pain and injury instead of refusing to play when hurt have prompted athletes to believe that accepting physical risks is their only choice. this will in turn lead to both physical and mental struggles for the athlete to endure simultaneously and could lead to a worse outcome if not treated appropriately. in addition, the influences of personal and situational factors can directly impact an athlete's perceptions about their injury. personal factors include the characteristics of the injury, the athlete's own approach to their injury, and their identity. situational factors include the nature of the athlete's sport, social influences, and the rehabilitation environment. for example, stressful events such as divorce or employment instability can increase the likelihood of experiencing an injury. an athlete's response to an injury is influenced by a variety of stressors they encountered before the injury and the coping skills they used to overcome previous struggles. therefore, it is important to utilize an integrated model in the rehabilitation process to account for the cognitive, emotional, and behavioral needs of the athletes. in the rehabilitation process, athletes may experience anxiety as a result of the injury as well as their underlying personal and situational issues. as mental trainer jeff troesch mentions, "recovering from injury can be one of the toughest psychological challenges any athlete faces." all of the uncertainty surrounding the injury and lacking full control over one's body can lead to more anxiety and stress on the athlete. studies have shown that higher anxiety scores are commonly associated with other comorbidities including depression. in addition, athletes with higher ratings for career dissatisfaction also exhibited higher anxiety scores compared to those who were career satisfied with their career. from these studies it can be inferred that injured athletes experience an increase in anxiety levels as a result of psychosocial factors. hence, taking these influences into account may assist sports medicine practitioners when planning for the psychological management needs of injured elite athletes. when addressing psychological readiness during the recovery process, rehabilitation facilities should encourage confidence-building and provide social support to the athletes. developing confidence in returning to sport includes "having trust in the rehabilitation provider, satisfaction of social support needs, and achievement of physical standards/clinical outcomes." social support can operate as a buffer for the amount of anxiety and stress associated with an injury by positively affecting the athlete's psychological and emotional wellbeing. in turn, this support can improve the athlete's motivation and coping skills during the rehabilitation process. in addition, research suggests that emotional social support, which prioritizes "empathy, love, trust, and caring" can benefit injured athletes psychologically as they recover. with greater emphasis on the psyche, athletes will be more motivated to envision their injury recovery as a new competition or task, rather than a roadblock that hinders them from achieving their dreams. to accommodate psychosocial factors in recovery, services must be accessible to the athletes. although many universities provide psychological services to their students, these employees may not be trained in handling athlete-specific factors, and thus may not be able to address the particular needs of injured athletes. therefore, certified athletic trainers who work with athletes on a consistent basis can be an important resource for providing emotional social support to injured athletes. in previous studies, athletes who were content with the social support they received by their athletic trainers were 87% less likely to report symptoms of depression and anxiety. thus, such athletic trainers involved in the athlete's regular activities can be effective in facilitating psychological interventions during the rehabilitation process. currently, mental health struggles are often surrounded by stigma and can be seen as a weakness for high-level athletes. when discussing kara goucher's openness to sharing her difficulty with negative self-talk and confidence, the author acknowledged that this example is rare in the world of athletics because such struggles are usually considered a weakness. if more athletes like kara goucher communicate about their mental health, others will feel more inclined to discuss their own issues instead of keeping it to themselves. therefore, de-stigmatizing and engaging in conversations about mental health can encourage athletes to enlist help for their internal struggles throughout their sports career and during an injury. mindfulness-based interventions that integrate the mind and body have begun to address mental health needs among high-level athletes. not only has mindfulness been shown to positively impact general well-being and improve performance, but it could also be utilized as a "protective factor to stress and stress-related psychological issues." the stigma associated with mental health as a weakness is a common barrier impeding help-seeking behaviors for athletes whose primary goal is to achieve perfection and success in their sport. elite athletes dedicate an immense amount of time and effort and can suffer from both physical and mental roadblocks. therefore, it is important that rehabilitation programs account for mental health as a strong component of the recovery process for athletes, so that they are better prepared to manage not only the physical burden but also the psychological effects of their injury. understanding the injured athlete experience from a physical, psychological, and social perspective is essential for athletes to return to their sport when they are both physically and mentally prepared and perform at their optimal level. many student-athletes do not seek mental health support. research suggests that only 10% of college athletes with mental health conditions seek support. this means that out of approximately 500,000 college athletes, only 50,000 seek help. awareness is another challenge of support. in a survey evaluating mental health support for college athletes, 60% of male athletes and 55% of female athletes were not aware how to find or access mental health support.