A program to optimize athletes' mental health and sport performance concurrently through a sport-specific, strength-based approach that reduces stigma and builds transferable life skills.
Blueprints: Under Review
Brad Donohue
University of Nevada Las Vegas
The Optimum Performance Program in Sports (TOPPS) adapts Family Behavior Therapy to athletic culture and reframes treatment as performance optimization rather than symptom elimination. Format and dosage consist of 12 sessions lasting 60 to 90 minutes over four months, with fading frequency over time. Significant others-family members, coaches, teammates, partners, and peers-are invited to participate in person or by phone/video, based on participants' preferences and availability. Protocol checklists guide each intervention component, and providers are trained and supervised to high fidelity.
The Optimum Performance Program in Sports (TOPPS) adapts Family Behavior Therapy to athletic culture and reframes treatment as performance optimization rather than symptom elimination. Format and dosage consist of 12 sessions lasting 60 to 90 minutes over four months, with fading frequency over time. Significant others-family members, coaches, teammates, partners, and peers-are invited to participate in person or by phone/video, based on participants' preferences and availability. Protocol checklists guide each intervention component, and providers are trained and supervised to high fidelity.
Providers emphasize descriptive praise, collaborative goal setting, and cognitive-behavioral skills practiced through imagery and role-playing. Sessions begin with mental preparation for imminent sport or academic demands, proceed on structured agendas that participants can modify, and incorporate cultural enlightenment through semi-structured interviews centered on ethnic and sport culture experiences. A gender-neutral athlete brand and sport-themed clinic aesthetics aim to normalize help-seeking and reduce stigma. Interventions include communication skills training with significant others, dynamic goal monitoring with rewards, performance planning by ranking components, motivation enhancement that contrasts costs of problem behavior with benefits of goal pursuit, environmental control around people and contexts, financial and career planning, job-getting skills, and self-control sequences that integrate cue-controlled relaxation, diaphragmatic breathing, solution brainstorming, and visualization. Providers maintain engagement between sessions with brief supportive texts and calls, and meetings may be held in athletic facilities when requested.
Individual: Stress
Family: Parent social support
*
Risk/Protective Factor was significantly impacted by the program
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
Brad DonohueUniversity of Nevada Las VegasDonohue@unlv.edu
A program to optimize athletes' mental health and sport performance concurrently through a sport-specific, strength-based approach that reduces stigma and builds transferable life skills.
Collegiate athletes participating in organized sport and using alcohol or drugs.
Perceived stigma of mental health treatment.
Individual: Stress
Family: Parent social support
*Risk/Protective Factor was significantly impacted by the program
The Optimum Performance Program in Sports (TOPPS) adapts Family Behavior Therapy to athletic culture and reframes treatment as performance optimization rather than symptom elimination. Format and dosage consist of 12 sessions lasting 60 to 90 minutes over four months, with fading frequency over time. Significant others-family members, coaches, teammates, partners, and peers-are invited to participate in person or by phone/video, based on participants' preferences and availability. Protocol checklists guide each intervention component, and providers are trained and supervised to high fidelity.
The Optimum Performance Program in Sports (TOPPS) adapts Family Behavior Therapy to athletic culture and reframes treatment as performance optimization rather than symptom elimination. Format and dosage consist of 12 sessions lasting 60 to 90 minutes over four months, with fading frequency over time. Significant others-family members, coaches, teammates, partners, and peers-are invited to participate in person or by phone/video, based on participants' preferences and availability. Protocol checklists guide each intervention component, and providers are trained and supervised to high fidelity.
Providers emphasize descriptive praise, collaborative goal setting, and cognitive-behavioral skills practiced through imagery and role-playing. Sessions begin with mental preparation for imminent sport or academic demands, proceed on structured agendas that participants can modify, and incorporate cultural enlightenment through semi-structured interviews centered on ethnic and sport culture experiences. A gender-neutral athlete brand and sport-themed clinic aesthetics aim to normalize help-seeking and reduce stigma. Interventions include communication skills training with significant others, dynamic goal monitoring with rewards, performance planning by ranking components, motivation enhancement that contrasts costs of problem behavior with benefits of goal pursuit, environmental control around people and contexts, financial and career planning, job-getting skills, and self-control sequences that integrate cue-controlled relaxation, diaphragmatic breathing, solution brainstorming, and visualization. Providers maintain engagement between sessions with brief supportive texts and calls, and meetings may be held in athletic facilities when requested.
The program follows the tenets of Positive Psychology and Family Behavior Theory, both strength-based therapeutic styles that focus on optimizing strengths rather than reducing symptoms. In the optimization approach, feelings, thoughts, and behaviors are conceptualized to reciprocally influence performance. Therefore, the intervention focuses on optimizing cognitive and behavioral skills that facilitate performance in both sport and life outside of sport.
Study 1 (Donohue et al., 2018)
Donohue, B., Gavrilova, Y., Galante, M., Gavrilova, E., Loughran, T., Scott, J., Chow, G., Plant, C. P., & Allen, D. N. (2018). Controlled Evaluation of an Optimization Approach to Mental Health and Sport Performance. Journal of Clinical Sport Psychology, 12, 234-267. https://doi.org/10.1123/jcsp.2017-0054
Blueprints: Under Review
Pre-Registration: The study did not report pre-registration and did not reference a registry such as ClinicalTrials.gov or the Open Science Framework.
The intervention consisted of 12 sessions lasting 60-90 minutes each and was delivered over four months.
Summary
Donohue et al. (2018) conducted a randomized controlled trial that examined 74 college athletes who were assigned to the intervention group or a services-as-usual control group. Participants completed assessments at baseline, four months post-randomization, and eight months post-randomization.
The results showed that, relative to the control group participants, intervention participants reported significantly
Evaluation Methodology
Design:
Recruitment: The study used a variety of means to recruit 316 collegiate athletes who attended a southwestern university between 2013 and 2016. Eligibility requirements included participation in an organized sport, alcohol or non-prescribed drug use within the past four months, and a willingness to involve a significant other in the intervention. Of the 107 athletes who met the criteria, 77 completed the baseline assessment and agreed to randomization.
Assignment: Participants were randomized after baseline using urn procedures balancing substance use and mental health diagnosis, type of substance, gender, ethnicity, and athlete type. Three participants (4%) dropped out after randomization but before baseline, leaving 74 who were assigned to either the intervention (n = 38) or a control group (n = 36) that received usual campus psychological counseling services.
Assessments/Attrition: Assessments occurred at baseline, four months post-randomization (posttest), and eight months post-randomization (four-month follow-up). For the sample of 74 participants, completion rates were 88% at four months and 85% at eight months.
Sample:
The initial randomized sample included 49% female and 51% male athletes. Race and ethnic composition was 41% White/Caucasian, 20% Black/African American, 11% Asian/Asian American, 22% Hispanic/Latino, 1% Pacific Islander, and 5% Other. The mean age was approximately twenty-one years.
Measures:
The outcome measures came from participant self-reports that blinded assessors administered. The measures included
Reliability and validity support for these instruments came from other studies, without any specifics for the study sample.
Analysis:
The analyses used 1) repeated measures ANOVAs with baseline outcomes controlled in the time-by-condition measures, and 2) independent samples t-tests to compare condition changes in outcomes from baseline to follow-up. The former models were used when testing for moderation by diagnostic severity, and the latter models were used when not testing for moderation.
Missing Data Method: The authors refer to their intent-to-treat management of missing data but offer no details. Typically, repeated measures ANOVA and t-tests require complete-case analysis.
Intent to Treat: It appears that all participants with complete follow-up data were included in the analyses.
Outcomes
Implementation Fidelity:
TOPPS providers implemented an average of 87% of protocol instructions. TOPPS participants attended an average of 9.79 meetings, and of those sessions, 4.92 meetings were attended by significant others.
Baseline Equivalence:
In Table 1, tests for seven baseline sociodemographic measures found no significant differences. The authors also stated that there were no significant differences in the outcome variables but did not present the tests.
Differential Attrition:
The authors reported that attrition did not differ significantly by condition at four months or eight months, and the difference in attrition rates across conditions meets both the WWC cautious and optimistic standards. No other tests were performed.
Posttest:
Tests for the significance of the time-by-condition interaction were presented separately for the four-month and eight-month assessments and were described in the text rather than listed in tables. Focusing on outcomes with a significant time-by-condition interaction at both four months and eight months, the intervention group participants relative to the control group participants reported significantly better overall mental health, lower depression symptoms, and less interference from mental health factors in training, competition, and life outside sport.
Other outcomes, substance use, relationship functioning, and happiness, had significant effects at either four months or eight months but not both.
Moderation tests showed strong intervention effects on mental health and substance use outcomes for those with more severe baseline diagnoses.
Long-Term:
Not examined.