The impact of COVID-19 and the NCAA’s (National Collegiate Athletic Association) season cancellation on sport support professionals [version 1; peer review: awaiting peer review]

The coronavirus (COVID-19) pandemic forced athletes to learn to navigate a world void of athletic competition and contend with the intricacies that life during a pandemic brings. Similarly, those that dedicate their lives to these athletes such as sport psychology practitioners, sport medicine personnel, athletic trainers, or academic advisors (i.e., sport support professionals) also experienced an abrupt ending to their routines, and in some cases their livelihoods. These professionals have been pushed to modify their art and find ways to engage their community from a distance (e.g., virtually, or physically from a social distance). Sport support professionals are experiencing a collective loss due to the COVID-19 pandemic. This paper addresses the impact of a global pandemic and the subsequent issues faced by sport support professionals across diverse disciplines, emphasizing the significance of these relationships and the necessary adjustments to manage the cessation of these relationships.


Introduction
Even as a mindfulness practitioner, a global pandemic can challenge one's practice and create copious amounts of emotions. This has been the roller coaster that many professionals have ridden during recent and unique times. While much of the current research has focused on our clients (i.e., athletes), this paper will focus on the impact the pandemic and subsequent cancellation of sport has had on the professionals involved primarily within the National Collegiate Athletic Association (NCAA) sports. To consider the global effect the pandemic had on a diverse range of professionals, we use the term sport support professionals to include sport psychology practitioners, sports medicine personnel, athletic trainers, and academic advisors. The COVID-19 pandemic has presented sport support professionals with a novel situation that has not had to be navigated before, and as such has never been studied. The coronavirus disease  prompted the cancellation of all sports during conference tournaments of the 2020 winter sports season (i.e., right at the start of "March Madness", the annual NCAA basketball tournament) and the remainder of all NCAA seasons, thereafter, across all divisions. As we entered into the fall 2020 season, COVID-19 and the decision of how and whether to return to sport was politicized; generating a debate between healthcare providers, politicians, and civilians concerning the impact of the virus on athletes and whether it was safe to begin a new season. As of July 2021, there is no standard practice nationally surrounding decisions to return to sport amidst a pandemic and professionals are left to answer this moment's determination, often made by an executive with limited scientific or medical knowledge. To put this article into context, let us look back to the initial impact of COVID-19 on sport.
During the spring of 2020, thousands of student-athletes in the U.S. were left without the proper goodbye; and senior athletes had the inability to conclude their intercollegiate athletic careers in the traditional manner. Due to college campuses closing and lockdowns being implemented, student-athletes were forced to leave campus abruptly and quickly. These student-athletes were prematurely lurched into a new world void of sports and were left to navigate the intricacies that come with being a retired or non-student-athlete. Entering the fall of 2020, athletes were faced with new problems including living in a bubble without their loved ones, uncertainty, and indecision about the fate of their upcoming athletic year, and so much more. Finding themselves in a similar situation are the sport support professionals (i.e., healthcare providers, sport psychologists, athletic trainers, or academic advisors) who work with these athletes.
Research has examined clinical terminations (the ending of relationships between practitioner and patient) within the context of case studies (Bhatia & Gelso, 2017;Fragkiadaki & Strauss, 2012). The global pandemic in 2020 has caused terminations on a scale not seen before. Sport support professionals were experiencing the stress brought on by the pandemic just as others were, and it is compounded with the shared stress from all different directions (i.e., economic stressors, job uncertainty, etc.). While "termination" is a psychological term referring to the natural end of a therapeutic relationship, the natural end to a relationship with a student-athlete occurs for all sport support professionals. As with therapeutic providers, when termination occurs abruptly and not through the normal process, the emotional impact may be greater.
While much of the supported research surrounding terminations and stress addresses the student-athlete experience (Lally, 2007;Putukian & Putukian, 2016), we instead focus on the experience of the sport support professional within the United States, including sport psychology practitioners, sports medicine personnel, athletic trainers, and academic advisors. These professionals form strong relationships with student-athletes and dedicate much of their craft to ensuring student-athlete wellbeing. Following the onset of COVID-19, these professionals were precluded from formal termination with their student-athletes in the traditional sense. The termination process includes reflection upon the relationship between the client and the professional, review of the current functioning and coping skills learned, application of these new skills in the real world, expectations related to potential future sessions, long-terms goals following the cessation of treatment, and sharing pride in the client's progress (Norcross et al., 2017).
Current research shows that sport support professionals build strong therapeutic bonds with student-athletes through their work together, and premature termination can affect these professionals in the future, while also causing feelings of abandonment, hurt, and disappointment (Alessandro et al., 2011). As such, we know these professionals experience loss of meaningful working relationships, which are often accompanied by anxieties and feelings of loss associated with the abrupt termination (Joyce, 2007). What is less understood is how these professionals navigated the abrupt end of their work with their student-athletes, and how they coped with the non-traditional termination during the COVID-19 pandemic.
The consequences of early termination Termination is defined as "an intentional process that occurs over time when a client has achieved most of the goals of treatment, and/or when psychotherapy must end for other reasons" (Vasquez et al., 2008, p. 653). The phrase, "termination within psychology", refers to the final stages of the process in mental health treatment, and in the context of this paper, we consider termination as a process which will eventually occur within any substantial relationship as it concludes. While this is the formal process within the practice of psychological sciences, we believe this sharing occurs at varying levels across all significant relationships.
For the provider, terminations bring about feelings of anxiety, guilt, and loss (Joyce, 2007). Despite commonalities in the experiences of termination, abrupt termination disrupts the natural processes and denies the traditional goodbyes. The abrupt termination of treatment that materialized gives one cause to examine the psychological toll that the ending of these therapeutic relationships has had on the sport support professional as well as the student-athlete.
The impact of early termination on sport support professionals is ever-present and far-reaching. For instance, Alessandro and colleagues (2011) studied the psychology of relationships and how ending therapeutic relationships impacts support professionals' future approaches to clients, their professional development, and personal well-being. Feelings of abandonment, hurt, and disappointment are common (Alessandro, 2011). Piselli et al. (2011) highlighted that the more personally invested the provider was in their client, the greater the emotional toll of the premature termination. This is particularly pertinent for sport support professionals working with student-athletes, as they often work with studentathletes for the entirety of their collegiate careers. Their ability to work effectively can be altered by powerful emotions (anxiety, guilt, and loss) that the provider struggles to cope with. It is important to note that there is a lack of literature examining the impact of abrupt termination, as well as termination resulting from a global pandemic. What we can infer from the literature is that the process of termination carries a heavy emotional burden.
The sport support professional The sport support team behind every student-athlete is composed of sport psychologists, sports medicine personnel, athletic trainers, and academic advisors who forge relationships with the student-athlete as they work to develop goals and tasks to work towards, and develop and emotional bond (Petitpas et al., 1999). For sport psychology practitioners, the aim of their relationship with the student-athlete may be to create therapeutic goals for behavioral change. Goals for treatment and preventative care are often set by medical physicians. For athletic trainers, this may look like student-athlete compliance with an injury rehabilitation program. Academic advisors help athletes to create goals for academic success and long-term vocational support. These professionals work with student-athletes to help them balance mental and physical wellness and maintain a healthy lifestyle. Through working with student-athletes and facing obstacles together, a therapeutic relationship is forged that has deep meaning to the student-athlete and to the sport support professional. This dynamic role establishes a strong relationship with student-athletes, and as we know from therapeutic alliance research (Sexton et al., 2005), requires a formal process; a process which begins during the first meeting with the provider and hinges on connection, personalities, and levels of engagement (Secton et al., 2005). Regardless of whether the conclusion of the relationship occurs following graduation, transferring, retiring, or a global pandemic, both the professional and the student-athlete are affected. Providers are known to experience their own anxieties over termination (Joyce, 2007) and student-athletes have difficulty coping with the loss of support that follows the conclusion of relationships (McKnight et al., 2009). A common thread running through these relationships is that while supporting the student-athlete in various sectors, all of these professionals share a vested interest in the student-athlete's collegiate success, and all allow for a mentorship relationship to form and a subsequent emotional bond (Petitpas et al., 1999). As an indispensable member of the sport support team, academic advisors ensure that student-athletes enjoy success in the classroom in addition to athletic competition. Since 1991, the NCAA has mandated that academic counseling services be a part of the studentathlete support system at all division one institutions, in an effort to ensure athletic success was not taking precedence over academic achievement (Meyer, 2005). Academic advisors help student-athletes utilize behavioral strategies which will help them succeed in the classroom. Academic advisors actively participate in all areas pertaining to academic and athletic evaluation, academic evaluation, support, and guidance (Meyer, 2005). As we consider the developmental nature of student-athletes within the NCAA context, the values impressed upon student-athletes often have a lifelong impact. A student-athlete will arrive at college with a strong athletic identity, but they may lack confidence in their identity as a student (Lally & Kerr, 2005). Academic advisors are tasked with motivating student-athletes to apply themselves in the classroom when they may not be intrinsically inclined to do so. Academic advising has been described as having overlapping responsibilities with counseling. (Kuhn et al., 2006). Kuhn and colleagues conclude that academic advisors, alongside academics, help with giving guidance for time management, interpersonal issues, career goals, and personal goals.
Student-athletes must also cope with the stress that accompanies the pressure to perform well in their sport. The convergence of athletic pressure, maintaining a social life, adjusting to college, and potentially contending with injury, can easily affect academic performance. Challenges arise from their involvement in athletics that require additional support (Watson & Kissinger, 2007). The pressure that accompanies athletic involvement converges with academic and social obligations, which in turn can cause overwhelming stress for the student-athlete. Sport support professionals serve as sounding boards, advocates, and confidants when student-athletes are most vulnerable. In many ways, these professionals are mentors, helping the student-athlete focus on growth and accomplishments whilst providing support. For reasons such as these, understanding how professionals have coped with the abrupt loss of such relationships is imperative to understanding how to protect their future well-being and careers.

Coping
The COVID-19 pandemic brought about a collective loss felt by sport support professionals, both professionally and personally; demanding the use of coping skills to maneuver this new landscape. Coping skills can be effective in preventing burnout; a pervasive and debilitating state resulting from an unsustainable period of overwhelming stress (Staten & Lawson, 2017). Mental health care providers, sports medicine providers, and academic advisors are all at higher risk for burnout due to the tremendous stress and personal involvement of their fields (Hendrix et al., 2000;Mullen et al., 2018;Vredenburgh et al., 1999). All sport support professionals utilize different coping skills, salient to their individual skill sets. Athletic trainers and other sport support professionals represent a vulnerable group, at a high risk of career burnout, who could greatly benefit from improved understanding of effective coping strategies to effectively manage challenging situations (Hendrix et al., 2000).
Findings from previous studies show there is typically a delayed trauma response following a life-changing event (McFarlane, 2004). After the SARS-Cov outbreak in Singapore in 2003, 27% of health care workers reported psychiatric symptoms (Lee et al., 2018). The ramifications and effects of the COVID-19 pandemic, and any associated delayed trauma, will likely be examined as time passes. Examining how sport support professionals have managed the months immediately following the crisis could provide knowledge applicable elsewhere. Understanding the coping strategies they used and how their support systems were utilized, as well as identify patterns and strategies that were most effective, could provide insight into how individuals can best cope with stressful situations more broadly.

Role identity
The relationship between sport support professionals and the student-athlete creates a mentorship that is meaningful to both sides. A qualitative study of 55 Black female student-athletes in the Big 12 conference found that mentors were perceived as needing to be guides or role models, who have relational characteristics, and provide constructive criticism (Carter & Hart, 2010). The relationship between the mentor and the mentee is acknowledged as being beneficial to both sides: through providing the mentee with career and professional development assistance, and for the mentor who serves as a confidant androle model, thus grows and learns from the relationship as well (Jacobi, 1991). The loss of this salient relationship can cause psychological distress (Umberson & Torling, 1997).
Role identity, the set of meanings applied to one's self in a social situation, is also at stake following the loss of a relationship like the one between these professionals and student-athletes (Burke, 1991;Umberson & Torling, 1997). Major life events such as a career change, death of a loved one, starting a family, and global events, like a pandemic, threaten psychological well-being and role identity, and can lead to a role residual: parts of a previous role carried into one's current roles and self-identity (Swann & Brown, 1990;Ebaugh, 1988). Losing a relationship entails losing information about the self (Umberson & Torling, 1997). Role identity is an important aspect of the self because it links the individual self and society, and this is threatened with the experience of stressful events (Callero, 1985). Salient role identities, the probability that a given identity will be invoked in social interaction, are an integral facet of how one defines oneself (Brenner et al., 2014). Self-esteem and evaluation of self are closely linked with salient role identities (Callero, 1985). COVID-19 has caused a disruption in the mentor-mentee relationship, leaving sport support professionals in a limbo state of being unable to perform their regular roles.
Sport support professionals have experienced significant loss as support figures to student-athletes due to COVID-19. Their role identity is at stake and the loss of relationships with the student-athletes they were working with puts them at greater risk of experiencing psychological distress. Research surrounding mental health is dedicated to finding ways to best support student-athletes during times of struggle including finding ways to destigmatize mental health for studentathletes, making mental health services more accessible by having various locations to go to for support close to the athletic facilities, and continuing to work to break down the barrier that exists for many student-athletes to seeking help. Our research team holds the opinion that research should be equally as invested in determining the best ways to help these professionals cope with unplanned change.

Conclusion
The research explored within this paper shows a general consensus on the feelings of anxiety, loss, grief, and sadness that a mental health care provider may feel after the termination of a therapeutic relationship. However, more research is needed to examine the effect that unplanned and sudden terminations have on the provider. The Center for Disease Control (CDC) highlighted that the COVID-19 pandemic presents a stressful situation, and anxiety and fear are common reactions to the current situation (Centers for Disease Control and Prevention, 2019). Unprecedented circumstances have resulted in trauma as well as moral dilemmas, relating to the challenges of maintaining a standard of care while transitioning to telehealth, (using digital technologies such as computers to access health care services remotely). This has the potential to increase the risk of mental health disorders such as post-traumatic stress disorder (PTSD), depression, anxiety disorders, and substance misuse in healthcare providers in the future (Greenberg et al., 2020). Healthcare providers, including mental healthcare workers, have experienced burnout during the COVID-19 pandemic due to a high workload and multiple psychosocial stressors (Sultana et al., 2020). Increased awareness of work-related stress, implementing mindfulness and self-care practices, and using technologies to address stress can help to mitigate burnout in this population (Sultana et al., 2020). Current research largely focuses on healthcare workers in hospital settings, but the findings can also be applied to mental healthcare providers serving the student-athlete population who are also considered essential workers. PTSD, losing sleep due to excessive worry, headaches, depression, anxiety, and general psychological stress are all effects of COVID-19 for this vulnerable population (Hall, 2020). Navigating a new virtual world in which medical appointments take place online, presents many challenges to these professionals and difficulties such as grappling with how to be inclusive of those who are less technologically savvy can weigh heavily on their minds. All sport support professionals in the U.S. have been impacted and while we, as mental healthcare providers, might write about this, it is also critical that we educate and provide support for our colleagues.
The COVID-19 pandemic affords us the opportunity to critically evaluate mental health care delivery systems which already exist in the United States and work towards equitable delivery of mental healthcare. When doing so, it is critical that we consider the needs of the sport support professional, as no sport support professional is immune to feelings of loss and grief in wake of the pandemic. Self-care is imperative during these stressful times. The APA Board of Professional Affairs Advisory Committee on Colleague Assistance conceptualizes the progressive downward spiral that can occur without successful management of stress through the stress-distress-impairment-improper behavior continuum (Wise et al., 2012). When stress is not managed effectively, professional functioning is impaired which can result in improper behavior. There is a broad consensus that implementing self-care strategies such as mindfulness, therapeutic lifestyle changes, and promoting physical health can help sport support professionals keep burnout at bay (Asuero et al., 2014). Just as sport support professionals are looking for ways to support the student-athletes who have been affected by abrupt season terminations, such as by providing increased access to mental health services (Fogaca, 2019;Kern et al., 2017), we should also seek ways to support their sport psychologist practitioners, sport medicine providers, and academic advisors who may be struggling with their own feelings of loss.