Olympic-level wisdom about addressing mental health

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Few people understand the mental pressures of being an Olympian the way sprinter Natasha Hastings does.

She endured thousands of hours of training to become one of the world's fastest women in the 400 meters. She has felt her heart beating fast and hard at the Olympic starting line as she anticipated the strain and pain she was about to inflict on herself. She knows the joy of being part of two gold-medal relay teams – and the shock of missing the team entirely.

At times, she was so focused on her sport that life became a blur. "I opened my passport one day, and I had all these stamps," she said. "And I was like, 'I don't remember going to these places.'"

As a former Olympian who openly discusses her own experiences with therapy, Hastings is part of a wave of elite athletes who have brought attention to mental health, with lessons that apply beyond sports.

Hastings took her interest further than most, becoming a licensed professional counselor. But even as she and celebrity Olympians such as gymnast Simone Biles and swimmer Michael Phelps have helped destigmatize the topic, the public conversation about mental health in athletes is really just beginning, said Dr. Julia Cawthra, a psychological services provider with the U.S. Olympic and Paralympic Committee, which has more than a dozen credentialed mental health experts to support Team USA athletes.

"I think that what we hear in the media, and what athletes are willing to share, is kind of like the tip of the iceberg," Cawthra said.

Athletes face many of the same mental health issues that non-athletes face, she said. Some also seek help for sports-related issues, either hoping to gain a performance edge or dealing with challenges such as the "twisties," a mental block that caused Biles, the most decorated gymnast of all time, to withdraw from several competitions in 2021.

Phelps, the most decorated Olympian of all time, has discussed getting therapy for anxiety, depression and having suicidal thoughts.

It's not clear whether athletes experience mental health issues at different levels from non-athletes. A review of research, published in the British Journal of Sports Medicine in 2019, found that mental health issues might be slightly higher in current and former elite athletes than in the general population. But a review published in the International Review of Sport and Exercise Psychology in 2022 found student athletes were at a similar or decreased risk for most mental health problems, though some showed higher levels anxiety, alcohol abuse, eating disorders and depression.

But some unique challenges for athletes are clear.

"There is an incredible amount of pressure," said Hastings, and it goes beyond the desire to win for the sake of winning.

Young athletes might see sports as a way to pay for an education or even lift a family out of poverty. At the Olympics, each runner knows, "if I don't leave here with a medal, I could potentially be dropped from my shoe sponsor, or they could cut my salary," Hastings said.

Cawthra said that while elite athletes in all sports feel pressure, the expectations for Olympians and Paralympians, who represent the entire nation and get only one shot at winning every four years, are at another level.

Pressure can be helpful, Cawthra said, if it helps someone shed distractions. But hyperfocus also can lead an athlete to think, "This is the only thing that matters." For winners, that means a medal can be validating, but those who miss the cut might deal with feelings of, "What a waste of my life."

Non-athletes also deal with disappointment, Cawthra said, although "not all of us are having to display that in front of the world." Still, she said, non-athletes can benefit from some of the same approaches that help Olympians.

The first is understanding that mental health is like any aspect of health – it requires attention before it becomes a crisis.

Addressing mental health isn't necessarily fixing something that's broken, Cawthra said. It can be about optimizing what you have. She quotes a colleague who taught her, "We don't have to be sick to get better."

The best treatment will vary by person and condition, Cawthra said.

If the issue is dealing with pressure, she might help someone reframe how they view their goals. For an Olympic athlete, that might mean shifting their focus away from winning a medal, because that's not within their control.

Instead, Cawthra might help them see their job not as winning, but to be "focusing on my routine, staying connected with my teammates or being present in the moment and not getting too caught up in what's about to happen."

She also helps athletes manage the hype around their Olympic moment. A lot of times, someone will feel like they have to do something special to rise to the occasion, she said, "when in reality, if they do their normal, that's all that's needed. Because trying to do too much is just as dangerous as not doing enough."

A non-athlete also can benefit from those same lessons, she said. "It really is about identifying what is within your control and maintaining a focus on that versus getting caught up in an outcome or comparing yourself to somebody."

It's also important to accept help, she said. Cawthra was a college volleyball player herself when she learned this lesson from a sport psychologist.

At the time, she was a perfectionist – something common in high-achieving athletes and non-athletes alike, she said. "And if it's not exactly right, then it's a failure."

But she learned that it was OK to try, fail, learn from the experience and try again. The psychologist "opened my eyes to the fact that you don't have to do any of that alone. Sometimes it takes a team effort to get where you're trying to go. It's not always about pushing and grinding and optimizing. Sometimes it's about giving yourself a little bit of a break."

Hastings' own encounter with a mental health professional had dramatic results – and broader lessons about mental health.

In the early phase of her track career, she said, a focus on hard work paid off. She was part of the gold medal-winning 400-meter relay team at the Beijing Games in 2008, and she fully expected to represent the U.S. in London in 2012.

Instead, she failed to qualify. "In hindsight, I realize that I probably pushed myself to some unhealthy limits."

A sport psychologist helped her learn to be less judgmental of herself and shift her focus from self-criticism and the pain involved in each race to being more optimistic.

"Changing my language toward myself really helped me to improve my confidence," Hastings said. The next year, she became U.S. champion in the 400 meters. Among her many subsequent victories, she was part of the gold-medal relay team at the 2016 Summer Olympics in Rio de Janeiro, where she ran the fastest split of the race.

Working in the mental health and performance department at the University of South Carolina in Columbia, plus a small private practice, her job often is to help people understand that whatever mental health issue they are dealing with is normal.

Like many of her clients, Hastings initially worked with a psychologist to improve her performance and learned lessons that have improved all aspects of her life. "I would say about 80% of what we talked about had nothing to do with track." She's also had therapy to help with other aspects of her life, which includes the challenges of being a single parent to her 4-year-old son. (Famously, she resumed training six weeks after he was born in 2019.)

Athletes often need help seeing themselves as complete humans, Hastings said. Yes, they need to know how to perform to the best of their ability, but they also need to have answers for, "Are you secure in who you are? Do you know who you are? Can you manage your anxiety or your depression or your ADHD? It's far more than just what you do out there on the field."

Not every athlete needs a psychologist, Cawthra said. "We have different pillars of wellness that are equally as important (as therapy), like physical fitness, nutrition, sleep, community, friends, relationships," and the like.

But for those who want professional help, she suggested getting recommendations from friends or starting with your health insurance provider. Online locators also can help.

Hastings said that a simple online search could work. "Be specific about what it is that you think you need help for," she said. And if you don't feel a connection, try someone else.

The 988 Suicide & Crisis Lifeline, which connects people in crisis with suicide prevention and mental health counselors, can be reached by calling or texting 988 or by chat at 988lifeline.org.

As a therapist, Hastings tells people that taking care of mental health requires the same sort of dedication an athlete gives to their physical health. "You have to practice this the same way that you practice going out to whatever sport it is that you play. It's not just going to happen in the therapy room."

The Paris Olympics opening ceremony is Friday, with the Paralympic Games kicking off Aug. 28. The International Olympic Committee and International Paralympic Committee have set up a mental health helpline in 70 languages. It will be available to all Olympians and Paralympians during the Games and for the next four years. In addition, the Olympic Village will have a relaxation and mindfulness area for athletes.

Olympians' physical achievements can make them seem other-worldly. But they're not so different when it comes to dealing with mental health, Hastings said.

"I think every athlete, if you listen to our stories, it's all very relatable," she said, because "at the end of the day, we're all still human beings trying to figure this life out."