Burnout or Depression? Understanding the Unique Mental Health Needs of Athletes

Published September 20, 2016

By Marina Galante
University of Nevada, Las Vegas

Athletes as a Special Population

Mental illness affects approximately 61.5 million Americans each year; despite this, mental health continues to carry negative stigma that interferes with proper treatment and effective care (National Alliance on Mental Illness, 2013). This is especially true for athlete populations. Athletic culture and a self-help mentality lead athletes to seek treatment less often and reject treatments at higher rates than non-athletes (Watson, 2005). Oftentimes, mental illness in athletes goes underdiagnosed. Thus, athletes should be considered a special population with needs unique from non-athlete counterparts (Beauchemin, 2014; Etzel & Watson, 2007).

Burnout VS. Depression

Depression in athletes is specifically underdiagnosed. Part of this issue stems from the similarities between Major Depressive Disorder (MDD) and Burnout. Major Depressive Disorder involves either depressed mood or loss of interest/pleasure in nearly all activities for a period of at least 2 weeks; this also involves other symptoms like changes in sleep, appetite, energy, and concentration (American Psychiatric Association, 2013). Overtraining or burnout in athletes can involve almost identical symptoms. These similarities provide difficulties for practitioners working with athletes; awareness of these similarities is vital for appropriate referrals, care, and competence in treatment. 

Common Symptoms of BOTH Depression and Burnout

  • Fatigue
  • Lack of motivation/energy
  • Irritability
  • Feeling discouraged
  • Difficulty sleeping
  • Difficulty maintaining responsibilities
  • Denial or avoidance to seek treatment
  • Inadequate or reduced coping skills

Differences in Depression and Burnout

  • Role Dysfunction: Inability to fulfill designated roles in work, school, or sport
    • Burnout involves role dysfunction in athletic performance
    • Depression involves role dysfunction of social, cognitive, and work settings
    • For athletes, role dysfunction may occur in all domains
  • Duration
    • Burnout: Anywhere from 1 week onward
      • Typically resolved with rest
    • MDD: Minimum of 2 weeks
      • Not resolved with rest


Awareness and insight into this issue among professionals is crucial to ensure comprehensive and ethical care of athletes. AASP Certified Consultants are encouraged to develop a vast and comprehensive referral network, including physicians, psychologists, athletic trainers, and coaches. Further, programs that adapt interventions to consider athlete culture are essential to meet the current needs of athletes regarding both mental health and performance programming. These discussions are vitally important to the promotion of athlete health and well-being.


National Institute of Mental Health http://www.nimh.nih.gov/health/publications/depression-easy-to-read/index.shtml
American Psychological Association Division 12; Find therapists in your area http://www.div12.org/
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.   
Beauchemin, J. (2014). College student-athlete wellness: An integrative outreach model. College Student Journal, 48(2), 268-280.
Etzel, E., & Watson, J. C. (2007). Ethical challenges for psychological consultations in intercollegiate athletics. Journal of Clinical Sport Psychology, 1, 304-317.
National Alliance on Mental Illness. (2013). Mental illness facts and numbers. Retrieved from http://www2.nami.org/factsheets/mentalillness_factsheet.pdf
Reardon, C. L., & Factor, R. M. (2010). Sport psychiatry: A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Medicine, 40(11), 961-980.
Schwenk, T. L. (2000). The stigmatization and denial of mental illness in athletes. British Journal of Sports Medicine, 34(1), 4-5.
Watson, J. C. (2005). College student-athletes’ attitudes toward help-seeking behavior and expectations of counseling services. Journal of College Student Development, 46(4), 442-449.

Published in: Athletes, Mental Health

Managing Emotions in Sport

Published September 6, 2016

By Dr. Andrew Friesen


There is no construct of human psychology and functioning more prevalent in sport than emotion. Mood, emotions, and general affect can influence every movement in every sport. Consider a typical 45 second shift in ice hockey. Within those brief 45 seconds, the player might begin the shift with high confidence (“I’m going to have a strong shift!”), receive the puck and skate in on the opposing goal with high excitement (“I’m going to shoot high glove side and score!”), get poke-checked by an opposing player inducing feelings of frustration (“That was a missed opportunity”) and guilt (“I could have really helped out my team”), back-check and makes a good defensive play which raises the player’s pride (“I helped my team by showing hustle and foiling the opposition”), and finally, end in a  scrum in front of the net where there is much shoving with opposing players where the player takes a spear to the midsection that the referee misses inducing anger (“I can’t stand that creep!”). Six different emotions within 45 seconds and each emotion will have the potential to help or hinder the player’s performance.

Effectively managing emotions then becomes an important skillset for every athlete. Emotion regulation means the use of strategies to initiate, maintain, modify, or display emotions (Gross & Thompson, 2007). This means that any attempt to change how long an emotion lasts, how intensely you feel the emotion, or what you are actually feeling is an attempt at emotion regulation. Further, emotion regulation isn’t just about changing how you feel, but can also involve changing the emotion’s action response (i.e., avoidance or confrontation) and physiological responses (e.g., facial expression or breathing patterns).

Emotion regulation: A family affair

There are literally hundreds of different emotion regulation strategies. James Gross (1998) has identified five families of emotion regulation. Each can be used in sport:

  • Situation Selection: An athlete can modify their emotions by selecting which situation to engage in. For example, a skier who is nervous about re-aggravating an injury might choose to skip a race in order to calm themselves. Goal-setting can act as a type of “situation selection” in that it can help ensure the athlete remains in desired and intended situations. 
  • Situation Modification: Once dedicated to the situation, the athlete can change some aspect of it to manage their emotions. For example, a figure skater who is nervous about a specific element might perform a modified version of the element at a lower difficulty in order to feel more confident about the whole performance. Consistently doing performance debriefs can help an athlete reflect on what potential tactics are available based on anticipated situations.
  • Attentional Deployment: An athlete can also choose what aspect of the situation to focus on (and/or ignore). For example, a volleyball player worried about the impending outcome of the game might choose to focus on specific aspects of the next serve-receive to shut out distracting thoughts about the outcome. Focus strategies that have primed the athlete about what is in, and out of, the athlete’s control can be an effective tool here.
  • Cognitive Change: An athlete can choose what meaning or perspective to have about any situation. For example, a basketball player who is happy with her performance in the first half of a game might remind herself that “there’s still another half to play” in order to maintain a high and focused intensity. Given the strong link between appraisals and emotions, self-talk (that is, the things we say to ourselves either out loud or in our head) is an essential tool for effective cognitive change.
  • Response Modulation (Suppression): After an athlete has experienced an emotion, he or she can try to alter the emotional response (behavioral, physical, or physiological). For example, a baseball player who strikes out can hide feelings of frustration by resisting the urge to curse or toss the bat. Having visualized potential “if-then” plans to employ based on anticipated emotional responses can be an effective tool in this circumstance.  

Each emotion has the potential to either help or hinder performance. Identifying which emotions do what in any given circumstance is the first step to learning how to manage emotions. Once this has been accomplished, athletes can begin to identify and practice emotion regulation strategies that are both effective and are likely to be employed based on the athlete’s ability and personality as well as the confines of the sport.

Gross, J. J. (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology, 2(3), 271-299. doi:10.1037/1089-2680.2.3.271
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp.3–24). New York, NY: Guilford Press.

Published in: Coaches, Athletes, Performance Psychology, Mental Skills Training

Freaked-out Kids in Sports: Keys to Stress Reduction

Published August 23, 2016

Frank L. Smoll photo

By Frank L. Smoll
Department of Psychology, University of Washington

Frank L. Smoll is Professor of Psychology at the University of Washington. He received his Ph.D. from the University of Wisconsin. Dr. Smoll’s research focuses on coaching behaviors in youth sports and on the psychological effects of competition on children and adolescents. He has published more than 135 scientific articles and book chapters, and he is coauthor of 22 books and manuals on children’s athletics. Professor Smoll is a fellow of the American Psychological Association, the Association for Applied Sport Psychology (AASP), and the National Academy of Kinesiology. In 2002, he was the recipient of AASP’s Distinguished Professional Practice Award. Dr. Smoll has extensive experience in conducting psychologically oriented coaching clinics and workshops for parents of young athletes.

A 20-year trend in youth sports emphasizes teaching coaches how to create a healthy psychological environment for their athletes. However, there’s also an important need to educate parents, so they can support and supplement what trained coaches are trying to do.

How do parents unintentionally become a source of stress for young athletes?

All parents identify with their children to some extent and thus want them to do well. Unfortunately, in some cases, the degree of identification becomes excessive, and the child becomes an extension of the parent’s ego. When parents over-identify with their child’s sport performance, they begin to define their own self-worth in terms of their son’s or daughter’s successes or failures.

A father who is a “frustrated jock” may seek to experience through his child the success he never knew as an athlete. A parent who was a star may be resentful and rejecting if the child does not attain a similar level of achievement. Some parents thus become “winners” or “losers” through their children, and the pressure placed on the children can be extreme. The child must succeed, or the parent’s self-image is threatened. When parental love and approval depend on how well their children perform, sports are bound to be stressful.

What can adults do to help combat performance anxiety?

Coaches and parents are in an ideal position to help young athletes develop healthy attitudes about achievement and an ability to tolerate setbacks when they occur. In fact, a study conducted with my colleagues, indicates that by educating coaches and parents, they can effectively reduce athletes’ competitive anxiety (Smoll, Smith, & Cumming, 2007). Our research demonstrated the combined effectiveness of two adult-education programs.

What were the research methods?

The 151 participants were 84 boys and 67 girls, who played in two different basketball leagues. The average age of the athletes was 11.6 years. Coaches in one league (an experimental group) participated in a Mastery Approach to Coaching workshop that we developed. The workshop content emphasized skill development, achieving personal and team success, giving maximum effort, and having fun (see Smoll & Smith, 2015).

Additionally, parents of youngsters in the experimental league participated in a Mastery Approach to Parenting in Sports workshop (see Smoll & Smith, 2012). The program taught them how to apply mastery principles and how to reduce performance anxiety in their children. Coaches and parents in the second league (a control group) were not offered either of the workshops.

What were the results?

Pre-season questionnaires showed little difference in the levels of performance anxiety among the youngsters in the two leagues. However, by the end of the season, athletes playing for trained coaches and whose parents attended the Mastery Approach workshop reported that their levels of stress, worry, and concentration disruption on the court had decreased. Players in the other league reported that their anxiety had increased over the course of the season.

What was learned?

The evidence indicated that a combined education approach helped coaches and parents to create a mastery-oriented climate. In regard to this, we never ignore the importance of winning, because it’s an important objective in all sports. But with a Mastery Approach, winning is placed in a healthy perspective. As a result, young athletes exposed to the mastery climate had less worries about their performance, and they were better able to concentrate while playing.

A core component of the Mastery Approach is a conception of success as giving maximum effort and becoming the best one can be. Coaches and parents are thus encouraged to adopt a four-part philosophy of winning (Smoll & Smith, 2012, pp. 29-32):

  1. Winning isn’t everything, nor is it the only thing. Young athletes can’t get the most out of sports if they think that the only objective is to beat their opponents. As noted above, winning is an important goal, but it’s not the most important objective.
  2. Failure is not the same thing as losing. It’s important that athletes don’t view losing as a sign of failure or as a threat to their personal value.
  3. Success isn’t equivalent to winning. Neither success nor failure need depend on the outcome of a contest or on a won-loss record. Winning and losing pertain to the outcome of a contest, whereas success and failure do not.
  4. Athletes should be taught that success is found in striving for victory (that is, success is related to commitment and effort). Athletes should be taught that they are never “losers” if they give maximum effort.

Fear of failure is an athlete’s worst enemy, and sport competition can easily create this type of anxiety. The encouraging thing is that educational programs for coaches and parents can give them the tools for decreasing pressure and increasing enjoyment. And an added bonus is that athletes who are not afraid of failure typically perform better. When coaches and parents are taught stress-reduction principles, they can be a winning combination for kids.

How can you get online training in the Mastery Approach?

To facilitate distribution of the workshops, the research-based coach and parent programs have been converted to video format. To find out more about the Mastery Approach, go to the Youth Enrichment in Sports website (http://www.y-e-sports.org).

Smoll, F. L., & Smith, R. E. (2012). Parenting young athletes: Developing champions in sports and life. Lanham, MD: Rowman & Littlefield.
Smoll, F. L., & Smith, R. E. (2015). Conducting evidence based coach-training programs: A social-cognitive approach. In J. M. Williams & V. Krane (Eds.), Applied sport psychology: Personal growth to peak performance (7th ed., pp. 359-382). New York: McGraw-Hill.
Smoll, F. L., Smith, R. E., & Cumming, S. P. (2007, Summer). Effects of coach and parent training on performance anxiety in young athletes: A systemic approach. Journal of Youth Development, 2. Article 0701FA002. http://www.nae4ha.org/directory/jyd/index.html

Published in: Coaches, Athletes, Parents & Youth Sport

“The Ripples Are Big”: Storying the Impact of Doping in Sport Beyond the Sanctioned Athlete

Published August 9, 2016

Dr. Kelsey Erickson photo

By Dr. Kelsey Erickson
Leeds Beckett University

Kelsey Erickson recently completed her Ph.D. at Leeds Beckett University (UK), which was partially funded by the International Athletics Foundation. She has now commenced a two-year postdoctoral research position funded by the International Olympic Committee (IOC) in cooperation with Leeds Beckett University. The project, an extension of her doctoral research, will involve designing, implementing and evaluating an intervention to promote Clean Sport within university student-athlete populations in the US, UK and Canada.

Recent doping allegations within track and field include systemic doping (e.g. Russian Athletics), corrupt administration (e.g. the International Association of Athletics Federation; IAAF), and leaked personal data.  No doubt, it is an issue currently affecting a number of individuals, organizations and nations.  While the sport scrambles to recover from the growing list of condemning allegations, the athletes are increasingly drawn into the conversation(s).  However, one group of athletes has been noticeably overlooked - the self-declared ‘clean athletes’ who have been personally impacted by others’ doping behaviors.  Meanwhile, their experiences and perspectives have the potential to shed important (and novel) light on the supposedly far-reaching and endemic nature of doping in track and field.

By collecting the stories of elite track and field athletes who have been personally affected by others’ use of performance enhancing drugs (PEDs), two stories were created depicting their unique lived experiences.  The first story, ‘Nobody saw it coming’, tells the story of the current competitive athletes: “I mean, I’m doing my sport for the same reasons I chose to do it when I was age seven – I always believed I could get to the top in my sport if I worked hard and did my best. I’ve just presumed everybody else was doing it for those reasons too. Well, I was wrong. Doping has affected me and my results. A lot… I could’ve been the best in the world but I was never told.’”

In the second story, ‘I’ve got scars’, the retired athletes relate their experiences: “You go through a period when you wonder ‘what’s the point?’… I think I was very angry and bitter that a guy cheated me out of my livelihood, cheated me out of places, cheated me out of maybe an opportunity to stand on the podium. Well actually, not just one athlete – a lot of athletes….. I do look back and wonder ‘what if?’”

The stories themselves offer unique insights into the widespread (and currently undocumented) impact of doping in sport.  In particular, they detail financial, emotional, and relational implications stemming from others’ use of PEDs.  Critically, the impact is not ephemeral; the retired athletes detailed the long-term implications of their experiences.  Meanwhile, the current competitive athletes suggest that given the current state of sport, they regularly have to defend their status as ‘clean athletes’.  Thus, the ripples of doping in sport appear to be far reaching and enduring.

The published paper is available to you for free by clicking here.

I invite you to read the paper, and then give yourself time to reflect on it.  The following is the reaction the stories triggered in me.  The process of creating these stories will certainly inform my research and practice going forward.  

What kind of reaction do the stories trigger for you?

“When an athlete breaks the rules by using PEDs, fellow athletes regularly miss out on prize and endorsement money, as well as losing opportunities for public recognition and glory”.

The quote above is a sentence that I originally wrote into the rationale for this research.  At the time, these seemed like really negative implications of PED use for fellow athletes. However, during the first interview I quickly realized how naïve I was.  I walked away from that experience with so many more concerns and questions.  Certainly the tangible losses (money, medals, glory, etc.) associated with being impacted by PED use must be devastating, but what does that actually feel like?  How long do the emotions last? What are the long-term implications of the losses?  Do you ever get over it? After just one interview I was acutely aware of how simplistic my understanding was regarding the potential implications of PED use in sport.  The emotional and long-term implications of being affected by PEDs are so much greater than I had ever considered.

Now months after conducting the interviews that shaped these stories, I still find myself reflecting on things my participants said.  I regularly make random comments to the people in my office, my friends, family; anyone who will listen really. The implications of doping for fellow athletes are severe.  The not knowing, always wondering; the ‘what ifs?’ and ‘if only’.  For the active athletes, they still have a chance to change things; their careers are not over.  Conversely, for the retired athletes there is nothing left for them to do but try and accept what has happened and be proud of what they managed to accomplish despite the circumstances.  That is tough.  I cannot imagine looking back on my career and wondering what could have and might have happened ‘if only’.  The worst part is, the ‘if only’ was (and is) out of their control. There is likely nothing they could have or would have done differently; rather, it’s something that the PED using athlete would/could have done different.  What would have happened then?  How different might their situation be now?  Chances are, they’ll never know.  I can’t imagine what that feels like.  However, I’m grateful that I’ve had a chance to offer these athletes (hopefully!) an opportunity to try and convey just that; what it feels like.  Also, I feel compelled to continue providing this opportunity.

Thank you to the International Athletics Foundation for helping fund the research.  Thank you as well to my participants for trusting me with your stories.  It is an honor.     

Kelsey Erickson, PhD
Research Fellow
Institute of Sport, Physical Activity and Leisure
Leeds Beckett University
United Kingdom
Twitter: @kelslee777

Published in: Athletes, Health & Fitness

Changing the Game

Published January 15, 2016

By Stephanie C. Coakley

"The player is on the clock from the day he arrives in the NFL. He's not thinking about what's going to happen when he exits. He's thinking that the fun has just begun."
-- Troy Vincent, EVP of Football Operations NFL, Former NFL player

Every professional football player will one day have to come to grips with the reality that they have played their final down, made their last tackle or kicked their last field goal.  It’s inevitable!  At that point, life as they know it will change - dramatically.  In the absence of football, they will have to find another way to provide for their family, and be productive, contributing members of society. 

This moment is the official beginning of the sport-career transition, and for many it can be terrifying, confusing….and humbling.   The onset of the sport-career transition can cause an athlete to question everything about their identity - past and present. Very quickly, most athletes realize that they have failed to adequately prepare for this stage in their personal and professional development.   Legendary basketball coach John Wooden held the belief that “failure to plan is like planning to fail”.  Developing a plan for the sport-career transition is a vital part of professional development for professional athletes.  Later we will discuss how to construct a plan, so that when they embark on the sport-career transition they do more than just survive – they thrive!

Athletes cope with the sport-career transition in various ways, typically falling into one of three categories. The most successful are those athletes who have prepared for life after the game.  They paid attention when they were told that the average career is 3.5 years, and that NFL stands for “Not for Long”!  At some point during their playing days they deliberately started taking action in preparation for the end of their career.  They established connections in the field that they eventually want to pursue.  They completed their undergraduate degree, or worked toward a graduate degree or certification, even while playing professional football.  They took advantage of internships, career boot camps and shadowing opportunities to gain exposure and experience in their chosen field. They involved their spouse or other support systems in developing a detailed plan to navigate the financial, social and emotional changes that lay ahead. These athletes did their due diligence and it paid off.  For them, the sport-career transition was a challenge, and like all the other challenges that they faced during their career, they trained in advance and were prepared.

A second group of athletes are those who gave some consideration to life after the game, but failed to make any concrete preparations.  Athletes who fall into this category often struggle in the sport-career transition because they are searching for the “what’s next”, while in the midst of the “what’s next”.   It like learning to swim after the boat that you were on has capsized. They may experience multiple failed business ventures, often falling prey to unscrupulous people who take advantage of them at this vulnerable time.  With unprecedented free time, and no plan in place, they are at great risk for engaging in unproductive activities and destructive behaviors.   As a result of the failures, poor decision-making and other post-career obstacles, these athletes can find themselves in a slump from which it may take years to emerge. 

The third category of athletes is those who refused to acknowledge that their football careers will end.  Whether out of denial, a desire to focus solely on football, or a fear of losing their competitive edge, these athletes made no plans for restructuring their lives after the game.  When these athletes do retire, the dramatic changes that occur cause them to feel overwhelmed and ill-equipped to cope.  Athletes in this third category are at greatest risk for major adjustment issues during the sport-career transition, and are likely to experience difficulty in many domains of life - physical, emotional, family, social, career, and spiritual.  The failure to plan can lead to a total crisis that can take years to resolve.

Contemporary sport-career transition research suggests that developing a concrete plan is highly associated with favorable sport-career transition outcomes, and greater satisfaction with life for former professional athletes.  Developing a plan for the sport-career transition is a multi-step process, featuring three important elements: acceptance, autonomy, and approach.   

Acceptance that a career is in fact over is the first important element of a successful sport-career transition. There is an undeniable sense of loss when an athlete retires from the NFL.  Kubler-Ross’ stages of grief and loss have been useful when explaining the various stages that retiring athletes may go through, including denial, anger, bargaining, depression and acceptance.  Only during the acceptance stage does the athlete come to terms with the reality of his situation, and only after acceptance can he move on.  The time that it takes to successfully make the transition to another career or interest can be mitigated therefore if an athlete acknowledges two facts early on: one, that his career will one day end, and two, that the athlete is unlikely to find anything else to compare with that feeling of being a professional athlete – the competition, camaraderie, income or the intoxicating surge of adrenalin that stems from playing at the highest level of the sport.  Early acceptance of these two facts allows an athlete to explore other opportunities during the off-season.

Embracing the concept of autonomy is another important element of the sport-career transition.  According to Daniel Pink, the author of Drive: the Surprising Truth about What Motivates Us, human beings have an innate need for autonomy.   The life of a professional football player is many things, but autonomous is not one of them.   So much of a professional athlete’s life is coordinated by others, and the ability to make major life decisions is practically non–existent. Contractual obligations, salary caps, team needs and coaching decisions determine the city in which an athlete will live; the position that he will play; the money that he will be paid, and more. For the vast majority of football players, even the decision to end a career is made by someone else.  The sport-career transition, therefore, is the perfect opportunity to satisfy our innate need for autonomy; it is up to the athlete to decide what to do next.  Exercising autonomy has a tendency to create intrinsic motivation, and intrinsically motivated people achieve more and have greater satisfaction with life.   

Finally, an athlete’s approach to the sport-career transition is important. The first step is to decide on a potential career, academic goal, or other interests, and then to determine how this can be achieved. There are a variety of methods available.  One approach is to enroll in an online class or degree completion program.  There are numerous resources, including the NFL’s Player Engagement Department, the NFLPA or the Trust, available to assist those players with a concrete plan for the sport-career transition when the time comes. The NFL organizes career boot camps during the off-season where athletes can gain valuable experience in fields such as coaching, music, broadcasting, business and franchising. In addition, there are list serves and blogs to subscribe to, and professional social networks such as LinkedIn that are helpful tools to learn and meet people with similar interests.  Finally, conversing openly about the process with a spouse, mentor, or career coach is an important part of an athlete’s approach to sport-career transition. Navigating the sport-career transition is a team sport – just like football!

The sport-career transition is sure to be a time of at least moderate upheaval in any athlete’s life.  Preparation is a winning strategy to ease the severity and length of the adjustment period, and this preparation can and should be initiated during the athlete’s career.  Acceptance, autonomy and a measured approach are important elements of the process; factors which can, and do, facilitate a smooth and successful sport-career transition.

About the Author
Stephany C. Coakley, PhD, LPC, CC-AASP
Director/Founder - Maximum Mental Training Associates (MMTA) LLC
Mental Strength and Conditioning Coach
Twitter: @BAForceofNature

Published in: Athletes

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