Mental training in competitive sports – sports psychiatry and psychotherapy

The pursuit of athletic success leaves no room for showing weakness. The fear of failure, of stigmatization and the discipline to put one’s own needs behind are too great. At the same time, competitive athletes are affected by mental illnesses no less frequently than the rest of the population. Almost daily strenuous training sessions, the permanent focus on the next competition and the goal of being able to call up top performances very quickly become chronic stress factors. Possible consequences are depression, sleep or eating disorders, and anxiety disorders

When national goalkeeper Robert Enke committed suicide in 2009, it became even clearer to the public how the strict performance requirements can put professional athletes under pressure. This and other prominent examples were the starting signal for a rethink in dealing with mental illness in competitive sports. The birth of the field of sports psychiatry and psychotherapy.

Important: Due to the increasing competition and the ever higher performance in the sports sector, the importance of psychological skills is growing. As early as 1980, psychological variables were estimated to account for 20 to 45% of athletic performance.

What do sports psychiatry and psychotherapy want in competitive sports?

Training is often about overcoming one’s limits and ignoring signs of exhaustion. There is a fine line between achieving the optimal level of performance and protecting mental health at the same time. One might think that it is the athletes’ coaches who would be able to identify problems early on, however, it is these coaches who are often caught in role conflict (athletic goals and performance optimization). For this reason, athletes often do not consult a sports psychiatrist or psychotherapist until the condition begins to severely limit athletic performance

From that point on, the department’s mission is to identify and treat mental health crises and illnesses and to prevent them in the future. Thus, sports psychiatry is concerned both with how sport and exercise can be used as a therapeutic measure for mental illness and with the damaging effects of competitive sport on mental health. Through their work, sports psychiatrists and therapists aim to contribute to the following:

  • Acceptance, diagnostics and treatment of psychological stress in competitive sports.
  • Routine psychiatric examinations and consultations in athletic careers
  • Expansion of prevention options
  • Improvement of interdisciplinary cooperation between sports psychologists, medical doctors, mental coaches and physiotherapists
  • More acceptance of responsibility by athletes for their own mental health

Psychological and social stress

Playing competitive sports not only involves deciding to compete with others, but above all means competing against oneself every day. In most sports, intensive and systematic training now begins earlier and earlier, which is why athletes are already exposed to many stresses and strains at a prepubescent age. Aesthetic disciplines in particular have their peak performance in adolescence because of the body’s proportions.

The focus on physical performance not infrequently limits gaining experience in social and emotional areas. Athletes are also often surrounded purely by adult caregivers. These factors make them vulnerable to mental illness, especially in crisis situations and when their careers end suddenly. Per Mertesacker, who last played for Arsenal FC in London, reported his stresses as follows: “When I could no longer, I was injured, it was always like that. I even claim that many recurring injuries are psychological. That the body helps the soul to rest with it. But no one questions that”.

Moreover, athletes are exposed to high social expectations, especially when they achieve great success. Just imagine the decisive missed penalty kick at a European Championship, with millions of people watching. It is not uncommon for there to be verbal or physical attacks on athletes in such situations. The rapid alternation between adoration and disdain makes for a difficult-to-conciliate spectrum of feelings between grandiosity and feelings of inferiority.

The price of success is bought not least with a lack of a private life. Magdalena Neuner, a very successful biathlete even decided to end her sporting career at the age of just 24 in order to reclaim her life. Equally stressful can be declining physical abilities in old age and the awareness that the peak of one’s career has already been reached in the first third of one’s life.

Sport-specific mental disorders

Psychological disorders that are particularly common in competitive sports:

  • Sports anorexia: Weight loss and underweight serve an athletic performance advantage. Often observable in aesthetic sports such as figure skating, gymnastics, or rhythmic gymnastics.
  • Obesity Athletica: Increased body mass and a weight above the “athletic normal” are aimed at increasing strength or endurance. Examples can be found in Sumō wrestling or open water and long distance swimming.
  • Female athlete triad: symptom triad of an eating disorder, absence of menstruation, and osteoporosis due to inadequate energy and nutrient intake. Also clustered in aesthetic sports such as floor gymnastics, ballet, or endurance disciplines.
  • Sports bulimia: binge eating is followed by excessive exercise to exhaustion instead of vomiting to burn off the calories.
  • Dementia pugilistica: Differently pronounced functional disorder of the brain, which is based on frequent blows and concussions of the head. Boxers in particular are affected.
  • Sports addiction: Affected individuals feel the compulsion to play sports excessively, although the idea of competition or performance need not be the primary motive.
  • Depression due to overtraining syndrome: Lack of regeneration often results in a depressed mood, reduced drive, loss of interest and a variety of physical symptoms such as insomnia or appetite disorders.

Sports psychiatric and psychotherapeutic treatment

Psychiatric and psychotherapeutic treatment measures are largely based on the athletes’ training calendar and general conditions. However, the athlete’s entire coaching team should be involved and psychological recovery should be given more weight than athletic performance during the therapy period. This is often very difficult, but it is a basic requirement for recovery. As in any other therapeutic treatment, education and the establishment of a trusting relationship are the basic building blocks. Building on this, work can be done on how athletes deal with their limited physical performance.

Often, the psychological stress greatly reduces confidence in one’s own physical abilities. How much athletes should exercise during treatment always depends on the type and severity of the condition. It is not uncommon for athletes to report that symptoms such as listlessness, fatigue and anxiety disappear during training sessions and only reappear afterwards. Especially in sports psychotherapy, behavioral therapy is usually chosen because its problem-oriented approach with the training of new cognitive, emotional and behavioral strategies is similar to that of physical skills.

Long-term psychodynamic treatments are often chosen after the career ends. Rehabilitation periods after physical injuries or periods between competitions are also readily selected to gain more focus on therapy. It should be noted that not all medications can be used concomitantly due to doping regulations and side effects (weight gain, drowsiness, nausea, etc.).

Prevention options

Considering the challenging treatment in addition to the strict training schedule as well as the sporting and financial disadvantages for athletes and clubs, the prevention of mental illness should be a top priority. Suitable measures here are:

  • Constant monitoring and adjustment of playing rules, sports equipment and sports clothing (especially head protection).
  • An early education in adolescence about possible psychological stress and sensitization to signs of own disease.
  • An expansion of the range of stress management and resilience training courses on offer.
  • The introduction of regular sports psychiatry consultations as part of general medical examinations.
  • The provision of basic knowledge in sports psychiatry to professional groups involved in competitive sports, such as sports physicians, sports psychologists, physiotherapists and mental coaches.
  • Adequate counseling of parents (in the case of younger athletes) as important reference persons in the career.

The range of preventive action options shows that there are multiple options for action and improvement for mental health in competitive sports as well as an urgent need for action. It is the task of the entire sports system to work together in the future to better protect athletes and thus also ensure long-term guaranteed performance, since physical health goes hand in hand with mental health.


Markser, Valentin Z.; Bär, Karl-Jürgen: Mental health in competitive sports. Stuttgart, 2019

University of Zurich:, accessed May 27, 2022.

Categories: Therapy

Verena Klein
Author Verena Klein
"LIMES Schlosskliniken specializes in the treatment of mental and psychosomatic illnesses. With the help of the blog, we as a clinic group would like to examine the various mental illnesses in more detail and present different therapies as well as current topics."

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