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  • Sarah Pospos, MD, MS

How to Overcome Performance Anxiety in Sports

Updated: Apr 24, 2023

Do you struggle to perform at the highest level in the brightest light? Is your coach noticing a decline in your athletic performance? Are your symptoms getting in the way of your training, relationships, personal life, or daily responsibilities?

As a sports psychiatrist and former student athlete, I’ll help you recognize sport-related performance anxiety symptoms and look at its treatment, including knowing when to see a sports psychiatrist, so you don’t have to suffer alone.

Sport-Related Performance Anxiety Symptoms

Feeling anxious before or during a competition is very normal and can even improve your performance. However, if you’re extremely anxious to the point that it deters your performance, then it may be time to seek help.

In general, anxiety is your mind trying to protect you from any perceived threats. In this case, those threats may include the possibility of failure (or success) or losing control of your body when you’re tired, which makes you lose focus without even realizing it.

Your mind may unconsciously use these self-defeating behaviors to cope:

  • Pacing

  • Too much or too little warm-up

  • Not being attentive to your form

Panic attacks are not uncommon. It’s described as a sudden rush of intense fear or discomfort that comes out of the blue, often accompanied with:

  • Heart racing, trembling, or sweating

  • Feeling like you are choking or having trouble catching your breath

  • Feeling sick to your stomach

  • Feeling dizzy and light-headed

  • Feeling hot or having chills

  • Numbness or tingling in your fingers or feet

  • Feeling like you are in a dream or you are outside of yourself watching

  • Fear that you are going crazy, might lose control, or might die

Treatment for Sports-related Performance Anxiety

With milder symptoms, you may consider a specific type of therapy called Cognitive Behavioral Therapy (CBT). CBT aims to identify and address our distorted thinking patterns, which will in turn affect our feelings, behaviors, and outcomes.

You may also consider some relaxation techniques, including meditation, deep breathing, and visualization:

  • Sit down with your eyes closed

  • Slowly and intentionally breathe with your belly/diaphragm. Count to 6 as you inhale, 6 as you pause, 6 as you exhale, and repeat the process several times

  • When your mind wanders, bring your attention back to your breathing

  • Visualize the big game

  • Observe what variables impact your anxiety level (the crowd, the chanting, etc.)

  • When self-defeating images pop up, bring your attention back to your breathing

  • Replace negative self-talk with positive thoughts (e.g., “I did, I can, I will”)

  • Use those verbal or other cues (e.g., clap loudly once) to reset and refocus

Click here for more relaxation techniques.


When to See a Psychiatrist for Anxiety

If sport-related performance anxiety interferes with your training, athletic performance, relationships, or daily responsibilities, more help is needed.

Psychiatrists are specialized medical doctors who require at least 12 years in higher education and 15,000 hours of clinical training before being allowed to independently diagnose, treat, or prescribe medications. In comparison, nurse practitioners (NP) require 500 clinical hours (typically supervised by a medical doctor); and physician assistants (PA) require 2,000 clinical hours. Sports psychiatrists are psychiatrists with specialized training who have in-depth understanding of the nuances when diagnosing, treating, or prescribing medications for athletes.

One major hesitation for athletes is inadvertently taking medication that negatively impacts their athletic performance or is classified as a "performance enhancer" and is prohibited in their sport. For example, propranolol is a common medication for performance anxiety. However, it can also lessen tremors and improve fine motor control, and therefore is prohibited at all times in archery and shooting, and in competitions for golf, automobile, billiards, darts, and some skiing, snowboarding, or underwater sports.

As a sports psychiatrist and former student athlete, I believe that every patient is different, and my recommendations are always made on a case-by-case analysis. If together we determine that medication is beneficial, I’ll walk you through different options, thoroughly explaining risks, benefits, alternatives and potential side effects, so you can be fully informed and content with the next steps. My Masters Degrees in Psychopharmacology and Applied Psychology add even more insight on all things medication and human behavior.

Your mental health is as important as your physical health. Book a free 15-minute initial phone call to reach your full potential without suffering alone.

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