The effectiveness of stress regulation interventions with athletes: A systematic review and multilevel meta-analysis of randomised controlled trials

ABSTRACT

We conducted a pre-registered systematic review of seven databases and meta-analysis of randomised controlled trials with athletes to examine the effectiveness of stress regulation interventions on performance outcomes, and the conditions under which their effects are strongest. We found a positive and significant moderate overall effect of stress regulation interventions on performance outcomes (65 effects, k = 21, N = 2022, g = 0.52, 95% CI = 0.19, 0.84) and a significant large effect on physiological outcomes (28 effects, k = 10, N = 368, g = 2.13, se = 0.81, 95% CI = .47, 3.79), yet the effect on psychological dimensions was statistically inconsequential (28 effects, k = 10, N = 787, g = 0.35, 95% CI = −0.12, 0.81). Sensitivity and meta-bias analyses generally supported the robustness of the pooled effect of stress regulation interventions on athlete performance, yet the prediction intervals suggested some interventions may be inefficacious or detrimental for athlete performance. The strongest effects on performance were observed at follow-up when compared with post-test. Collectively, our findings offer a high-quality assessment on the effectiveness of stress regulation interventions for athlete performance and provide direction for future research in terms of conceptual and methodological issues.

KEYWORDS:

• Behaviour change techniques
• biofeedback
• cognitive–behavioural
• mindfulness
• relaxation
• three-level meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Technically, Rumbold and colleagues used the terminology ‘stress management’. By definition, the term ‘manage’ implies that one has dealt with difficult circumstances successfully (https://dictionary.cambridge.org/dictionary/english/manage), whereas ‘regulate’ reflects doing something in a specific way irrespective of outcome (https://dictionary.cambridge.org/dictionary/english/regulate). We believe this distinction is important for two key reasons: (i) regulate conveys both reactive and proactive approaches to engaging with internal or external stimuli, which is most reflective of the ideal approach to engaging with stressors in one’s life; and (ii) regulate does not conflate the concept with its outcome, which is important because one might regulate their efforts in/effectively depending on context. The term regulate is also preferred in other areas of psychological science, such as emotion regulation and self-regulation, where there exists large bodies of conceptual and empirical work.

Additional information

Funding

Elizabeth Murdoch is supported by the Australian Government’s Research Training Program and a top-up scholarship from the Western Australian Institute of Sport.