Sports Mental Toughness and Pain Anxiety Among Injured Filipino Student-Athletes

Mental toughness and pain anxiety are critical psychological factors in student-athletes’ psychological health and ability to cope with the physical and emotional challenges of recovery. While mental toughness is often regarded as a protective attribute that enhances resilience, emerging evidence suggests it may also interact with pain-related anxiety in many complex ways, potentially hindering recovery when accompanied by pressure to return to play. This study investigated the relationship between mental toughness and pain anxiety using a sequential explanatory mixed-method design. Through the said method, the study first conducted a quantitative phase (Phase 1) with 124 Filipino collegiate student-athletes (18–25 years) who had sustained significant injuries. Participants completed the Sports Mental Toughness Questionnaire and the Pain Anxiety Symptoms Scale-20. Regression analysis revealed a significant model, F(1, 122) = 12.50, p < .001, with SMT accounting for 9.3% of the variance in PA (R² = 0.093). SMT was a significant positive predictor of PA (B = 0.934, β = 0.305, p < .001), contrary to the hypothesized negative association. In Phase 2, nine participants were purposively sampled and participated in semi-structured interviews, which were analyzed using Braun and Clarke’s thematic analysis. Integration was achieved by using qualitative insights to explain the quantitative trend. Four themes emerged: (1) mental toughness as a double-edged factor, (2) psychoemotional challenges during recovery, (3) post-injury adjustments and coping, and (4) adverse environmental influences. These themes clarified how high SMT could coexist with elevated PA due to internalized pressure and expectations to recover quickly. The findings highlight the paradoxical role of SMT, suggesting that while it supports resilience, it may also intensify pain and anxiety. Interventions should aim to strike a balance between mental toughness and adaptive emotional processing.