On fields, courts, tracks, and arenas everywhere athletes are pushing the limits of what the human body can do (and what their own bodies can do). But at what point does all of that pushing jeopardize an athlete’s mental and emotional health — or put them at risk for burnout or an injury?

Professional tennis player Naomi Osaka made headlines with her decision to prioritize her mental health and well-being and withdraw from the French Open earlier this year.

Olympic swimmer Michael Phelps has been open about battling his own mental health obstacles, which led to depression, suicidal thoughts, and multiple drunk-driving arrests. “I basically carried just about every negative emotion you can possibly carry along for 15, 20 years and I never talked about it,” he told Today in December 2017.

Cleveland Cavaliers player Kevin Love opened up about his own panic attack, and how the experience taught him he needs to pay more attention to his mental health in a 2018 essay on The Players’ Tribune:

“It was real — as real as a broken hand or a sprained ankle,” he said in the essay. “In the NBA, you have trained professionals to fine-tune your life in so many areas. Coaches, trainers, and nutritionists have had a presence in my life for years. But none of those people could help me in the way I needed when I was lying on the floor struggling to breathe,” he said.

Olympic runner Deena Kastor told her story of transforming vulnerability and fear of failure into a positive in her book Let Your Mind Run: A Memoir of Thinking My Way to Victory.

“It wasn’t until a decade and a half into the sport that I learned that disappointment didn't mean that I failed,” said Kastor. “It was so liberating.”

And she achieved more success in her sport as a result. It was after this mindset change that she became the first American woman to run a marathon in less than 2 hours and 20 minutes; and she became the first American woman to earn an Olympic medal in the marathon in two decades.

Athletes who spend hours a day training their bodies but don’t address the mental part of their game are missing an essential piece of the puzzle, says Tia Konzer, DO, a psychiatrist who specializes in sports psychology.

“There has been increased dialogue and awareness around mental health in the world of sports — and outside of it, which is a step in the right direction,” says Dr. Konzer, who serves on the advisory boards of two nonprofits that focus on supporting and raising awareness for student athlete mental health: The Hidden Opponent and Professionals Beyond the Game.

The COVID-19 pandemic, too, made all of us more aware of the fragility, and importance, of mental health, she says.

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To compete at a high level, athletes are taught to hone very specific skills, says Bradley Donohue, PhD, a psychology professor at University of Nevada in Las Vegas (UNLV).

“Athletes are so tuned into criticism,” he says. But this critique from coaches and teammates (that they need in order to improve in their sports) means they may be similarly tuned into criticism in other parts of their lives, which can lead to low self-esteem.

Stigmas surrounding mental health can be especially strong in athletes. They may feel that seeking therapy is a sign of weakness, or they may not able to seek on-campus counseling anonymously, adds Donahue, who competed in National Association of Police Athletic and Activities League boxing competitions during his college years.

A review published in May 2019 in the British Journal of Sports Medicine found that stigma is the number one reason athletes don’t seek the mental health help they need, according to 52 studies that collectively looked at more than 13,000 professional, Olympic, and collegiate- or university-level athletes across 71 different sports.

And then there’s the pressure.

Athletes are under a lot of pressure to push themselves rigorously during training day after day — and then perform at their very best as soon as the game, match, or race starts. That pressure gets amplified today thanks to technology and social media that connects the public with events happening everywhere, often in real-time, explains Lani Lawrence, PsyD, the director of wellness and clinical services and supervisor of player engagement and development for the New York Giants.

“Athletes from high school to professional teams are constantly living within a fishbowl,” she says. Thanks to social media, successes and failures are more public today than was the case for previous generations of athletes, she says. It used to be that mistakes were only witnessed by those in attendance, unless a competition was televised.

“Now, mistakes can be immediately uploaded, tweeted, placed on Instagram, Facebook, or Snapchat, where the individual and team can be ridiculed — all before they return home,” she says. “The pressure to succeed in this fishbowl, especially for athletes who have not developed effective coping skills, can be overwhelming.”

It’s easy to focus on weaknesses and losses as an athlete, as opposed to strengths and victories, Kastor says. For the vast majority of athletes, actual wins or first-place finishes are rare, while losses and second- or umpteenth-place finales are much more common. “It’s easy to stand in front of the mirror and find weaknesses,” Kastor says.

Feelings of "not measuring up" can be especially high in individual sports, adds Todd Wells, a cycling coach and former professional mountain bike racer in Durango, Colorado (who retired from the sport in 2017 at age 41). "One person wins and everyone else loses," he says.

The COVID-19 Pandemic Benched Everyone in Sports at the Same Time

The COVID-19 pandemic has led to challenges for all of us, including athletes. Many top tournaments, including the 2020 Olympics, were cancelled or postponed. “Some players got an extra year of eligibility, some missed their final seasons, and some realized they were on autopilot going down a path they were no longer satisfied with,” says Konzer. “It’s like everyone in sports was being benched or put on the injured list at the same time. No one knew what to do or how to handle it.”

“Handling it” for athletes meant figuring out new ways to train, be a team, and be ourselves, says Konzer. Sport, especially one that you devote a lot of time and energy to, can provide a sense of identity and it might be your coping mechanism to deal with other stressors. “That was ripped away,” Konzer says.

The NCAA published survey data in February 2021 from nearly 25,000 student athletes that revealed 27 percent of males and 51 percent of females reporting feeling overwhelmed either constantly or most every day. And 11 percent of males and 29 percent of females felt overwhelming anxiety. Mental health concerns were higher in women, student athletes of color, and people on the queer spectrum. In most areas that were surveyed, the rates of reported mental health concerns experienced by student athletes during the time of the survey were 1.5 to 2 times higher than have been historically reported in pre-pandemic studies, according to the report.

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While there’s still a ways to go when it comes to mental health awareness in sport, experts say it’s important to recognize that there is more attention being paid to it at all levels of participation now, than ever before.

“When I started in sports psychiatry over a decade ago, people didn’t want anyone to know that they were seeing me,” Konzer says. Now mental health professionals are often included on the staff of collegiate and professional teams, she adds.

The International Olympic Committee released a consensus statement in an effort to improve mental health among elite athletes. It was published in 2019 in the British Journal of Sports Medicine.

The NCAA published a report in 2014 to provide an overview for coaches, students, healthcare providers, and others about the mental health challenges student athletes face, and some best practices for addressing those challenges.

At UNLV, Dr. Donohue completed a five-year study investigating a new mental health approach that he helped design specifically for athletes, focusing on optimization of sports performance rather than pathology, disorders, or mental illness.

Called The Optimum Performance Program in Sports (TOPPS), the program recruits students who want to learn how to improve their sports performances by learning cognitive and behavioral skills. “It’s not about fixing anything; it’s about learning ways to gain an edge,” says Donohue, who designed the program.

Athletes and performance coaches identify aspects of their performance they struggle with (physically or mentally), and then find ways that changing their thoughts or behaviors could help them overcome them. If a basketball player feels paralyzed every time she steps up to the free-throw line, what’s causing it? Is it the anxiety that all eyes are on her? Is she self-conscious of the response of her teammates if she misses the shot?

"We explain how thoughts, behaviors, and feelings all have an influence on performance," he says. "[Athletes] can practice those skills just like any other skill in their sport."

And that goes for people of all physical activity levels.

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“I see more and more athletes going to see sports psychologists as a way to gain an edge,” says cycling coach Wells.

Konzer offers these suggestions for athletes of any level who want to up their mental game:

Set goals that are specific. While long-term goals, like running a marathon, are great, Konzer suggests having “bite-sized” goals, too. “Focus you want to accomplish on today’s run or workout. Write them out, tell a friend or coach, measure them, and celebrate,” she says.
Build awareness. Start paying attention to your thoughts during your workouts and performances. What’s your inner dialogue? For example, how do your thoughts and feelings change when you work out alone versus with a friend or when you’re in a different environment?
Determine the narrative. Once you’ve begun to recognize and track your thoughts and emotions, the next step is determining the narrative, says Konzer. “Thoughts aren’t facts. Begin to separate out what the indisputable facts are and what is just the story you’re telling yourself about that fact; you have the control and the power to affect change,” she says.
Find your "why." Remember when you fell in love with your sport and take yourself back to that time, suggests Konzer. “Your ‘why’ isn’t just for the love of the sport, it’s also for what you want to accomplish,” she says. If your "why" isn’t big enough, you won’t move out of your comfort zone to reach it, but if it’s so big it requires perfection, that won’t work either, she says. “Embrace your challenges and make them your own, but be kind to yourself,” she says.

With additional reporting by Becky Upham.

Can Getting Mentally Tough Up Your Game? In All Sports, the Answer Is Yes

Why Celebrating Where You’re at Can Be Tough When You’re Striving for More

The COVID-19 Pandemic Benched Everyone in Sports at the Same Time

How Can Coaches, Sports Leagues, and Trainers Do Better at Mental Health Training?

How to Work on Mental Toughness to Boost Your Personal Fitness