Paula Thomson, PsyD & S. Victoria Jaque, PhD
Performing artists and athletes are generally regarded as highly skilled and disciplined. In order to achieve professional / elite level performance, they must dedicate long hours to attain expertise in their field. To manage these demands, many performers and athletes employ dissociative processing, both within the normative and pathological range (Thomson, Keehn, & Gumpel, 2009; Thomson, Kibarska, & Jaque, 2011). Our laboratory mission is to address the reality that minimal attention is given to the investigation of trauma exposure and dissociation in these populations (Leahy, Pretty, & Tenebaum, 2008; Swart, van Niekerk, & Hartman, 2010). Generally, research in sport and performance psychology tends to focus more on performance anxiety, injury rates, and protocols to optimize performance (Swart et al., 2010). This review will present findings that reveal a significant proportion of performers and athletes struggle with pathological dissociation, high trauma exposure, and toxic levels of shame, despite the fact that they continue to perform and compete at high levels.
Dissociation is often regarded as operating on a continuum, with many individuals experiencing everyday dissociative absorption such as getting lost in a task, daydreaming, or entering brief trance-like states; this may occur while driving or engaging in mundane repetitive activities (Butler, 2006). A smaller percentage experience dissociative states that disrupt functioning, including a sense of a continuous self; these states are regarded as pathological and are no longer operating in the normative range of the continuum (Allen, Filtz, Huntoon, & Brethour, 2002; Waller, Putnam, & Carlson, 1996). Dissociation is also a multidimensional construct (Briere, Weathers, & Runtz, 2005), which includes compartmentalization, depersonalization, disengagement, and identity and / or memory confusion. Examining dissociation in populations that achieve elite level expertise requires inclusion of these multidimensional dissociative processes, as well as differentiating normative from pathological experiences.
In sport psychology, dissociation and association are regarded as opposite ends of a spectrum; dissociative processing removes attention from the task, whereas association directs attention towards the task (Masters & Ogles, 1998). Optimal dissociative engagement is described as the ability to distract from pain while training (Masters & Ogles, 1998). Athletes learn to compartmentalize their pain and detach from their emotional responses in order to increase skill competency. However, when dissociation is employed during competition the performance results tend to be poor (Tenenbaum & Connolly, 2008). Within a sport culture, dissociation is encouraged as a training strategy and discouraged during competition (Hutchinson & Tenenbaum, 2007). Unfortunately, for many athletes and performers this dissociative strategy may lead to increased injury and body objectification. This was found in a study that examined elite international rhythmic gymnasts and professional dancers (Thomson, Kibarska, & Jaque, 2011). The athletes endorsed extremely high dissociative abilities to ignore pain and the professional dancers identified prolonged periods of feeling that their body did not belong to them.
Unlike the field of sport psychology, performance psychology is currently in the early stages of development. Studies in this field generally investigate dissociation as a multidimensional and pathological process. For example, in a study that examined actors compared to non-actors, there was a higher prevalence of actors (32% of the actor sample compared to 23% of control participants) who claimed clinical levels of dissociation (as measured by the Dissociative Experience Scale-II Taxon subscale [DES-T], with a cut off score of 25 on the taxon scale). In this study, there were significant mean differences between the two groups (actors DES-T mean = 29.31 [sd= 7.08] compared to control DES-T mean = 21.19 [sd= 8.34] with a significance level ≤ .01); the actors readily identified a disruption in their sense of a continuous self (Thomson & Jaque, 2011). Other studies suggest that actors struggle with boundary blurring of self and other and have more difficulty with identity formation, in particular, when they are actively rehearsing or performing a character (Burgoyne, Poulin, & Rearden, 1999; Hannah, Domino, Hanson, & Hannah, 1994). In a study that examined musicians, higher dissociative processing was identified as a factor that diminished memory retention as well as decreasing their ability to perform at optimal levels (Swart et al., 2010). Another investigation compared dissociative processing in two groups, the generators of the arts (choreographers, directors, composers, and playwrights) and the interpreters of the arts (actors, dancers, singers, musicians); the interpreters experienced more intense dissociative processing, especially absorption and depersonalization (Thomson, Keehn, & Gumpel, 2009).
Identifying performers and athletes with pathological dissociation enables researchers to compare individuals with and without dissociative pathology. Findings suggest that performers and athletes who endorse pathological levels of dissociation are less able to enter high flow states (optimal performance) (Thomson & Jaque, 2012a). Specifically, they are less able to focus on the task at hand, receive unambiguous performance feedback, and sustain a sense of control. Their ability to match their skill level to meet the performance or athletic challenge is compromised; they remain highly self-conscious, which interferes with the immediacy of their responses to internal and external stimuli (Thomson & Jaque, 2012a). Likewise, findings indicated that individuals who suffered clinical levels of depersonalization (high intensity, frequency, and duration) were less able to achieve flow states. Highly depersonalized performers were also more anxious and employed more emotion-oriented coping strategies under stress (Thomson & Jaque, 2018). In general, performers who experienced depersonalization were less likely to achieve optimal performance and expressed more emotional distress than those who did not.
Examining childhood adversity exposure and the effects of cumulative trauma in performer and athlete samples also reveals strong associations between trauma and dissociation. For example, in a study that investigated PTSD and dissociation in dancers, dissociation was even more intensely present in dancers with a diagnosis of PTSD (20.2% had PTSD) (Thomson & Jaque, 2015a). In a study that examined athletes, those who were exposed to childhood maltreatment also displayed increased dissociation (Leahy et al., 2008). Investigations that identify performers and athletes with a classification of unresolved mourning (as determined by the Adult Attachment Interview assessment), demonstrated that pathological dissociation was higher in those classified with unresolved mourning (Thomson & Jaque, 2012b). Sadly, a higher prevalence of unresolved mourning was found in performing artists compared to athletes and healthy control samples (Thomson & Jaque, 2018a). Further, actors (30.8%) experienced a higher rate of unresolved mourning and dissociation compared to dancers (16.7%), athletes (17.4%), and a non-clinical active control sample (28.6%) (Thomson & Jaque, 2011, 2012c, 2018a).
Research findings also demonstrated that elevated dissociation in performers and athletes was associated with heightened shame (Thomson & Jaque, 2013). Many performers and athletes are at increased risk for intense shaming experiences during training and performing/competing. Repeated shaming experiences may become toxic, which reinforces an internalized belief that the self is deeply flawed and unworthy (Eusanio, Thomson, & Jaque, 2014; Thomson & Jaque, 2013). Likewise, shame that is internalized in response to exposure to childhood traumatic events further intensifies dissociation (Dorahy, 2010) and also significantly compromises optimal performance (Thomson & Jaque, 2015). Unfortunately, childhood trauma, including sexual abuse, is often under-reported in sport and performing arts settings (Leahy et al., 2008). Performers and athletes with a history of childhood adversity, cumulative trauma experiences, and exposure to shaming events tend to have more intense dissociative processing; they may employ dissociation to thwart painful emotions and compartmentalize traumatic memories. Study investigations indicate that many performers and athletes are unable to disclose these experiences despite heightened suicidal ideation (Thomson & Jaque, 2015a). They are well practiced at dissociating pain during training and they may employ this coping strategy when interacting with health care professionals, coaches, and other performers (Leahy et al., 2015; Thomson & Jaque, 2015a).
Study findings indicate that approximately 17 – 30% of performers and athletes (Thomson & Jaque, 2012) exhibit pathological levels of dissociation; greater awareness of this prevalence rate may influence subsequent research. Studies should include the moderating and mediating effects of dissociation on other performance-related disorders, in particular, eating disorders, self-injurious behaviors, substance use, anxiety, depression, and musculoskeletal injuries. Although these elite performers derive meaning from their chosen artistic or sport domain (Thomson & Jaque, 2018b), their level of performance is often compromised. Unfortunately, the cultures of sport and the performing arts encourage non-disclosure of psychological or physical illnesses or injuries (Barker, Soklaridis, Waters, Her, & Cassidy, 2009). Many elite performers, and those who work with them, may misconstrue pathological dissociative processing as poor concentration, disinterest, burnout, or lack of motivation in the athlete or performer. For example, one world-class rhythmic gymnast in our research study expressed great frustration that her dissociative disorder remained undiagnosed throughout her career. Only later did she discover that her flawed competitive performances were directly related to severe depersonalization. Sadly, many performers, coaches, and medical practitioners do not understand the nature of dissociation in these elite populations; they may also lack awareness that performers and athletes with pathological dissociation may need to continue to perform or compete in order to bolster wellbeing and enhance purpose and meaning (Thomson & Jaque, 2018b; Wilhelm, Kovess, Rios-Seidel, & Finch, 2004).
Despite expertise and an ability to perform at professional / elite levels, evidence from international research studies demonstrates that performing artists and athletes are not protected from the deleterious effects of dissociation, shame, and trauma exposure. Ideally, clinicians, coaches, and educators need to recognize that elite performers and athletes may outwardly demonstrate that they are engaging normative dissociative processes; however, many actually have unidentified dissociative disorders. Recognizing when a performer or athlete requires professional help may alleviate suffering and enhance optimal performance levels. It is recommended that coaches and educators refer these performers / athletes to trained mental health workers, in particular, those with expertise in treating dissociation and complex trauma.
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Paula Thomson, PsyD, is Professor at California State University, Northridge (CSUN), licensed Clinical Psychologist, adjunct faculty (Pacifica Graduate Institute), and Professor Emeritus / Senior Scholar (York University, Canada). She is Co-Director of the Performance Psychophysiology Laboratory (CSUN). She is co-author of the books, Creativity and the Performing Artist: Behind the Mask and Creativity, Trauma and Resilienceand co-author/author on over 50 peer-reviewed publications and chapters. She is a former ISSTD Board Director and a reliable coder of the Adult Attachment Interview. In 2013, she was named one of the top 20 female professors in California.
Victoria Jaque, PhD, earned her PhD in Exercise Science from the University of Southern California, and is professor and graduate coordinator in both the Department of Kinesiology and Assisted Technology Studies and Human Services at California State University, Northridge (CSUN). She is Co-Director of the Performance Psychophysiology Laboratory at CSUN and co-author of the book, Creativity and the Performing Artist: Behind the Maskand Creativity, Trauma, and Resilience. As an Exercise Physiologist, she has conducted research in a variety of areas, including the influence of physical activity on the development of peak bone mass in humans and rodents. Her current research focuses on developing a better understanding of how the autonomic nervous system responds to physiologic and psychological stressors in performing artists, athletes, healthy active individuals and patients with functional disorders. She is an active researcher in laboratory and field settings (concert halls, studios).