however, creating trauma-informed sports environments also requires the intentional cultivation of spaces where traumatized athletes feel safe and supported every day.

The Substance Abuse and Mental Health Services Administration (SAMHSA)’s Concept of Trauma and Guidance for Trauma-Informed Approach (2014) provides guidelines for trauma-informed approaches that can be applied to sports environments. In recognition that creating trauma-informed sports environments is a shared responsibility, these approaches can be adopted by a variety of professionals who interface with athletes (e.g., treatment providers, coaches, administrators).

The Four R’s: Key Assumptions in a Trauma-Informed Approach

1. Realize: Realize trauma and its effect on people and groups by understanding how trauma affects athletes and how coping strategies are often designed to survive trauma. What may be observed as “problem behaviors” (e.g., non-compliance towards authority figures) among athletes can actually be symptoms of trauma or represent coping skills that were helpful when surviving trauma or other difficult experiences. These same behaviors can emerge when someone is triggered or re-traumatized in sports.
2. Recognize: Recognize the signs of trauma through education on common symptoms and instituting trauma screening and assessment. Understand that trauma symptoms among athletes may differ from the general public (e.g., somatization, lack of rehabilitation adherence). Sports organizations may consider adding screeners that assess for adverse childhood events and trauma symptoms during pre-participation examinations, though should first consider their capacity to adequately respond to these screeners.
3. Respond: Understand that trauma impacts all people involved by offering both staff training and adequate resources to traumatized athletes. All members of athletic organizations should understand their response and reporting obligations. Trauma-informed responses for traumatized athletes may range from resilience-building to psychoeducation to referrals for specialized mental health services.
4. Resist: Recognize that sport ecosystems can be inherently retraumatizing. Resist retraumatization by recognizing that there are aspects of sport that are involuntary, physically coercive, and triggering. Aim to mitigate this reality through key principles of trauma-informed approaches (e.g., asking for permission, providing rationales).

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6 Key Principles of a Trauma-Informed Approach

1. Safety: Ensure physical and psychological safety and respect in interpersonal interactions by developing rapport with athletes. Ask for permission before providing medical and mental health screenings and treatment or providing strength and training instruction that involves personal touch. Recognize that many trauma survivors have experienced abuse of autonomy and personal boundaries in their past and these interactions may be unintentionally retriggering.
2. Trustworthiness and Transparency: Develop relationships with athletes founded in trust and respect by offering explanations and providing rationales for mental and physical health screenings and treatment and individual/team instruction. Be willing to answer even seemingly basic questions, as these may be efforts for athletes with trauma histories to ensure trust in relationships.
3. Peer Support: Establishing cultures of well-being among athletes by welcoming discussions related to mental health and creating opportunities for connection between those with lived experiences. The more opportunities that are built into an athlete’s already busy schedule (e.g., team sessions with sport psychologists), the more likely athletes are to reap the benefits.
4. Collaboration and Mutuality: Balance power and share decision-making. Allow athletes to be active participants in their sport environments, whether this be through shared decisions about their physical and mental health care or components of sports training, as appropriate. Identify and utilize team leaders who athletes trust and respect.
5. Empowerment, Voice, and Choice: Facilitate rather than control. Share power through mutually agreed upon decisions, goals, and choices. Many traumatized athletes have experienced a sense of loss of control over their voices, bodies, and environments. Recognize that empowering athletes to provide input into their medical care and training and emphasizing strength-based approaches will allow individual athletes and teams to maximize their potential.
6. Cultural, Historical, and Gender Issues: Recognize the unique impact of historical and identity-based marginalization on trauma and recovery. Acknowledge that these dynamics are inherently at play in sports environments. Ensure that athletes have people and spaces to explore the impact of these dynamics on their well-being and performance (e.g., identity-based affinity spaces and mentors).

Ultimately, trauma lives in the body and its pain demands to be felt. Trauma survivors carry their traumatic experiences with them wherever they go and they do not get left at the door of fields and gymnasiums. Because even our “toughest” athletes are susceptible to traumatic histories and experiences, efforts to prevent the re-traumatization of athletes and providing swift, effective intervention in the (inevitable) situations where we cannot are equally important.