Introduction

Elite athletes often experience high levels of psychological stress due to the competitive nature of their sport, intense training demands, and performance expectations from coaches, teammates, media, and fans. These stressors can lead to mental health challenges, decreased motivation, burnout, and performance decline. In the high-pressure sport of basketball, where decision-making under time constraints and team coordination are essential, such challenges are even more pronounced (1). Among the psychological variables influencing performance are irrational beliefs and cognitive distortions such as catastrophizing, low frustration tolerance, and perfectionistic thinking, which can impair self-efficacy and increase anxiety and depressive symptoms (2). Rational Emotive Behavior Therapy (REBT), a cognitive-behavioral approach developed by Albert Ellis, targets these dysfunctional beliefs (3). REBT has shown promise in reducing performance anxiety, improving emotional resilience, and optimizing athletic functioning (4). However, most existing research on REBT in sport psychology is based on group designs, with less attention to individualized responses to therapy. Furthermore, few studies incorporate both psychological and objective performance outcomes, or track the sustainability of changes over time.

The present study aimed to address these gaps by employing a structured, individualized REBT intervention with a single elite basketball player using a single-subject experimental design. The study sought to evaluate the intervention's effectiveness in reducing irrational performance beliefs and psychological distress while improving free throw accuracy—an objective marker of performance.

Method: A single-subject A-B design with a three-month follow-up was used. The participant was a 22-year-old male athlete with six years of experience in national basketball teams and active participation in the national league. He trained approximately 30 hours per week and reported significant anxiety during critical game moments, particularly during free throws. Initial assessment indicated high scores on irrational beliefs and general psychological distress, qualifying him for inclusion.

The intervention was based on the REBT model, incorporating the ABCDE framework (Activating event, Beliefs, Consequences, Disputation, and new Effects). Eight weekly individual counseling sessions (30–45 minutes each) were conducted over two months, divided into three phases: psychoeducation (2 sessions), disputation (5 sessions), and reinforcement (1 session). Each session involved reviewing homework, discussing sport-specific scenarios, and applying cognitive-behavioral techniques to challenge and restructure irrational beliefs. Content was adapted from established REBT sport psychology protocols (5, 6) and intervention fidelity was ensured by oversight from two experienced sport psychology supervisors.

Three main variables were assessed in this study: (1) Irrational performance beliefs, measured using the Persian version of the Irrational Performance Beliefs Inventory, evaluating four cognitive distortions—primary irrational beliefs, low frustration tolerance, awfulization, and depreciation; (2) Mental health, assessed through the General Health Questionnaire-28 (GHQ-28), covering somatic symptoms, anxiety and insomnia, social dysfunction, and depression; and (3) Athletic performance, evaluated by calculating the participant’s free throw success rate during the baseline, intervention, and follow-up phases, based on official competition records validated by national-level coaches.

Data were collected weekly during a five-week baseline phase to establish stability, continued throughout the eight-session intervention phase, and were gathered again three months after the intervention during the follow-up phase. Visual analysis (line graphs), effect size calculations (Cohen’s d), and percentage of non-overlapping data (PND) were used. Additionally, paired t-tests assessed statistical significance between phases. A social validity questionnaire and open-ended feedback were also collected post-intervention to assess participant satisfaction and perceived impact.

Results: The intervention produced substantial positive changes across all key variables. Irrational performance beliefs decreased by 49.98%, with the most substantial improvements in awfulization (58.19%) and depreciation beliefs (51.77%), and these gains were largely sustained at the three-month follow-up (62.92% reduction from baseline). Mental health indicators also improved substantial, with an overall 44.30% reduction in psychological distress, especially in somatic symptoms (47.61%), anxiety/insomnia (48.27%), depression (37.50%), and social dysfunction (38.09%), all of which remained stable or improved at follow-up. Free throw performance increased substantially from a baseline average of 60.09% to 90.64% post-intervention, with minimal decline at follow-up (88.88%). Statistical analyses showed significant differences in somatic symptoms (p = 0.019), free throw accuracy (p < 0.001), and irrational beliefs (p < 0.05). Ultimately, social validation results confirmed the intervention's effectiveness, with both the athlete and his coach reporting high satisfaction and perceived benefits such as improved sleep, reduced pre-competition anxiety, more flexible thinking, and enhanced self-confidence.

Conclusion: This study provides empirical support for the effectiveness of a structured REBT-based psychological intervention in improving both mental health and athletic performance in elite sport. By targeting sport-specific irrational beliefs and applying individualized disputation strategies, the participant demonstrated clinically and statistically meaningful improvements across psychological and performance domains.

Importantly, the intervention’s benefits were not only evident immediately post-treatment but were largely maintained after three months, reinforcing the sustainability of REBT outcomes in applied athletic contexts. The use of a single-subject design allowed for detailed within-person analysis, overcoming the limitations of group-based designs in detecting individual responsiveness to psychological interventions.

These findings have practical implications for sport psychologists, coaches, and clinical practitioners working with elite athletes. Implementing structured REBT sessions—especially in individualized formats—can be a valuable component of psychological training in high-performance environments. Furthermore, combining psychological metrics with objective performance indicators provides a comprehensive view of intervention impact.

 Given the increasing psychological pressures associated with high-level athletic competition—particularly during critical moments of performance—the application of such interventions plays a vital role in preventing mental health challenges. Therefore, integrating cognitive-emotional skill training and restructuring of performance-related beliefs into athletes’ psychological preparation programs, especially at elite and professional levels, is an essential necessity. Moreover, these findings highlight the importance of having sport psychologists who are well-versed in Rational Emotive Behavior Therapy (REBT) principles actively involved alongside coaching staff. Structured and targeted interventions addressing cognitive beliefs can directly contribute to enhancing performance quality and strengthening athletes’ psychological resilience in competitive settings.

Limitations and Future Directions

While the single-subject design offers depth, it limits generalizability. Future research should replicate these findings using larger samples, multiple-case designs, and control groups. Additionally, exploring brief-session formats, independent raters, and mixed-method approaches could strengthen the evidence base. Nonetheless, this study demonstrates the value of REBT in sport and highlights its potential to bridge the gap between mental health support and performance enhancement for elite athletes.

Keywords: Rational Emotive Behavioral Therapy (REBT); Irrational Beliefs; Elite Athlete; Basketball; Mental Health; Single-subject Experimental Design (SSED).

Ethical Considerations

Compliance with ethical guidelines

This study was conducted with an applied objective and in full adherence to research guidelines and ethical principles related to human participants. These principles included obtaining informed and voluntary consent from the participant, respecting the right to withdraw from the study at any stage, and maintaining the confidentiality of personal information and collected data.

Funding

This study was extracted from the Ph.D. thesis of first author at Department of Psychology of Islamic Azad University. This research received no financial support from public, commercial, or non-governmental sources and is solely derived from the first author's doctoral dissertation.

Authors' contribution

All authors equally contributed to the implementation of this study, and the second author (supervisor) assumed corresponding.

Conflict of interest

The authors declare that there is no conflict of interest regarding this study.

Acknowledgements

The authors extend their gratitude to all the athletes and coaches who patiently and attentively supported the execution of this research.