Mind-Body Integration versus Cognitive Restructuring: A Randomized Comparison of Physical-Mindfulness Therapy and Cognitive Behavioral Therapy for Stress, Anxiety, and Performance Optimization in Emerging Adult Athletes

Competitive sport places extraordinary psychological demands on young athletes, often resulting in heightened stress, sports-specific anxiety, and compromised performance. This randomized controlled trial investigated the comparative efficacy of two promising interventions—Mind-Body Physical Therapy (MBPT) and Cognitive Behavioral Therapy (CBT)—in addressing these challenges among 100 competitive athletes aged 20–25 years recruited from sports centers in India (mean age = 22.4 years, SD = 1.6).
Participants screening positive for elevated stress and anxiety were randomly allocated to 12 sessions (3 per week, 60 minutes each) of either MBPT (integrating yoga-based movement, diaphragmatic breathing, progressive muscle relaxation, mindfulness meditation, guided imagery, and psychoeducation) or CBT (emphasizing cognitive restructuring, behavioral activation, anxiety coping strategies, performance visualization, and stress management training). Outcomes were assessed pre- and post-intervention using validated instruments: Perceived Stress Scale (PSS), Sport Anxiety Scale-2 (SAS-2), Warwick-Edinburgh Mental Well-Being Scale (WEMWBS), and a custom Sports Performance Rating Scale (SPRS).
Both interventions produced robust, statistically significant improvements across all domains (p < 0.001), with large effect sizes (Cohen’s d > 1.2). While overall efficacy was comparable, nuanced modality-specific advantages emerged: MBPT yielded greater reductions in perceived stress and somatic anxiety symptoms, likely through enhanced physiological regulation and interoceptive awareness; CBT demonstrated marginally superior gains in psychological well-being and self-reported performance, particularly in cognitive domains such as focus and self-efficacy. These findings highlight the complementary strengths of somatic-mindfulness and cognitive restructuring approaches, supporting tailored or hybrid mental training models in sports psychology. Future research should explore long-term sustainability, integrated protocols, and cultural adaptations for diverse athletic populations.

Mind-body therapy, Cognitive behavioral therapy, Sports anxiety, Perceived stress, Athletic performance, Psychological well-being, Young athletes, Integrative interventions

1. Anshel, M. H. (1990). Toward validation of a model for coping with acute stress in sport. International Journal of Sport Psychology, 21(1), 58–83. [Google Scholar] [Crossref]

2. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press. [Google Scholar] [Crossref]

3. Beenen, K. T., Vosters, J. A., & Patel, D. R. (2025). Sport-related performance anxiety in young athletes: A clinical practice review. Translational Pediatrics, 14(1), 127–138. [Google Scholar] [Crossref]

4. https://doi.org/10.21037/tp-24-258 [Google Scholar] [Crossref]

5. Birrer, D., & Morgan, G. (2010). Psychological skills training as a way to enhance an athlete’s performance in high-intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20(Suppl. 2), 78–87. https://doi.org/10.1111/j.1600-0838.2010.01188.x [Google Scholar] [Crossref]

6. Chang, C. J., Putukian, M., Aerni, G., Diamond, A., Hong, E., Ingram, Y., Reardon, C. L., & Wolanin, A. (2020). Mental health issues and psychological factors in athletes: Detection, management, effect on performance, and prevention: American Medical Society for Sports Medicine position statement. Clinical Journal of Sport Medicine, 30(2), e61–e87. https://doi.org/10.1097/JSM.0000000000000817 [Google Scholar] [Crossref]

7. Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and practice. Guilford Press. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associates. [Google Scholar] [Crossref]

8. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404 [Google Scholar] [Crossref]

9. Gard, T., Noggle, J. J., Park, C. L., Vago, D. R., & Wilson, A. (2014). Potential self-regulatory mechanisms of yoga for psychological health. Frontiers in Human Neuroscience, 8, Article 770. [Google Scholar] [Crossref]

10. https://doi.org/10.3389/fnhum.2014.00770 [Google Scholar] [Crossref]

11. Gill, S., & Singh, P. (2024). Supporting mental health: Pre–post four-week psychological capacity building program for Indian target sport athletes. Human Movement, 25(4), 117–137. https://doi.org/10.5114/hm/195915 Gould, D., & Udry, E. (1994). Psychological skills for enhancing performance: Arousal regulation strategies. Medicine & Science in Sports & Exercise, 26(4), 478–485. [Google Scholar] [Crossref]

12. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43. [Google Scholar] [Crossref]

13. https://doi.org/10.1016/S00223999(03)00573-7 [Google Scholar] [Crossref]

14. Gustafsson, H., DeFreese, J. D., & Madigan, D. J. (2017). Athlete burnout: Review and recommendations. Current Opinion in Psychology, 16, 109–113. [Google Scholar] [Crossref]

15. https://doi.org/10.1016/j.copsyc.2017.05.002 [Google Scholar] [Crossref]

16. Jacobson, E. (1938). Progressive relaxation (2nd ed.). University of Chicago Press. [Google Scholar] [Crossref]

17. Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press. [Google Scholar] [Crossref]

18. Kaiseler, M., Polman, R. C. J., & Nicholls, A. R. (2012). Effects of the Big Five personality dimensions on appraisal, coping, and coping effectiveness in sport. European Journal of Sport Science, 12(1), 62–72. https://doi.org/10.1080/17461391.2010.551410 [Google Scholar] [Crossref]

19. Kaufman, K. A., Glass, C. R., & Pineau, T. R. (2018). Mindful sport performance enhancement: Mental training for athletes and coaches. American Psychological Association. [Google Scholar] [Crossref]

20. https://doi.org/10.1037/0000092-000 [Google Scholar] [Crossref]

21. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer. [Google Scholar] [Crossref]

22. Martens, R., Vealey, R. S., & Burton, D. (1990). Competitive anxiety in sport. Human Kinetics. [Google Scholar] [Crossref]

23. Meichenbaum, D. (1993). Stress inoculation training: A 20-year update. In P. M. Lehrer & R. L. Woolfolk (Eds.), Principles and practice of stress management (2nd ed., pp. 373–406). Guilford Press. [Google Scholar] [Crossref]

24. Noetel, M., Ciarrochi, J., Van Zanden, B., & Lonsdale, C. (2019). Mindfulness and acceptance approaches to sporting performance enhancement: A systematic review. International Review of Sport and Exercise Psychology, 12(1), 139–175. https://doi.org/10.1080/1750984X.2017.1387803 [Google Scholar] [Crossref]

25. Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., Budgett, R., Campriani, N., Castaldelli-Maia, J. M., Currie, A., Derevensky, J. L., Glick, I. D., Gorczynski, P., Gouttebarge, V., Grandner, M. A., Han, D. H., McDuff, D., Mountjoy, M., Polat, A., Purcell, R., Putukian, M., Rice, S., Sills, A., Stull, T., Swartz, L., Zhu, L. J., & Engebretsen, L. (2019). [Google Scholar] [Crossref]

26. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine, 53(11), 667–699. https://doi.org/10.1136/bjsports-2019-100715 [Google Scholar] [Crossref]

27. Shamim Ahmed, A., Qudus, A., Munawar, A., Karim, R., Liaqat, U., & Tabassum, M. F. (2022). The role of cognitive-behavioral therapy in improving athletes’ performance: A systematic review. Journal of Population Therapeutics and Clinical Pharmacology, 29(2), e20–e30. [Google Scholar] [Crossref]

28. https://doi.org/10.53555/jptcp.v29i2.3062 (Note: Year adjusted based on common citation; original review in 2023 may vary). [Google Scholar] [Crossref]

29. Smith, R. E., Smoll, F. L., Cumming, S. P., & Grossbard, J. R. (2006). Measurement of multidimensional sport performance anxiety in children and adults: The Sport Anxiety Scale-2. Journal of Sport & Exercise Psychology, 28(4), 479–501. https://doi.org/10.1123/jsep.28.4.479 [Google Scholar] [Crossref]

30. Streeter, C. C., Gerbarg, P. L., Saper, R. B., Ciraulo, D. A., & Brown, R. P. (2012). Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder. Medical Hypotheses, 78(5), 571–579. [Google Scholar] [Crossref]

31. https://doi.org/10.1016/j.mehy.2012.01.021 [Google Scholar] [Crossref]

32. Taylor, J., & Wilson, G. (Eds.). (2005). Applying sport psychology: Four perspectives. Human Kinetics. [Google Scholar] [Crossref]

33. Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J., & Stewart-Brown, [Google Scholar] [Crossref]

34. S. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes, 5, Article 63. https://doi.org/10.1186/1477-7525-5-63 [Google Scholar] [Crossref]

35. Tossici, G., Zurloni, V., & Nitri, A. (2024). Stress and sport performance: A PNEI multidisciplinary approach. Frontiers in Psychology, 15, Article 1358771. https://doi.org/10.3389/fpsyg.2024.1358771 [Google Scholar] [Crossref]

36. Turner, M. J., & Barker, J. B. (2014). Using rational emotive behavior therapy with athletes. The Sport Psychologist, 28(1), 75–90. https://doi.org/10.1123/tsp.2013-0040 [Google Scholar] [Crossref]

37. Wang, Y., Lei, S. M., & Fan, J. (2023). Effects of mindfulness-based interventions on promoting athletic performance and related factors among athletes: A systematic review and meta-analysis of randomized controlled trial. International Journal of Environmental Research and Public Health, 20(3), Article 2038.https://doi.org/10.3390/ijerph20032038 [Google Scholar] [Crossref]

38. Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49–54. https://doi.org/10.4103/0973-6131.85485 [Google Scholar] [Crossref]

39. Yang, H., Tsai, Y., Lu, M., & Hu, J. (2024). Effects of mindfulness-based interventions on stress and anxiety in athletes: A meta-analysis. Psychology of Sport and Exercise, 70, Article 102566. https://doi.org/10.1016/j.psychsport.2023.102566 [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar