Therapy For Athletes in San Francisco, CA

Athletes are often perceived as strong, confident individuals who excel under pressure. The reality is that many athletes grapple with anxiety, pressure to perform, scrutiny from others, career dissatisfaction, setbacks from injuries, and even harassment or abuse throughout their athletic journeys (Reardon, Gorczynski, Hainline, Hitchcock, Rice, 2024). These challenges can manifest in various forms of anxiety throughout our stages of life. For those who have experienced a major injury, it can feel like the entire world has turned upside down. 

Even in the absence of injury, competitive sports environments can be intense and demanding, triggering anxiety at different stages—from training and practice to getting to the starting line of a race or competitive event. This anxiety can stem from the pressure to perform consistently, fear of failure or injury, or the expectation of meeting (and fear of not measuring up to) personal and team goals.

For those who identify as an athlete, and for those who simply love the outdoors, the anticipation and stakes of building a lifestyle around being highly active can lead to heightened anxiety. While many active folks consider physical activity to be the element that keeps them fit and happy, physical signs of heightened stress on the body can include fluctuations in heart rate or heart palpitations, GI distress, inconsistent sleep, muscle tension and tightness that can trigger new fears, and even panic attacks. These physiological responses are the body's natural reaction to stress, but can affect performance and overall well-being if not managed effectively.

Whether it’s prepping for a long run, or getting ready for a day of cycling, climbing, swimming, or a longer backpacking trip with friends, anxiety in active folks can also impact their mental game. Overthinking plays a significant role, with athletes often dwelling on past mistakes or worrying excessively about future outcomes. This cognitive burden can cloud concentration, disrupt focus, and undermine confidence—affecting performance in critical moments. From my years playing basketball, water polo, and as a swimmer, I know how much a negative or fear-based mindset can impact the performance of the entire team.

Active folks can also experience social anxiety among peers or in thinking about new opportunities for cross-training, feeling pressure to fit in or meet expectations. Perfectionism can set in at the thought of being at the back of the pack or of being perceived as slowing everyone else down. This social dimension of anxiety can further complicate our overall experience and sense of belonging in the community. Many athletes refuse to try something new until they feel “good enough” to show up. The solitude of a demanding training block can also amplify feelings of vulnerability and isolation and can negatively impact our relationships, which can be detrimental to our mental health.

As a trail runner, I’m familiar with the impact of fear and anxiety. The pressure to stay focused and consistent through various technical terrains, maintain stamina over long distances, and surpass previous achievements can intensify stress and self-doubt. Overthinking trail conditions, pacing and fueling strategies, and how competitors are holding up at any given moment can consume valuable mental energy and detract from the enjoyment of the experience. The demanding nature of maintaining a highly active lifestyle—juggling training schedules, recovery routines, and daily responsibilities—can contribute to stress and overwhelm. Balancing physical exertion with adequate rest and recovery is crucial for optimal performance and for reducing the risk of injury, yet perfectionism or fear of falling short can intensify anxiety.

Recognizing and addressing anxiety is crucial for active folks to perform at their best and maintain mental resilience and longevity. Those who are going through a major injury are managing different stressors and risk of isolation as they recover. Whether or not you identify as an athlete, I can support you in exploring and managing your anxiety, developing effective coping strategies, strengthening your mindset through mindfulness and visualization, and fostering a healthier relationship with your sport.

Reardon CL, Gorczynski P, Hainline B, Hitchcock M, Rice S. Anxiety Disorders in Athletes. Clin Sports Med. 2024 Jan;43(1):33-52. doi: 10.1016/j.csm.2023.06.002. Epub 2023 Jul 11. PMID: 37949513.)