When prominent athletes tell the world they’re struggling with their mental health, it serves as a reminder that athletic success can have little bearing on how one feels.
Olympic gymnast Simone Biles and tennis star Naomi Osaka have taken breaks from their sports while candidly talking about the challenges that confront athletes who are dealing with high expectations. Swimmer Michael Phelps, winner of a record 23 gold medals over five Olympics, has been open about his ongoing challenges with anxiety and depression, as has Kevin Love, a five-time NBA All-Star.
The essential point: Star athletes are not immune from mental health issues. The same is true of athletes at any level. Fortunately, Sanford Health has people who can help.
Coaching with a mental approach
Andy Gillham, Ph.D., CMPC, is the lead performance psychology specialist with Sanford Sports who advises athletes and coaches on developing and maintaining strong mental approaches to the sports they’re involved in.
Sometimes, Gillham said, the strongest mental approach begins with realizing you’re not where you need to be.
“What Naomi and Simone have done is to stand up and say, ‘I’m just not square right now. I got a bunch going on. Upstairs, in my being, I’m just not OK right now. I need to take a step back and deal with me, the person — not me, the athlete,’” Gillham said.
Openness among famous athletes can be a great help in encouraging the not-so-famous to be sensitive to their own mental health issues. It is an encouraging trend.
“The media attention on mental health over the last decade has been a big help,” said Jacob Miller, M.D., a Sanford specialist in family and sports medicine who serves as Northern State University’s team doctor. “I feel like I’m having a lot more athletes reach out to me and tell me ‘I’m really not feeling OK with what is going on here.’”
Mental health challenges are common
While exercise can have antidepressant effects, athletes still deal with mental health challenges. In fact, they can experience additional pressures that the general population does not. A few numbers illustrate these challenges:
- Up to 35% of professional and elite athletes face mental health challenges including disordered eating, burnout, depression and/or anxiety, reports the American College of Sports Medicine.
- By comparison, about 1 in 5, or 20% of Americans live with a mental illness in their lifetime, according to the Centers for Disease Control and Prevention.
- Meanwhile, research conducted among NCAA student athletes reveals high awareness of mental health and where to go for treatment, but also high amounts of stigma about actually going to treatment.
Typically, Dr. Miller will ask his patients if the way they feel is affecting sports performance. Is it affecting diet? Is it affecting sleep? In recent years, he’s found that athletes are more willing to come forward sooner.
“It has been good in terms of helping student athletes speak up for themselves and to try and intervene earlier when they feel like things are getting out of control,” Dr. Miller said.
As in other aspects of life, disappointment is a part of sports. Handling those disappointments can help athletes develop skills they can use every day.
“What we’re talking about is the difference between a performance issue and a mental health issue,” Gillham said. “One can lead to the other and the other can be indicative of the other, right? It’s a chicken-and-egg sort of thing.”
One telling barometer is sleep, Gillham explained. Athletes need sleep to perform well. If they don’t get it, their performance may suffer. Alternatively, poor performance can increase anxiety and lead to problems sleeping.
“Do we need to have weighted blankets and lavender and self-talk meditation before bed so we sleep better?” Gillham asked. “Or do we need to solve the performance issue?”
Separating clinical mental health from what Gillham refers to as “applied performance issues” gets at the chicken/egg nature of mental health for athletes. For parents and coaches of young athletes, it’s advisable to be sensitive to changes in behavior in either case.
“You have to decide how much of it is normal,” Gillham said. “It is 100% normal to care about your performance. It’s normal to not want to disappoint your parents and it’s normal to want to do well for your coach. Those are all normal things.”
Performance pressure vs anxiety
The challenges of dealing with pressure can accumulate, both for those who are the best in the world and younger athletes dreaming of getting there.
“I think it’s very important to know there is pressure inherent in just about everything we do in life,” Dr. Miller said. “It’s part of our jobs, our school and certainly on the athletic field. How we choose to handle that pressure — what we choose to shape that into to motivate us — can determine our performance and also how our personalities and how our responses to stress develop.”
As a doctor for college student athletes, Dr. Miller has many conversations with people living busy lives. They may not initially realize the extent to which they’re taking on what can be a long list of responsibilities. What they may discover is that they’re not giving themselves enough credit for all the things they have going on.
“Once you recognize that, then it can become easier to identify the things that are priorities for you,” Dr. Miller said. “Step two is listing those priorities. What is most important? What are the things that you have to get done every day? What things are really important for you to have so that you can function within a healthy paradigm?”
Sometimes the stress of competition is just that — stress fueled by anxiety that is created by uncertainty. It is a common part of athletics at every level.
“There is an almost exact inverse relationship between anxiety and self-confidence,” Gillham said. “One goes up and the other goes down. Essentially, the brain can’t handle being really confident and freaked out about the same thing at the same time. So you have to pick one or the other. You’re either really confident you can do something or you’re really anxious.”
Coping skills for athletes
The options for Gillham in helping athletes are to teach skills that lower anxiety or teach those that build confidence. In either case, anxiety levels vary from athlete to athlete. What may be a toxic level for one might not move the needle for another.
“One might have sweaty palms and butterflies in the stomach and think, ‘Oh, I’m in trouble. This is going to be a rough day,’” Gillham said. “Another might have those exact same sweaty palms and butterflies in the belly and say, ‘This is game day, baby, I’m ready to go.’ And they’re dealing with the exact same data. They’re just interpreted very differently.”
Though the challenges are real for athletes and mental health, so are the benefits. Participation in sports, as researched by the Aspen Institute, leads to higher test scores early in life and lower health costs and reduced risk of heart disease, stroke, cancer and diabetes later in life. Most importantly in a mental health context, it leads to lower levels of depression and higher self-esteem as youth advance into adulthood.
“It’s not going to matter 50 years from now who wins this or that basketball game,” Dr. Miller said. “But knowing that you learned how to work within a team framework, knowing that you understood how to handle that pressure — that you were able to prioritize those things that were most important to you — those things are important. You can learn to put pressure into perspective so that you can use those same tools later in life.”
Where to find help
If you or a loved one need help, you have options at Sanford Health:
- Primary care provider. Start by scheduling a visit with your primary care provider to discuss your concerns and develop a personalized plan.
- Virtual behavioral health. Schedule an online visit with a licensed therapist or psychiatrist from the comfort and privacy of home.
- Behavioral health specialist. Find a provider who is specially trained to care for your specific mental health needs.
- Mental performance training. Schedule a session with a specialist who helps athletes, coaches and leaders develop and maintain a strong mental approach to their sport or profession.
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