Psychophysiological stress testing (PST) should be routinely administered to all athletes at intake. This test provides an additional layer in the evidence hierarchy by extending Athlete’s Profile Primary Higher Order (AP PHO) constellation self-report and behavioral measures to underlying mind-body responding. Feelings of discomfort, worry, nervousness, and overall stress are expected to heighten in athletes with the most detrimental AP PHO constellation or in athletes who score high for neuroticism/subliminal reactivity (N/SR), and induce changes in heart rate variability (HRV) that are associated with increases in sympathetic nervous system (SNS) activity. While differential levels of activation are usually necessary for sport performance, in the context of a static situation and cognitive stressors, greater low frequency (LF) and accompanying SNS is hypothesized to be disruptive and interfere with mental tasks, such as strategic planning as a precursor to motor action.

Mental imagery (MI) or visualization can be considered the go-to mental training (MT) method and is used by the vast majority of sport psychology practitioners. MI is addressed in the context of the Theory of Critical Moments and athlete’s profile (AP) models of peak performance construct bases and the brain-heart-mind-body-motor dynamics they advance in regard to intervention efficiency and efficacy. Athlete is tested for Visualization Responsivity (VR) using the Carlstedt Protocol Visualization Responsivity Test-Athlete Version (CPVR-A). This chapter provides some consecutive autonomic nervous system (ANS)-heart rate variability (HRV) reports that emanate from a professional tennis player who was high in hypnotic susceptibility (HS)/subliminal attention (SA), namely the baseline condition, positive-negative and relaxation visualization scenario-based HRV responses. It presents an MI intervention efficacy case study in the context of actual competition using a repeated A-B-A design. Variance explained in a visualization-based or associated outcome measure should be the intervention efficacy benchmark.

Heart rate variability (HRV) measures have been found to consistently predict macro- and micro-level sport-specific outcomes, including performance during critical moments as well as reflecting differential states of attention, intensity, and mental control, especially when an athlete is under competitive pressure. This chapter explores and explicates HRV in the context of pre-intervention assessment of athlete mind-body-motor and outcome responses and attempts to arrive at an athlete’s individual zone of optimum functioning (IZOF), as well as criterion reference athlete’s profile primary higher-order (AP PHO) constellations with autonomic nervous system (ANS)/psychophysiological measures in both training and real competition. The polar system allows for real-time wireless and telemetry HRV data acquisition and analyses opening up the possibility of isolating specific inter-beat intervals during action. Such a capability facilitates micro-analyses of HRV and heart rate deceleration (HRD) on an unprecedented level, since investigations of HRV/HRD can be carried out during high-intensity training and competition.

Heart rate deceleration biofeedback (HRD BF) is a relatively unknown intervention whose origin can be traced to an extensive body of research on pre-stimulus or pre-action cardiac activity. HRD BF is a very mechanistic approach, whose effects can be immediately documented independent of speculative interpretive components associated with more cognitively based interventions. BF attempts to induce or shape mind-body responses by first showing baseline autonomic and/or central nervous system activity as reflected in waveform oscillations or other representations that are observable on a computer screen, and then reinforcing prescribed performance or wellness-related target psychophysiological responses. In multi-modal HRD BF, video and visualization components are integrated into the mental training process. In terms of intervention efficacy, the tested player won more and lost fewer games in the HRD BF compared to the no-intervention condition. Conceptually consistent intervention efficiency and efficacy findings support its utility as an athlete assessment and intervention approach.

Practitioners should be aware of and critically appraise the conceptual bases and construct validity of an intervention or mental training (MT) method. Intervention dose–response relationships (IDRR) and time to achieve enduring change (TAEC) is a conceptual issue that is closely related to temporal properties of MT. Evidence-based approaches to MT and intervention must take temporal and time to achieve enduring change parameters into account using the systematic methodologies. Ecological validity is a vital prerequisite for high evidentiary athlete assessment and intervention. The Polar heart rate variability (HRV)/heart rate deceleration (HRD) paradigm allows for more extensive and time-locked predictive validity statistical analyses so that in-the-moment MT over the course of entire official games/matches/competition can be delineated and quantified in terms of MT’s predictive validity.

This chapter presents interventions and mental training (MT) modalities in order of the hypothesized probability that engaging in a select method will lead to a successful outcome per Carlstedt Protocol (CP) efficacy criteria. There are numerous intervention and MT modalities to choose from, both as a practitioner and an athlete. The American Board of Sport Psychology-Carlstedt Protocol (ABSP-CP) approach to intervention and MT is based on the athlete’s profile (AP) model of individual differences that has isolated key primary higher-order (PHO) factors that are intimately related to critical components of performance: attention, physiological reactivity, and strategic planning/coping, all of which play a mediating role in the intervention and MT process. The chapter addresses interventions in the context of ABSP-CP perspectives, procedures, and methodologies, and, particularly, how a specific MT technique can be applied/used to facilitate in-the-moment peak performance as reflected in heart rate deceleration (HRD).

Multi-modal approaches to mental training (MT) involve the incorporation of more than one intervention method in attempts to enhance performance. Intervention amenability and compliance relative to multi-modal MT, as when using singular modalities alone, need to be seriously considered. Multi-modal MT can be very straightforward and designed to specifically address psychological or technical issues or goals independently. This chapter provides an example of a select individualized multi-modal intervention. As with all MT modalities, multi-modal methods must be documented and scrutinized for efficiency and efficacy. Heart rate variability (HRV) and autonomic nervous system (ANS) reports are used to determine intervention efficiency and efficacy. Multi-modal mental training (MMMT), as with any form of intervention that has established efficiency and efficacy, should be carried out independently by athletes who travel to competitions or are assisted by coaches and/or team mates in the absence of a sport psychology practitioner.

This chapter presents a validated multifaceted assessment and intervention protocol that has been used on hundreds of athletes over the last 15 years. It provides data and findings on athletes who have experienced the Carlstedt Protocol (CP), and recommends for the integration of procedures and methodologies that are vital to evidence-based applied sport psychology, and the credibility of the field of sport psychology/biofeedback and its practitioners. In addition to guiding biofeedback, the established athlete’s profile is a strong predictor of intervention amenability and compliance tendencies, pain thresholds, attentional control during competitive stress, coachability, and the placebo-nocebo effects. During critical moments, athletes possessing the most negative or disruptive constellation of primary higher-order (PHO) factors exhibit heart rate acceleration (HRA) prior to action, while those having the most facilitative or protective constellation continue to demonstrate heart rate deceleration (HRD).

Video-based mental programming (VBP) is a more direct intervention modality that accesses and uses visual processing to facilitate, especially motor and technical, performance; although it can also be used in attempts to increase motivation, emotional engagement, and attain individual zone of optimum functioning (IZOF) established levels of physiological reactivity. VBP can be viewed as a very direct mental training approach, one that circumvents esoteric and extraneous intervention procedures that are more difficult to assess in terms of efficiency and efficacy. It can also be used as a stress test, whereby an athlete’s underlying psychophysiology is monitored while watching his or her self-performance over the course of a complete game or match. Baseline heart rate variability (HRV) profiles should be compared with intervention-induced HRV to establish intervention efficiency. The chapter also presents a real case study to illustrate the VBP intervention process and an outcome associated with it.