Living with Anxiety

How to manage anxiety to get more from your training and recovery

“Go home and get some rest,” your coach tells you. You take a shower, the warm water streaming around you. This ordinarily might be soothing, a signal to your body that the workout is done and now it’s time to eat, rest and recover. But instead you are thinking about practice, analyzing what you did and worrying about your next competition. Will it be enough? Your stomach does a nervous flip. When you get home you eat something you’ve determined is the right thing to eat to maximize performance, but you second guess it after you’re done and you can’t decide if that was enough or too much. You try to watch a show you like, but you’re restless and distracted. When it’s time to sleep, you toss and turn, worrying you won’t get enough rest to be ready for tomorrow’s practice.

This may be a familiar experience for an athlete experiencing generalized anxiety disorder or someone who is just not maximizing their recovery. Some of the most disciplined and committed athletes are potentially more vulnerable to this experience, because anxiety and/or OCD can take these positive qualities and cause them to interfere with proper training and recovery, resulting in suboptimal performance.

Elite level athletes are managing a careful balance of training and recovery. Most training programs include a phase where you push yourself into the usual sensations of fatigue and muscle soreness, which is then followed by a recovery phase. During the recovery phase, the body undergoes physiological adaptations that allow you to do it again, the next time going a little further. Those cycles repeat over and over and when appropriately balanced, the result is a higher level of athletic performance.

How anxiety interferes with recovery

The key to being able to train hard is resting effectively. If you train hard and don’t get the benefit of the recovery phase, your body isn’t really undergoing as much adaptation as it could be and you aren’t likely to see great results. When you are training or competing, your body’s stress system, called the sympathetic nervous system, is activated, providing your body and mind with the energy it needs to push hard. When you are adequately recovering, your body’s parasympathetic system, or rest and digest system is activated. You might feel relaxed, cozy, drowsy and well-nourished. When you feel that way, you are completing a very important part of the training cycle that allows your body to adapt and become a better athlete.

A number of things can interfere with the activation of the rest and digest system, including chronic worry, ruminating, compulsive activity and rigid beliefs that interfere with the ability to relax. The key is to find ways of activating your parasympathetic system and removing any mental obstacles you might have preventing you from truly resting.

What can help

  • Adopt a recovery routine. Some examples of recovery could include mindfulness or meditation exercises, progressive muscle relaxation, taking an ice bath or hot shower, getting a massage, stretching, working with a foam roller, sauna, hot tub, gentle yoga, reading, listening to relaxing music, snuggling with a person or pet, or literally anything else that gives you a cozy feeling.
  • Keep track of your recovery activities in your training log. Many athletes track their mileage or performance during test sets or practices in a training log, but few keep track of their recovery activities in the same way. Tracking a behavior raises your awareness and commitment to it and can help you prioritize recovery. It can also provide you with information when you look back on your season and look at what did and didn’t work.
  • Change beliefs that contribute to chronic worry and prevent recovery. For example, it’s hard to relax when you are worried about how your workout went or how you might perform in the future. It’s easy to feel like worrying will somehow help your performance and that if you let it go for the day (or night) that you’re somehow letting go of control. Elite athletes are striving for their very best and it might feel as though accepting a disappointing performance is “giving in,” when in fact it’s just recovering so you can set yourself up for better next time. You may want to work with a cognitive behavioral therapist for assistance on this goal.
  • Resist compulsive urges. Some compulsions that might get in the way of recovery are things like double or triple (or more) checking that you have items you need, getting on the scale or checking the mirror repeatedly, indulging superstitions that you believe are linked to good performance, excessive mental rehearsal (rather than planned visualization) or purposefully spending a lot of time trying to “figure out” how to enhance your performance, rather than accepting that there is some degree of uncertainty that you can’t avoid. While a lot of these things may seem “normal” or pretty benign, they can feed an ongoing cycle that can keep your mind from relaxing, being present, enjoying other aspects of life and getting some rest. You may want to work with a therapist trained in exposure and response prevention (ERP) to help reduce compulsions, as it’s often easier said than done.

Having a disciplined mindset and a strong commitment to your sport are factors that can help an athlete achieve their best. Coaches and athletes can often focus on applying these concepts to the hard training phase, but not to the recovery phase. Working to engage your parasympathetic system and reduce anxiety during recovery can assist you in getting more out of your training and ultimately achieve better performance.

Jessica Kieras, PhD

Athletes and Substance Use

This content was originally published on the Galea Health website. Galea connects athletes with therapists and mental performance coaches who have worked extensively with athletes or were athletes themselves. We’re passionate about offering athletes access to holistic care, ranging from mental health to performance support. Alongside our provider network, Galea promotes mental health in athletics through blogs, resources, athlete stories, and our athlete advocate network.

Many athletes learn early on in their competitive careers that it’s worth making sacrifices to succeed in their sport, from waking up at the crack of dawn to missing friends’ birthday parties for morning practices and competitions. While the benefits associated with a competitive nature are plenty, this drive combined with the pressure to succeed, coping with injuries, or facing a difficult transition can cause athletes to seek relief and escape in substances. For some athletes, what starts as casual and controlled alcohol and drug use can lead to substance use disorder (formerly recognized as ‘substance abuse’) or addiction.

Substance use disorder and addiction are complicated issues, and especially in college, substance use and binge drinking are common and even encouraged behaviors. Based on research from the NCAA, student-athletes experience higher rates of heavy episodic drinking, “binge drinking,” than their non-athlete peers. Despite the prevalence of substance use disorders, it can be tough to spot when someone is struggling. Some student-athletes try to keep their substance use secretive to avoid drawing attention to their behavior. Some might not realize anything’s wrong because people around them are drinking heavily, it feels normal or expected to participate, and/or they believe it’s something they’ll kick as soon as they graduate. The misunderstanding that you can’t develop a substance use disorder or addiction while in college can keep athletes who are struggling from seeking help. Being aware of the signs and symptoms associated with substance use disorder can help you spot when you or your teammate might need support.

Symptoms and warning signs

The following are warning signs that someone might be struggling with their substance use (American Addiction Centers):

  • They talk about stopping their substance use but don’t follow through.
  • They lie about their substance use.
  • They are regularly getting drunk or using drugs.
  • They are becoming increasingly isolated and/or using drugs alone.
  • Most of their social activities involve drinking or using drugs.
  • They are experiencing memory loss or blackouts due to substance use and have a hard time remembering what happened the night before.
  • They seem increasingly irritable or depressed.
  • They are spending a significant amount of time recovering from the effects of drugs or alcohol.
  • They have an increased tolerance for alcohol or drugs.
  • They are unable to moderate their drug use.

Substance use is a complex issue, and you or your teammate do not need to experience all of these symptoms before seeking help — the earlier you reach out, the better. If you are concerned about, frustrated with, or curious about changing your substance use, it is worth reaching out to a doctor and/or mental health professional.

Types of substances and warning signs

The main types of substances athletes use include alcohol, performance enhancing drugs (PEDs), and artificial energy. While general warning signs including behavioral, emotional, or psychological changes might seem like obvious changes to note, specific warning signs can help you recognize when and with what type of substance someone might be struggling. Note that this is not an exhaustive list but rather some of the common substances and side effects.

Alcohol — Warning signs: Being irresponsible regarding commitments or responsibilities to school, sport and relationships; consuming alcohol in situations that are dangerous to themselves and others (NCAA).
Performance Enhancing Drugs (PEDs) — Anabolic steroids (often users of tobacco, alcohol, and illicit drugs), Androstenedione, Human Growth Hormone (HGH), Erythropoietin, diuretics, Creatine, stimulants. Warning signs: Severe mood swings, depression, violent tendencies, increased aggression, changes in body build (muscle growth, rapid weight gain, development of upper body), increased acne (Mayo Clinic).
Artificial energy — Amphetamine, cocaine, Ephedra, caffeine. Warning signs: shakiness, rapid speech or movements, difficulty sitting still, difficulty concentrating, lack of appetite, sleep disturbance, irritability (NCAA).
Marijuana/weed — Warning signs: red eyes, lethargy, apathy, anxiety, nervous or paranoid behavior, slowed or poor coordination, slowed reaction time, memory impairment, lack of motivation (NCAA).

High-risk times

Understanding when athletes are more susceptible to developing substance use disorders can help us provide support to those who are currently going through a tough time and also prevent others from struggling. Based on research conducted by the Gateway Foundation, those with mood and anxiety disorders are “twice as likely to struggle with a substance use disorder (SUD), and people with SUDs are about twice as likely as those without to have a mood or anxiety disorder.” Athletes might take to substances to alleviate symptoms of underlying mental health challenges. However, substance use ends up exacerbating the challenges they are trying to avoid/curb/keep at bay. In general, transitions are tricky times and can set an athlete who is predisposed to addiction down a tough path.

Injuries, especially head injuries and concussions, are incredibly difficult to deal with as an athlete, especially when an athlete’s identity is tied closely to their ability to play. Athletes might use painkillers to cope with their injuries, and these substances can serve as a gateway to other drugs. Athletes might also use painkillers to get through practice out of fear of being labeled as “injury prone” or out of fear of having their career end if they speak up about their injuries. Athletes can develop tolerance to painkillers and need to use more and more in order to feel the same amount of relief.

Off-season and retirement are particularly difficult times for athletes. The upheaval in routine, identity, and community can feel jarring and leave athletes struggling to find structure and fulfillment. Additionally, athletes are accustomed to the dopamine rush associated with exercising. When they leave sport, they might miss/have a tough time replicating this feeling, and, as a result, turn to drugs as a substitute (Michael’s House).

Athletes facing changes in their practice schedules and competition seasons due to COVID-19 are susceptible to many of the same challenges that athletes facing injuries, off-seasons, and retirements struggle with. More student-athletes are struggling with their mental health over the pandemic, and the lower activity levels, canceled seasons, as well as decreased sense of community might cause athletes to seek relief in substances.

Support & treatment

Seeking support for yourself or a teammate who is concerned about substance use requires help from a medical professional. The American Addiction Centers suggests treatment by providers trained to treat the medical, psychological, and performance aspects of this condition. While you can’t force someone to seek help, you can let them know you’re there to support them and guide them to resources and treatment once they feel ready. Free resources, such as Alcoholics Anonymous and school counseling centers, are available and great options for those looking for affordable and effective support options.

To help someone in recovery, educate yourself on the substance use disorders and the specific substance they were using, show your support by lending a listening ear or offering to drive them to treatment, and gather resources to share with them when they are ready to seek treatment (Gateway Foundation). By consistently checking in and letting them know you’re there for them, you are reminding them that they are not alone and that there is hope. Supporting someone in recovery can feel like a lot of responsibility, so make sure you’re taking care of yourself, too. Joining a support group for those with loved ones with a substance use disorder can be a great option. Al-Anon and Nar-Anon are free support groups for friends and family members supporting a loved one with drinking and drug challenges, and Alateen is a free support group for young people (13–18) with a friend or family member struggling with a substance use disorder. Due to Covid-19, these resources are offering online options for meetings, making them even more accessible.

Whether you’re concerned about your own substance use or the substance use of a teammate or loved one, know that there are resources and support available and you don’t have to go through this alone.

Free treatment and support resources:

IOCDF Lead Advocate Thomas Smalley Weight Training
Cali Werner running a marathon
Runner about to start a race