Interactive evening organised by Engage Your Mind @EymPsychiatry, inspiring foundation trainee doctors and final year medical students to consider Psychiatry as a profession.

1. Dr Nicoletta P. Lekka, MD, MSc, PhD
Sheffield Medical School, 6 November 2018

6. Sports Psychiatry
 Diagnosis and treatment of psychiatric
illness in athletes, as well as using
psychological approaches to enhance
performance.
 Competencies: the same as any
Psychiatrist, but with insight into both
individual and team culture of the specific
sport.
 Complexities of prescribing.
 Overlap and distinction from the role of
Sport Psychologist.

7. RCPsych Sport and Exercise
Special Interest Group
 Raising awareness of mental health
problems in sport and promoting best
practice in addressing these.
 Promoting physical activity and
exercise interventions throughout
mental health services.

9. Dancers = Athletes/Artists plus!
 Physical, intellectual and
psychological demands of dancing
comparable to those of most
strenuous sports.
 Years of dedication, perseverance
and intense practice.
 Keeping in shape, undertaking
repetitive practices before a
performance.
 Heavy physical workloads, great
deal of mental stress.
 Need for endurance, longevity,
resilience.

10. What can doctors learn?

11. Dancers’ Mental Health
 Dancers’ mental and physical state will
determine how ready they are to perform at
a high level.
 They may be at risk of mental health
problems because of age-related issues,
trying to keep in shape, heavy physical
workload, frequent transitions, a great deal
of mental stress, serious injuries, the idea
that they need to "dance through” pain
even when it is detrimental, or anticipated
retirement.
.

13. Anxiety
 In Performance Anxiety, dancers may
experience nervousness or anxiety before,
during and after a performance.
 They might experience self-doubt and
repetitive negative thinking, worry that they
will not perform well, focus only on
negative aspects of their performance,
have difficulties concentrating, or worry that
their performance was inadequate and that
they have disappointed people who are
important for them.

14. Depression
 Depression can affect dancers’ performance,
especially if they are not sleeping or eating
well, have negative thoughts, poor motivation,
or cannot concentrate.
 It can also increase their risk of injury as they
may not be able to concentrate, are less alert,
distracted and indecisive, responding more
slowly, or making poor judgements. Their body
might not be in its optimum state because they
may have been eating or sleeping poorly.

15. Disordered Eating
 Many people believe that being thin
enhances dancers’ performance and that if
they are performing well, they are healthy.
 In reality, disordered eating can negatively
affect dancers’ performance. It can
decrease their concentration, make them
feel anxious, depressed, isolated, and
thinking obsessively about their weight; it
can cause malnutrition, dehydration and
muscle weakness, making them feel tired
and cold.

16. Substance Misuse
 Dancers may use substances to relax, feel more
energetic and alert or to "feel good". Sometimes
they might use substances to control their weight
or to help with anxiety or depression.
 Unfortunately many substances cause further
depression or anxiety because of their effects on
the brain. For example, there is a known
connection between Alcohol and Depression.
 Using substances can make people neglect
commitments and responsibilities in their work,
personal and social life.

17. Perfectionism
 Striving for excellence is different to striving for
perfection. Perfectionists may be setting high standards
and goals, and be highly driven and determined.
 However, they may also be concerned about making
mistakes, ruminating, procrastinating, experiencing self-
doubt, feeling they are not "good enough", or feeling
highly critical of themselves and others.
 They may be experiencing constant anxiety about their
own performance, the performances of colleagues and
the reactions of observers.

18. Perfectionism
 Perfectionists’ pursuit for unrealistic
perfection may make them allocate
substantial time, energy and resources to
unachievable goals.
 They may end up with financial
uncertainties, relationship difficulties,
restricted social support and feelings of
isolation and loneliness.

19. Perfectionism
 Perfectionist dancers may feel that their
performance and body should be perfect, or
that every move they make is subjected to
scrutiny. They might be surrounded by others
who may also be perfectionists, such as
colleagues, dance teachers or family.
 Perfectionism is pervasive and particularly
problematic in dance and can make dancers
vulnerable to anxiety, disordered eating,
injury, re-injury, overtraining and burnout.

20. Stress
 Dancers may experience stress because of
environmental conditions in their work (poor facilities
and equipment, crowded working conditions, extreme
temperatures), or may have financial concerns,
unexpected obligations, misunderstandings, and
interruptions during work.
 They may experience role stressors (perceived lack of
autonomy and control, inadequate or inconsistent
direction, intra-group rivalry, poor social support, and
role conflict) or major life events (death of a loved one,
relationship problems, relocation, serious injury, or
career transition).

21. Stress
 Dancers may be working in a competitive environment,
feeling they are constantly evaluated and selected, with
minimal feedback. They may feel under pressure to stay
thin and perform perfectly.
 Occupational stress can make them vulnerable to more
days off-sick or to absences from work. It can cause
compulsive, workaholic tendencies, eating disorders,
injuries, and addictive behaviour (e.g. alcohol).
 Dancers may experience workaholic and perfectionist
tendencies as a diminished sense of humour, skipping rest
and meals, increased overtime or no vacation, physical
complaints, withdrawing from social life, a decline in their
performance, or self-medicating. Anxiety disorders can get
worse after stress.

22. Stress and Burnout
 Dancers may experience training distress,
involving feeling stressed, having mood
disturbances / fatigue, physical symptoms, sleep
difficulties, or motivational changes (a shift toward
higher levels of extrinsic motivation and a shift
toward lower levels of self-determined
motivation).
 Symptoms related to staleness and the
overtraining syndrome might be followed by
burnout, i.e. feelings of reduced accomplishment
as well as devaluation and resentment of an
activity people used to enjoy. Burnout can reduce
significantly dancers’ career duration.

24. How to get help
 To reach dancer-centred care, mental health
professionals should be able to understand dancers’
specific needs, risks, strengths and wishes.
 Dancers’ mental health problems may affect their
studies, work or career. Mental health professionals
should ask dancers about the stressors of their day-
to-day study or work and how they affect their mental
health.
 Dancers should explain their particular circumstances
and should stress the importance of returning to
dance in full mental health.

25. How to get help
 Having a mental health problem is not trivial or
a sign of weakness. It's not "your choice" or
"not trying hard enough". People can't "just get
over it".
 Mental illnesses come with significant
difficulties and need treatment.
 Talking to a healthcare professional will help
determine if there is a mental health problem
that needs treatment.

26. Sources
 Accessing mental health services - NHS services - NHS Choices
 Alcohol & Athletic Performance - NCAA.org
 Challis J, Stevens A, Wilson M. Resource paper: Nutrition. IADMS, 2016
 FAQs: How to get help - Royal College of Psychiatrists
 Grove JR, Main LC, Sharp L. Stressors, recovery processes, and manifestations of training distress in dance
Journal of Dance Medicine & Science, 2013: 17(2), pp. 70-78
 Hernandez BM. Addressing Occupational Stress in Dancers. Journal of Physical Education, Recreation & Dance,
2012:83(6), pp. 3-50
 Information & support | Mind, the mental health charity
 Jeste DV1, Palmer BW, Rettew DC, Boardman S. Positive psychiatry: its time has come J Clin Psychiatry. 2015
Jun;76(6):675-83
 Klockare E, Gustafsson H, Nordin-Bates S. An interpretative phenomenological analysis of how professional
dance teachers implement psychological skills training in practice. Research in Dance Education. 2011;12:3, 277-
293
 Mainwaring LM, Finney C. Psychological Risk Factors and Outcomes of Dance Injury: A systematic review.
Journal of Dance Medicine & Science, 2017: 21(3), pp. 87-96
 Noh YE, Morris T, Andersen MB. Psychosocial Stress and Injury in Dance. Journal of Physical Education,
Recreation & Dance, 2003, pp. 36-40
 Nordin-Bates S. Perfectionism. Resource Paper: IADMS, 2014
 Overview of urgent and emergency care services in England NHS Choices
 Russell JA. Preventing dance injuries: current perspectives. Open Access Journal of Sports Medicine, 2013; 4:
pp. 199–210.
 Seeking help for a mental health problem | Mind, the mental health charity
 Sherman R and Thompson R, NCAA Managing the Female Athlete Triad
 Thompson RA, Sherman R, and Bloomington Center for Counseling and Human Development. Managing
Student-Athletes' Mental Health Issues - NCAA.org
 Wan Nar Wong M, Wing Kee To W, Chan K. Dance Medicine. In Mafulli, N., Chan, K., Malina, R. and Parker, T.,
eds. Sports Medicine for Specific Ages and Abilities - 1st Edition - Elsevier, 2000; pp.161-168

27. Photos
 Drew Graham on Unsplash
 chuttersnap on Unsplash
 Michael Zittel from Pexels
 Ahmad Odeh on Unsplash
 Eugenia Maximova on Unsplash
 Ahmad Odeh on Unsplash
 Ahmad Odeh on Unsplash
 Gez Xavier Mansfield on Unsplash
 Ahmad Odeh on Unsplash

28. Thank you!

29. Sport and Exercise Special Interest Group - Royal
College of Psychiatrists
@nicoletta_lekka twitter updates and information on
dancers’, athletes’ & performing artists’ mental health,
sports and exercise, coaching