ENHANCING HEALTH AND WELL-BEING PART II

IV. Addictive and Unhealthy Behaviors

Eating Disorders
Eating disorders are behavior issues distinguished by serious and consistent disruption in
eating habits, along with stressful thoughts and emotions. It can be life-threatening illnesses that
damage physical, psychological, and social function (American Psychiatric Association, n.d.). The
main eating disorders are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder
(BED) (EDs) (Himmerich & Treasure, 2018).
Eating disorders are significantly sexually differentiated conditions with a female risk
predominance. The findings of Klump, Culbert and Sisk (2017) recommended that increased
prenatal testosterone exposure in male serves as protection against binge eating. In females,
however, studies show that a deficiency of prenatal testosterone associated with the organizational
effects of pubertal ovarian hormones may contribute to greater binge eating.
Furthermore, cognitive behavioral therapy is presently the best remedy for bulimia nervosa
and binge-eating disorder and existing information supports the use of a certain type of family
therapy for youth with anorexia nervosa (Wilson, G. et al, 2007).

Substance Abuse
Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment
for drug abuse concluded that this modality offered a “promising, but not definitive” approach to
treating drug abuse among adolescents and adults. Less than a decade later, significant progress
can be seen in the treatment of drug abuse problems using family-based approaches, particularly
with adolescents. Family-based treatments are currently recognized as among the most effective
approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has
also advanced in important ways with the recent systematic application and testing of engagement
techniques and behavioral couples therapy approaches. The current review characterizes and
discusses the developmental status of this subspecialty and outlines areas in which continued
research attention is needed.
Although the prevalence of drug use among high school students and household members
has been declining in recent years, high rates of substance use among arrestees, homeless
individuals, and school dropouts, and an increasing trend in the number of drug-related hospital
emergency room incidents, suggest that substance abuse among some populations has not
declined. Prospective longitudinal studies have identified a number of risk factors that consistently
predict greater likelihood of substance abuse. Individuals experiencing multiple risk factors and
few protective influences during infancy, childhood, and early adolescence are at greatest risk for
abusing substances during late adolescence and early adulthood. Efforts to reduce risk and enhance
protective factors in multiple domains hold promise for effective substance abuse prevention
among high-risk populations.

Addiction to Exercise
Exercise in appropriate quantity and of proper quality contributes significantly to
preserving our health. On the contrary, excessive exercise may be harmful to health. The term
'exercise addiction' has been gaining increasing recognition to describe the latter phenomenon. The
exact definition of exercise addiction and its potential associations with other disorders is still
under study, although according to the authors this phenomenon can be primarily described as a
behavioral addiction. Accordingly, exercise addiction, among other behavioral and mental
disorders, can be well described within the obsessive-compulsive spectrum suggested by
Hollander (1993).
To prevent exercise addiction, avoid excessive trips to the gym. Limit your workout time
and the amount of daily exercise. Take breaks from exercise throughout the week to let your body
rest. If you find yourself becoming obsessed with exercising, talk to your doctor about what you
can do (Stubblefield, 2017).

V. Burnout and Overtraining

Definitions of Overtraining, Staleness, and Burnout

Overtraining can be regarded as a natural process when the end result is adaptation and
improved performance; the supercompensation principle — which includes the breakdown process
(training) followed by the recovery process (rest) — is well known in sports. However, negative
overtraining, causing maladaptation and other negative consequences such as staleness, can occur.
Staleness as a state characterized by reduced performance in concert. Meanwhile, burnout is a
psychological syndrome that involves a prolonged response to chronic interpersonal stressor.

Frequency of Overtraining, Staleness, and Burnout

Intense and frequently performed physical training can result in both adaptation and
maladaptation often referred to as overtraining syndrome/ staleness or burnout depending on the
severity of the condition.
Too much training (physiologically driven), high levels of psychosocial stress in
combination with moderate training loads (psychosociological driven), and an obvious lack of
recovery actions undertaken (poor recovery driven) are major pathways accounting for the
majority of stale and burnout athletes. (Kenttä, Göran. 2001., p. 81).

Models of Burnout
Smith’s (1986) Cognitive-Affective Stress Model

Smith proposed a stress-induced model of burnout. In Smith’s model, burnout is

hypothesized to develop via a four-stage process where stress and burnout evolve in parallel.
In the first phase demands such as high training load, extreme expectations and parental
pressure are placed on the athlete. The second stage involves cognitive appraisal of the situation.
All athletes will not interpret the demand similarly. Some will perceive the situation more
overwhelming than others and experience feelings of helplessness. Third, if the demand is
perceived as overwhelming or threatening, a physiological response will arise.
The burnout symptoms here are typically tension, fatigue, and insomnia. Finally, the
physiological response will lead to behavioral responses or coping such as decreased performance,
avoidant behavior or withdrawal from the activity.
Smith also proposed that the model is circular and continuous, which means that the coping
and behavioral responses will affect subsequent stages of demands and appraisal. All four stages
are also influenced by personal and motivational factors. Much of the early research on athlete
burnout adopted a stress perspective.
 1. Silvas’s (1990) Negative Training Stress Model
Silva AJO developed a model with a strong focus on physical and training factors, although
he also recognized the importance of psychological aspects.
This model states that burnout is a product of excessive training and that the training load
can have both positive and negative effects. If a positive adaptation to the training load takes place
this will lead to enhanced performance, which is the goal of the training, but a negative adaptation
will eventually lead to burnout and withdrawal from sport.

2. Coakley’s (1992) Unidimensional Identity Development and External Control Model

The models of Smith and Silva are mainly focused on stress. Another perspective suggests
that the social organization of high-performance sports is causing burnout in athletes due to a lack
of control and identity constrictions.
Coakley based his model on informal interviews with young high-level athletes and argued
that stress is not the cause of burnout but only a sign. Coakley proposed that the amount of time
the athletes commit to sports limits the possibility for developing a multifaceted identity. They
have no time to spend with friends or on activities outside of sport.

3. Schmidt and Stein’s (1991) and Raedeke’s (1997) Commitment Model

Commitment was proposed as an important factor in the development of burnout.
Commitment is defined as a “psychological construct representing the desire and resolve to
continue sport participation”.
Three categories of “causal conditions” for commitment have been proposed. The first
category is how attractive or enjoyable the activity is perceived; the second category involves
which alternatives to the activity are viewed as in a greater or lesser degree as attractive. The last
category contains the restrictions the athlete perceives to withdraw from sport such as personal
investments and social constraints (such as social pressure).
There is empirical support for this model and the concept of commitment and entrapment
give valuable insights into burnout in addition to more stress-based perspectives.

4. Self-Determination Theory
Self-Determination Theory has been used as a framework from which to explain burnout.
According to this theory, the satisfaction of the core human needs of relatedness, autonomy, and
competence is fundamental for wellbeing, whereas frustration of these needs contributes to ill
health. Moreover, these needs relate to differential motivational regulations. Studies using this
theoretical framework have shown that burnout is positively associated with amotivation and
negatively associated with intrinsic motivation

5. Gustafsson et al.’s (2011) Integrated Model of Athlete Burnout

Gustafsson and colleagues made an attempt to integrate knowledge from several burnout
models. This integrated model includes antecedents, early signs, consequences, as well as factors
that influence the burnout process, including personality, coping and environmental factors. This
model provides an integrative conceptual framework for understanding athlete burnout.

Factors leading to Overtraining and Workout

Overtraining is one of the biggest problems in the process of sport training. Especially,
freshmen and amateur athletes who do not have enough knowledge about the behavior of their
body, training and who do not have personal trainers encounter overtraining. So far, some
theoretical and practical solutions for avoiding overtraining have arisen.
 To achieve performance gains, training schedules balance challenging workouts and short-
term fatigue with adequate rest to enable adaptation. When exercise intensity and volume are
increased too rapidly and recovery is persistently inadequate, athletes are at risk of developing
overtraining syndrome (OTS), defined as fatigue and suboptimal athletic performance persisting
for more than two weeks despite complete rest. Associated findings include altered mood,
increased risk of infection, and alterations in several biochemical and immunologic markers.

In today's digital world many individuals spend their day in front of a computer or mobile
phone for entertainment. Individuals enjoy a more sedentary lifestyle from advances in technology.
This is one of the leading factors contributing to a decrease in fitness level for large parts of the
populations in developed countries.

Workout is a relatively new word in the English language -- only about 100 years old. It
supposedly originated in boxing jargon. It is formed, in my opinion, on the pattern of 'run out' or
'play out', in both of which the word out is added to indicate "all the way", "to completion",
"exhaustively", or "until nothing is left". Hence, a workout is the expanding of effort (that is,
working) until no further work can be done. The exhaustion of the body thus forms something like
a parallel with the exhaustion of, say, supplies.

Symptoms of Overtraining and Burnout

Overtraining is typically caused by excessive mental overloading, despite the fact that it is
primarily a physical imbalance between exercise and rest. As a result, athletes may exhibit
overtraining and burnout symptoms at the same time.
The first alarming symptoms of athlete overtraining, and burnout seem to be mental
dysfunctions, such as increased irritability for minor issues, signs of depression and defensive
attitude, sleeping disorders, and tiredness. Physical symptoms appear later on. Athletes suffering
from burnout or overtraining syndrome have higher resting heart rate and abnormal heart rate
increase in orthostatic test, and less heart rate variation during the day Selanne (2016).
In addition, Cronkleton (2020) states that overtraining can occur when you work out
without allowing enough recovery time between sessions. Too much exercise, especially if your
exercises are close together, can be damaging to your health and impair your outcomes after a
certain point. Some of the signs of overtraining as well as ways to prevent, treat, and recover from
OTS are not eating enough, soreness, strain, and pain, overuse injuries, reduced appetite and
weight loss, Irritability and agitation, persistent injuries or muscle pain, decline in performance,
workouts feel more challenging, disturbed sleep, decreased immunity or illness, weight gain, Loss
of motivation.

Ways to measure Burnout

One of the scientific issues we face is figuring out how to measure a phenomenon.
Physiological markers, such as cortisol hormone tests, may be employed because elevated levels
indicate higher stress. Heart rate variability (HRV) is a term that measures any changes between
your successive heart beats. A decrease in HRV indicates the body’s increased response to burnout.
A questionnaire is another tool for determining burnout.

Stress is a general response syndrome marked by a shift in the organism’s

psychobiological homeostatic state. Emotional symptoms such as anxiety and anger, as well as
increased autonomic and central activation, humoral reactions, immunological function
alterations, and behavioral changes, are all associated with stress. Stress activates the adaptive and
coping mechanisms (Kellmann & Kallus, 1999). Therefore, we can also measure burnout
depending on individuals’ reaction and level of physical, emotional and mental exhaustion caused
by prolonged stress.

Burnout in Sport Professionals

Burnout among athletes as a consequence of the stress of highly competitive sport became
a concern following the emergence of commentaries on troubling chronic experiential states
experienced by some professionals in stressful alternative health care. Freudenberger’s
observations on a phenomenon involving physical and mental deterioration and workplace
ineffectiveness as a consequence of excessive demands among alternative health care professionals
are typically regarded as formally ushering the term “burnout” into the psychosocial lexicon
(Eklund & Cresswell, 2007). observed a similar phenomenon in studying human service workers.
Her development of the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981, 1986) to
study the phenomenon effectively served to conceptually formalize burnout as an experiential
syndrome involving symptoms of sustained feelings of emotional exhaustion, depersonalization
(negative attitudes and feelings toward the recipients of the service), and inadequate personal
accomplishment (a sense of low accomplishment and professional inadequacy). Following the
emergence of these insights and developments in work settings, “burnout” in sport quickly became
an amorphous catch-all explanation for an array of troubling phenomena, including the negative,
a motivated, and exhausted states sometimes suffered by athletes as well as implicated problems
with injury, sport withdrawal, and/or personal dysfunction.
Participation in sports is a source of great enjoyment for most athletes. Unfortunately, the
intense demands associated with elite sport may in some cases lead to burnout, as a consequence
of chronic stress (Gustafsson et al. 2011; Smith 1986). Burnout is generally considered a
multidimensional construct comprised of three dimensions: (1) emotional and physical exhaustion,
(2) a reduced sense of accomplishment, and (3) sport devaluation (Gustafsson et al. 2017; Raedeke
and Smith 2009). The first dimension is characterized by the perceived depletion of emotional and
physical resources beyond that associated with training and competition. The second dimension is
characterized by a tendency of evaluating oneself negatively in terms of sport abilities and
achievement. The final dimension reflects the development of a cynical attitude towards sport
participation. physiological consequences. Chronic fatigue is the core component of burnout
(Gustafsson et al. 2011; Schaufeli and Buunk 2003), burned out individuals feel extremely
emotionally and physically exhausted. Burnout also leads to affective, cognitive, motivational and
behavioral consequences. A person who is burned out often experiences depressed mood, feelings
of helplessness, loss of motivation and withdraws from friends and col- leagues (Schaufeli and
Enzmann 1998). Research from occupational settings also shows that burnout leads to
physiological consequences such as an increased risk of cardiovascular disease, impaired immune
function, and is also related to chronic inflammation (Melamed et al. 2006).

Treatment and Prevention of Burnout

Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job
satisfaction. Rates of burnout in orthopedic surgeons are higher than those in the general
population and many other medical subspecialties. Half of all orthopedic surgeons show symptoms
of burnout, with the highest rates reported in residents and orthopedic department chairpersons.
This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated
instruments exist to objectively diagnose burnout, although family members and colleagues should
be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing
relationships at work and home. Emerging evidence indicates that mindfulness-based interventions
or educational programs combined with meditation may be effective treatment options. Orthopedic
residency programs, departments, and practices should focus on identifying the signs of burnout
and implementing prevention and treatment programs that have been shown to mitigate symptoms.
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