Assisting Athletes With Anxiety on Game Day

May 5, 2020 by Elizabeth Quinn

Editor’s note: In honor of Mental Health Month, NATA is conducting a weekly mental health blog series throughout May to examine different facets of this topic and how they impact athletic trainers and their patients. This week’s article focuses on how athletic trainers can work with sports psychologists to help athletes with anxiety on game days.

It’s almost game time and you notice one of your athletes is a little off. They might be feeling apprehensive or powerless or have a sense of impending danger, panic or doom. Do they have an increased heart rate? Are they breathing rapidly, sweating, trembling and/or feeling weak or tired? According to the National Collegiate Athletic Association (NCAA), the athlete could be dealing with an anxiety disorder. The NCAA found that 85 percent of athletic trainers believe anxiety disorders are an issue with student athletes on their campus. Sometimes, that anxiety is heightened prior to a game as there are different triggers for many types of anxiety.

Chris Carr, PhD, HSPP, CMPC, sport psychologist at Ascension St. Vincent Sports Performance, has worked for more than 30 years with athletes at all levels of competition. He has seen firsthand how anxiety can affect an athlete before a game.

“Anxiety is a normal and expected composure at games and practice,” Carr said. “Every athlete has some sort of anxiety response to a competitive environment. That’s why, often times, athletes have a routine. Then they go to a bigger game and that intensity is very different from what they experience, which can be a fatiguing factor than impacts them.”

There are two parts to anxiety, Carr said: physiological and cognitive. The physiological aspect includes increased heart rate, increased muscle tension, arteries enhancing or over-aroused physio state, he said. The cognitive part refers to the mental thoughts associated with anxiety.

“A good athlete trains their mental health, just like their physical health,” Carr said. “So, if an athlete is training their mental health, it’s easier to manage it in a competitive moment. Athletes who are not training mentally, the best course to stay mentally healthy during an anxious situation is to help them slow down, focus on slow breaths, anchor cues to focus on to allow them to breath slowly, calmly, in deep breaths.

“Because a hyper arousal state can be a panic state. It can be fatiguing, so prior to competition, they are already fatigued. Also have athletes focus on controllable aspects of performance, such as focusing on the next play or how they feel when they hit a good shot or swing.”

Although anxiety disorders, which affect one-third of adolescents, according to the Centers for Disease Control and Prevention, can be debilitating, Carr recommends keeping the following skills in an athlete’s toolbox:

  • Relaxation
  • Self-control
  • Mindfulness

“Mindfulness is a therapeutic concept where individuals use semantic techniques, relaxation techniques, intentional techniques to focus less on the distraction and more on the calming cues,” Carr said.

“It’s geared toward the relaxation status where pulse, respiration is at a calm and functional level. Athletes have a hectic pace in life, and then they are trying to find any time to slow everything down to gain composure to get their body and mind still. Mindfulness has been found to have positive effects on stress management.”

Carr said when looking at an athlete’s holistic health care, leaving out mental and behavioral health is only treating part of the person. As a sports psychologist, Carr, who recently has been named as the director of performance psychology/team behavioral health clinician for the Green Bay Packers, has been integrated into sports medicine teams to assist in this specific part of health care. The role of sports psychologist has gained more popularity, he said, as sports medicine has seen an increased focus on mental and behavioral health.

In fact, Carr has worked with athletic trainers for a majority of his career as the health care professionals work in tandem with one another for holistic health. A consensus statement published in 2013 is especially important for athletic trainers to review, Carr said. The statement outlines how sports psychologists and other disciplines can come together to identify an athlete’s mental health.

“Not having a sports psychologist integrated as part of the team is like a leaving a wound unattended and becoming infected,” Carr said. “It wouldn’t be fair to a wound [or athlete].”

Athletic trainers have an integral role to incorporating sports psychologists into the athlete’s health care team to treat the athlete holistically, physically and mentally, Carr said.