Are mental toughness and mental health contradictory concepts in elite sport? A narrative review of theory and evidence

Published:August 09, 2016DOI:



      Athlete development and management encompass a complex interaction of biological, psychological, and social factors. Within elite sport, multidisciplinary sport science and medicine teams play an important role in achieving an optimal balance between preventing athlete ill-health and optimizing health and performance. The psychological aspects of athlete health and performance have gained increased attention over the past two decades, with much of this research concerned with the mental health of athletes and the concept of mental toughness. Recently, it was proposed that mental health and mental toughness are contradictory concepts in the world of elite sport. Although an interesting proposition, this claim was not substantiated. Thus, the purpose of this narrative review was to evaluate theory and evidence regarding the thesis that mental health and mental toughness are contradictory concepts in the world of elite sport, with the view to advance scholarly knowledge and inform professional practice.


      Narrative review.


      A critical evaluation of this literature suggests that mental toughness may represent a positive indicator of mental health, or facilitate its attainment, rather than be at odds with it.


      When implemented alongside multilayered approaches to organizational change (e.g., group structures, policies), mental toughness could be used as a ‘hook’ to attract athletes into settings that can open dialogue on the importance of mental health and improve knowledge of key issues (e.g., stigma, symptoms).


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        • Bauman N.J.
        The stigma of mental health in athletes: are mental toughness and mental health seen as contradictory in elite sport?.
        Br J Sports Med. 2016; 50: 135-136
        • Keyes C.L.M.
        Mental illness and/or mental health? Investigating axioms of the complete state model of health.
        J Consult Clin Psychol. 2005; 73: 539-548
        • U.S. Public Health Service
        Mental health: a report of the Surgeon General.
        Author, Rockville, MD1999
        • WHO
        Mental health action plan 2013–2020.
        World Health Organization, Geneva2013
        • Gucciardi D.F.
        • Hanton S.
        • Gordon S.
        • et al.
        The concept of mental toughness: tests of dimensionality, nomological network, and traitness.
        J Pers. 2015; 83: 26-44
        • Anthony D.R.
        • Gucciardi D.F.
        • Gordon S.
        A meta-study of qualitative research on mental toughness development.
        Int Rev Sport Exerc Psychol. 2016; ([in press])
        • Mahoney J.
        • Ntoumanis N.
        • Mallett C.
        • et al.
        The motivational antecedents of mental toughness: a self-determination theory perspective.
        Int Rev Sport Exerc Psychol. 2014; 7: 184-197
        • Rusk R.D.
        • Waters L.E.
        Tracing the size, reach, impact, and breadth of positive psychology.
        J Posit Psychol. 2013; 8: 207-221
        • Maslow A.
        A theory of human motivation.
        Psychol Rev. 1943; 50: 370-396
        • Arnold R.
        • Fletcher D.
        A research synthesis and taxonomic classification of the organizational stressors encountered by sport performers.
        J Sport Exerc Psychol. 2012; 34: 397-429
        • Hanton S.
        • Fletcher D.
        • Coughlan G.
        Stress in elite sport performers: a comparative study of competitive and organizational stressors.
        J Sport Sci. 2005; 23: 1129-1141
        • Mellalieu S.D.
        • Neil R.
        • Hanton S.
        • et al.
        Competition stress in sport performances: stressors experienced in the competition environment.
        J Sport Sci. 2009; 27: 729-744
        • Sarkar M.
        • Fletcher D.
        Psychological resilience in sport performers: a review of stressors and protective factors.
        J Sport Sci. 2014; 32: 1419-1434
        • Hughes L.
        • Leavey G.
        Setting the bar: athletes and vulnerability to mental illness.
        Br J Psychiatry. 2012; 200: 95-96
        • Gucciardi D.F.
        • Jones M.I.
        Beyond optimal performance: mental toughness profiles and developmental success in adolescent cricketers.
        J Sport Exerc Psychol. 2012; 34: 16-36
        • Mahoney J.W.
        • Gucciardi D.F.
        • Ntoumanis N.
        • et al.
        Mental toughness in sport: motivational antecedents and associations with performance and psychological health.
        J Sport Exerc Psychol. 2014; 36: 281-292
        • Gucciardi D.F.
        • Gordon S.
        Development and preliminary validation of the cricket mental toughness inventory (CMTI).
        J Sports Sci. 2009; 27: 1293-1310
        • Bell J.J.
        • Hardy L.
        • Beattie S.
        Enhancing mental toughness and performance under pressure in elite young cricketers: a 2-year longitudinal intervention.
        Sport Exerc Perform Psychol. 2013; 2: 281-297
        • Arthur C.A.
        • Fitzwater J.
        • Hardy L.
        • et al.
        Development and validation of a military training mental toughness inventory.
        Mil Psychol. 2015; 27: 232-241
        • Gulliver A.
        • Griffiths K.M.
        • Christensen H.
        Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study.
        BMC Psychiatry. 2012; 12: 157
        • Hammond T.
        • Gialloreto C.
        • Kubas H.
        • et al.
        The prevalence of failure-based depression among elite athletes.
        Clin J Sport Med. 2013; 23: 273-277
        • Bonanno G.A.
        Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events?.
        Am Psychol. 2004; 59: 20-28
        • Sarkar M.
        • Fletcher D.
        • Brown D.J.
        What doesn’t kill me…: adversity-related experiences are vital in the development of superior Olympic performance.
        Psychol Sport Exerc. 2015; 18: 475-479
        • Allen S.V.
        • Hopkins W.G.
        Age of peak competitive performance of elite athletes: a systematic review.
        Sports Med. 2015; 45: 1431-1441
        • Gulliver A.
        • Griffiths K.M.
        • Christensen H.
        • et al.
        Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial.
        J Med Internet Res. 2012; 14: e69
        • Rice S.M.
        • Purcell R.
        • De Silva S.
        • et al.
        The mental health of elite athletes: a narrative systematic review.
        Sports Med. 2016; : 1-21
        • Keyes C.L.M.
        Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health.
        Am Psychol. 2007; 62: 95-108
        • Glick I.D.
        • Stillman M.A.
        • Reardon C.L.
        • et al.
        Managing psychiatric issues in elite athletes.
        J Clin Psychiatry. 2012; 73: 640-644
        • Reardon C.L.
        • Factor R.M.
        Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes.
        Sports Med. 2010; 40: 1-20
        • Van Raalte J.
        • Brewer D.
        • Brewer B.
        • et al.
        NCAA division II college football players’ perceptions of an athlete who consults a sport psychologist.
        J Sport Exerc Psychol. 1992; 14: 273-282
        • Clement S.
        • Schauman O.
        • Graham T.
        • et al.
        What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies.
        Psychol Med. 2015; 45: 11-27
        • Jorm A.F.
        • Oh E.
        Desire for social distance from people with mental disorders.
        Aust N Z J Psychiatry. 2009; 43: 183-200
        • Storch E.A.
        • Storch J.B.
        • Killiany E.M.
        • et al.
        Self-reported psychopathology in athletes: a comparison of intercollegiate student-athletes and non-athletes.
        J Sport Behav. 2005; 28: 86-98
        • Watson J.
        College student-athletes’ attitudes toward help-seeking behavior and expectations of counseling services.
        J Coll Stud Dev. 2005; 46: 442-449
        • Watson J.C.
        Student-athletes and counseling: factors influencing the decision to seek counseling services.
        Coll Stud J. 2006; 40: 35-42
        • Martin S.B.
        • Lavallee D.
        • Kellmann M.
        • et al.
        Attitudes toward sport psychology consulting of adult athletes from the United States, United Kingdom, and Germany.
        Int J Sport Exerc Psychol. 2004; 2: 146-160
        • Tibbert S.J.
        • Andersen M.B.
        • Morris T.
        What a difference a mentally toughening year makes: the acculturation of a rookie.
        Psychol Sport Exerc. 2015; 7: 68-78
        • Coulter T.J.
        • Mallett C.J.
        • Singer J.A.
        A subculture of mental toughness in an Australian football league.
        Psychol Sport Exerc. 2016; 22: 98-113
        • Vaillant G.E.
        Mental health.
        Am J Psychiatry. 2003; 160: 1373-1384
        • Si G.
        • Duan Y.
        • Li H.-Y.
        • et al.
        The influence of the Chinese sport system and Chinese cultural characteristics on Olympic sport psychology services.
        Psychol Sport Exerc. 2015; 17: 56-67
        • Martin S.B.
        • Akers A.
        • Jackson A.W.
        • et al.
        Male and female athletes’ and nonathletes’ expectations about sport psychology consulting.
        J Appl Sport Psychol. 2001; 13: 19-40
        • Addis M.E.
        • Mahalik J.R.
        Men, masculinity, and the contexts of help seeking.
        Am Psychol. 2003; 58: 5-14
        • Rees T.
        • Haslam S.A.
        • Coffee P.
        • et al.
        A social identity approach to sport psychology: principles, practice and prospects.
        Sports Med. 2015; 45: 1083-1096
        • Morgan P.B.C.
        • Fletcher D.
        • Sarkar M.
        Defining and characterizing team resilience in elite sport.
        Psychol Sport Exerc. 2013; 14: 549-559
        • Morgan P.B.C.
        • Fletcher D.
        • Sarkar M.
        Understanding team resilience in the world’s best athletes: a case study of a rugby union World Cup winning team.
        Psychol Sport Exerc. 2015; 16: 91-100
        • Reid C.
        • Stewart E.
        • Thorne G.
        Multidisciplinary sport science teams in elite sport: comprehensive servicing or conflict and confusion?.
        Sport Psychol. 2004; 18: 204-217
        • Dijkstra H.P.
        • Pollock N.
        • Chakraverty R.
        • et al.
        Managing the health of the elite athlete: a new integrated performance health management and coaching model.
        Br J Sports Med. 2014; 48: 523-531
        • Schwenk T.L.
        The stigmatization and denial of mental illness in athletes.
        Br J Sports Med. 2000; 34: 4-5
        • Fletcher D.
        • Wagstaff C.R.D.
        Organizational psychology in elite sport: its emergence, application and future.
        Psychol Sport Exerc. 2009; 10: 427-434
        • Sebbens J.
        • Hassmén P.
        • Crisp D.
        • et al.
        Mental health in sport (MHS): improving the early intervention knowledge and confidence of elite sport staff.
        Front Psychol. 2016; 7: 911