Heads in the Game

As more and more people have increased their participation in sports, there has been a concurrent expansion in our understanding of the importance of an athlete’s mental and emotional health as they relate to performance. Fortunately, the field of mental health has grown to include sports psychology and psychiatry, a specialty that focuses on the mental and emotional well-being of athletes—while they are actively competing and after leaving the sport.

One type of mental health obstacle that athletes face is performance anxiety. Michael Young, MD, medical director of The Retreat by Sheppard Pratt, has completed training in sports psychiatry and counsels athletes—and others—about the origins of performance anxiety and how to cope with it. 

“Performance anxiety is pretty common, particularly among athletes and student athletes,” says Dr. Young. “Everybody knows what it’s like to get nervous in a high-pressure situation, and it can actually help us recognize that it’s time to perform. But if it crosses a certain threshold, creating physical symptoms that are problematic, or just really taking away that focus and concentration to a point that is hurting performance, that’s when we can describe it as performance anxiety.”

Dr. Young helps the people he works with understand how their anxiety arises and how to accommodate those feelings. “The anxiety is going to be there. It can even drive your performance. If you can reframe that anxiety as something that is normalized, you can create a mindset of gaining mastery over that anxiety,” he explains. 

One step at a time

It helps to begin by recognizing the signs of anxiety. Often, that is marked by behaviors like clenching one’s jaw, pacing, or being jittery or ill at ease. “After identifying it, it’s important to acknowledge and normalize those feelings. These feelings are okay,” Dr. Young explains.

After identifying the anxiety, then acknowledging and normalizing the feelings, he advises making a game plan to calm down. “When you’re under pressure, your mind can start racing in different directions,” he says. “You can lose your concentration and become fearful of making mistakes. What can be helpful is to develop a game plan and stick with it. Short, direct strategies are best.” 

One game plan for reducing anxiety can take the form of combining movements with thoughts that act as a mantra of sorts. For instance, if you’re up to bat, you can visualize three steps: focusing on the ball, dialing in, and swinging through. Or if you’re at the free-throw line, you can visualize yourself bouncing the ball, aiming, and shooting. By focusing on this mini, interior game plan, you can “preview” what you’re going to do without letting the anxiety take over. 

“The other thing is, you want to remind yourself to breathe. Breathing—especially deep breathing—has the physiologic effect of self-regulating, calming your heart rate, and releasing tension,” Dr. Young says.

“It’s always essential, particularly with kids, to stay positive,” he continues. “You want to give positive feedback, reinforcing what’s going well more than what’s not going well. That can help increase self-esteem and decrease anxiety. It can lessen the negative thoughts, and at the right time, you can make room for constructive feedback in an effective way.”

When the game is over

Some athletes, particularly those who play at a high level, may find it difficult to adjust when leaving the sport. You may be reluctant to retire, especially if you are forced out abruptly due to an injury. 

“Athletes can be at increased risk of depression and anxiety upon retirement,” Dr. Young says. “Often an athlete has a very strong tie to their overall identity through sport, so when they retire, there’s a dramatic shift in identity from active athlete to former athlete. There can sometimes be feelings of sudden grief, withdrawal, and emptiness. There may also be a rapid loss of social support. Sometimes the athlete’s major social support network is made up of their coaches, teammates, and trainers, and upon retirement, that goes away.”

There are ways to mitigate those feelings of loss, Dr. Young says. One step is to plan ahead. Elite athletes should adopt other interests even while playing, so that when you leave the sport, you have other people and activities to sustain you. 

Even if you can’t plan too far ahead, look at the transition as an opportunity, not just a loss. 

“Think about having an opportunity to explore other career fields and fulfilling interests that had to be put on the back burner when you were pursuing the sport,” says Dr. Young. “You might experience relief from not being under the constant pressure and scrutiny that an athlete often faces. 

“But it’s also important to remember the positive skills that led you to being a high-performing athlete—or a high performer in any field,” he adds. “The stamina, the strength, and the high sense of resilience can be useful when building a new career. The psychological discipline and accountability an athlete needs can be excellent skills for a developing new career.”