Mental Health and Skills for Sports Performance, with Dr. Justin Ross

By Chris Carmichael,
Founder and Head Coach of CTS

When I was an elite athlete and even during the early years of my career as a coach, too little attention was paid to sports psychology, both in terms of how we could apply it to enhance performance and in terms of the ways harsh coaching and training practices affected athletes psychologically. Those were more archaic times that rewarded athletes who could shoulder enormous pressure without being taught psychological skills for coping and thriving. Regretfully, I think the severe practices from those times prevented many gifted athletes from achieving their full potential. That’s why sports psychology is a significant focus within the CTS Coaching College and our Coaching Continuing Education Program.

Recently, we brought Dr. Justin Ross, PsyD., in to lead a continuing education session. Dr. Ross is a licensed clinical psychologist specializing in athlete mental health and performance – addressing issues such as anxiety, depression, disordered eating, insomnia, and stress to developing high performance sport psychology skills on the chosen field of play and managing the psychological impact of injury or transition in sport. He has been a longstanding resource for CTS Coaches, works with athletes of all ages and abilities, and is vetted as a psychologist for the NBA and NFL players associations.

Following the session, I asked Dr. Ross for his insights on a wide range of topics I think time-crunched and age-group athletes should know more about, including the connection between mental health and sports performance, the role of exercise in the prevention and treatment of depression, and how to effectively deal with pre-race jitters. I hope you find Dr. Ross’s responses as valuable as I have.

Q: The connection between mental health and sports performance was a hot topic in 2021 with Naomi Osaka withdrawing from the French Open and Simone Biles withdrawing from some Olympic events. What can age group and amateur athletes learn from the challenges experienced by elite athletes?

Dr. Ross: I always like to start with the tagline, “There is no health without mental health. And optimal performance demands both.” Not being an athlete at their level, it’s practically impossible for me (or most of us for that matter) to know what either of these athletes may have been experiencing with the eyes of the world watching their every move. But we do know that both Naomi Osaka and Simone Biles have brought significant attention to the role the mind plays in performance while competing on the world stage. And I think there are parallel takeaways we can all learn from them. First and foremost, we are all human. We often look at amazement with what elite and professional athletes can do in their specific sport. And we often can fall into a belief that those extraordinary athletic abilities channel into extraordinary psychological abilities to somehow not experience pressure or anxiety as it relates to competition. We need deep alignment between our minds and bodies in so many ways in order to perform at our peak. This requires a unique confluence of psychological factors that simultaneously includes trust, confidence, focus, concentration, control, and a deep belief that we will be ok should we fall short of our goals. And it takes a tremendous amount of personal awareness and courage to be able to raise your hand and say that you’re not in the right state of mind and need some help.

Exercise can improve mood and reduce stress, and during the pandemic many people turned to exercise for these reasons, but we also see people perhaps overestimating the idea that exercise is all you need to cure or prevent depression. What is your view on the role exercise can or should play in the treatment for or prevention of depression?

Dr. Ross: There is compelling data that shows exercise to not only be a treatment strategy but also a preventative mechanism for depression. Researchers are still theorizing on all the various components that make movement such a powerful influencer on our wellbeing and mental health, from neurological changes that include increasing serotonin and dopamine levels and releasing endorphins and endocannabinoids to physiological changes such as reduced oxidative stress markers and neuronal regeneration and growth in the brain. There are certainly psychological variables that occur with exercise, and importantly, regular exercise as well, that include shifting perception, increasing a sense of empowerment, willingness to endure discomfort, improved self-esteem and self-worth, and commitment to goals. If depression is the paucity of hope, then exercise is an actionable, daily habit that helps shift the perception of “I can’t” to “I can.” Mental health requires a deep belief that we are capable and worthy – and a daily habit of training helps us tap into each of those in profound ways. That internal, psychological struggle alone can see significant shifts thorough consistent exercise. But I also caution statements I hear far too often such as, “Running is my therapy” or “movement is my  medicine.” While certainly anecdotally true, exercise alone is not a replacement for professional mental health help.

In a coaching education presentation to CTS Coaches, you talked about the “3 Pillars of Anxiety” (Uncertainty, Lack of control, Threat to something of value). If people recognize those pillars in aspects of their lives or training, how do you recommend they start addressing their anxiety?

Dr. Ross: Anxiety is one of, if not the most common psychological ailment we all experience, both in sport and life. Anxiety first and foremost is a human experience connected to not being sure what is about to happen and not feeling as though we have control over ourselves or the outcome. It is human tendency to want to either solve the problems underneath anxiety or to push the experience away, as it can be quite unpleasant in both mind and body. But I’m a big believer that there is another, likely more powerful, way we can work through anxiety. It requires that we look for, develop, and capture trust.

Trust is the biggest psychological antidote we have for anxiety. To build trust we must believe we have capability in the present moment to take an actionable step towards health, safety, or control. The deeper layer of trust I call the “no matter what” clause – getting to a point where you believe that no matter what, regardless of outcome, that you will be okay.

Last, but not least, we all need to learn the power of breathing for emotional regulation. Evidence shows that a single minute of deep rhythmic breathing can help us move from the sympathetic nervous system (i.e. the fight or flight response) to the parasympathetic nervous system (sometime referred to as the rest and digest system).

Something that doesn’t get enough attention in elite sports is the turmoil some athletes face when they either retire or their careers end unexpectedly. Having worked with athletes through that extreme transition, what lessons can “regular people” experiencing transitions in their lives (i.e., becoming a parent, changing career, starting/ending marriage, retiring, dealing with a life-changing illness or injury) learn from your experiences?

Dr. Ross: Transitions are hard! They demand we work through letting go of one identity and work towards developing another. Elite and professional athletes who have spent their entire lives surrounded with sport will often develop a very deep athletic identity and really struggle with the transition out of sport, especially if the choice is forced upon them. “Regular people” are prone to the exact same psychological challenges through other types of life transitions. One of the more common experiences for the adult amateur athlete is working through an injury and needing to take off to rest, recover, or heal.

Any transition that is forced upon us is going to feel more psychologically impactful than one we get to choose for ourselves. So, recognize that as you go into those transitions and allow yourself time to grieve if needed. Loss is the greatest driver of sadness we have as human beings. We need to give ourselves permission to feel sad about losing key aspects of our identity or how we spend our time. The balance is allowing the sadness to be felt but not allowing it to take over all parts of our lives. That sometimes proves tricky to navigate.

We have a lot of conversations with athletes about pre-event and pre-race jitters. Although each athlete is unique, are there some techniques you’d recommend athletes try to implement?

Dr. Ross: First, give yourself permission to feel anxious pre-event. That experience is 100% normal and shows that you care about your performance. Second, recognize that you have tremendous power over regulating your experiences in mind and body, but that regulation needs to include not trying to get rid of or push anxiety away (that almost never works). This process starts with coming back to a breath practice­–again the reminder here is 1 minute of slow, deep, rhythmic breathing helps to reduce the stress/anxiety response in the body. I think we have all heard the advice “trust your training” as a common refrain. Although I like the sentiment, I believe we need to be more specific. I’ll recommend athletes work through 3 key aspects of trust. Another reminder: trust is the greatest antidote to anxiety we have in our lives.

First, trust your most recent training cycle. Look back at the training you put into this event’s preparation–remind yourself of the volume, the intensity, the hours, and the times you showed up with mental toughness. Go back over your training journal and find those key workouts.

Next, find key elements of what you know and trust to be true in your career as an athlete. Look back at the other races/events your prepared for, and the collective training and racing experiences you’ve endured to remind yourself of your strength as an athlete more broadly.

Finally, look at your life with a wider lens and remind yourself of the amount of adversity, hardship, and difficulty you’ve faced in your life as a human being. None of us has gotten to this point in life unphased, and it’s important to remind ourselves just how strong we’ve been in the human element.

The more you can remind yourself of what to trust from this current training block, your career in athletics, and those key elements throughout your life–while practicing deep breathing–the more likely you’ll be to balance out the pre-race jitters.