Anxiety Therapy for Athletes: Managing Pressure and Performance
Pressure is part of sport. It gets athletes out of bed for a 6 a.m. Lift and keeps a sprinter pushing through the final meters. The same pressure can also knot a stomach, tighten a throat, and turn finely tuned mechanics into something that looks foreign. I have coached and treated athletes who can knock down shots all week in practice, then during the game feel as if their hands belong to someone else. The difference isn’t effort. It is physiology, attention, and the way the brain tags threat.
Good therapy for athletes is not about “relaxing” or eliminating nerves. It is about changing the relationship to arousal so that intensity becomes a resource instead of a saboteur. It is about training attention, resolving old injuries the nervous system still treats as danger, and building routines that generalize from Tuesday practice to championship Sunday.
Why pressure in sport feels different
Sport adds moving parts that a standard office presentation doesn’t. The body is the instrument, and micro-changes in muscle tension or breath depth shift timing and feel. Athletes also compete on a public stage. The scoreboard keeps a running judgment, and careers are short. That combination triggers the brain’s threat systems even when the athlete is technically safe. The body reads fast heartbeats and shallow breathing as warning, attention narrows to threat cues, and automatic skills move from the cerebellum into conscious control. A pitcher who now “thinks” about his release point has already lost tempo.
There is also the hidden workload. Travel disrupts sleep by 60 to 120 minutes per night on road trips for many teams. Minor dehydration, even one to two percent body weight, raises perceived exertion. Small injuries create protective muscle guarding that an athlete stops noticing. Over months, this background noise primes anxiety.
How performance anxiety shows up
Performance anxiety rarely announces itself with the word “anxiety.” It looks like hesitation out of the blocks, second guessing a play call, rushed breathing between points, or a sudden need for perfect conditions before pulling the trigger. Athletes often report:
- a body that feels too light or too heavy
- “high chest” breathing and tight intercostals
- over-focusing on outcome or on tiny mechanical details
- intrusive what if images during quiet moments
- a drop in sleep quality, especially wake ups at 3 to 4 a.m.
I once worked with a goalkeeper who could train for 90 minutes with flow, then, under lights, feel as if his peripheral vision collapsed. Nothing about his reaction was irrational. He had taken a hard collision the season before, stayed in the match, and never processed the shock. His system tagged night games with threat. Once we treated the stored injury response and built a warm up that expanded gaze and breath, his “tunnel” cleared.
The arousal-performance curve, without the myth
Coaches often cite the Yerkes-Dodson curve: performance rises with arousal to a point, then drops. The curve is real in spirit but misleading in practice. The location of the peak is individual and context dependent. A middle-distance runner may perform best with heart rate at 120 to 140 during introductions, while a golfer might need 80 to 100. The peak also shifts with fatigue, nutrition, and confidence. A big part of anxiety therapy is helping athletes feel and manipulate their own curve: noticing when arousal is too low and they feel flat, or too high and they feel jittery.
Breath is the most accessible lever. Slow nasal breathing at six breaths per minute, roughly five seconds in and five seconds out, can increase heart rate variability within two to three minutes. A brief up-regulating burst, such as 10 to 20 seconds of fast nasal breathing or a few explosive exhales, can wake up a sluggish nervous system. The trick is matching the state to the sport and the moment.
What therapy adds that coaching cannot
Great coaching tackles mechanics, strategy, and accountability. Therapy adds mastery of internal states. In practice this looks like:
- building body literacy so athletes can name and adjust internal cues before they avalanche
- treating stored physiological threat responses from injuries or humiliating performances
- training attention control so an athlete can shift from threat scanning to task focus on command
- aligning self-talk with action, not false positivity
Cognitive and behavioral techniques do matter. For a tennis player who spirals after a double fault, we might anchor a reset script with a physical cue: bounce, breath, gaze to the back fence, one sentence that narrows focus to the next serve target. Repeating that same sequence in practice until it is boring is the point. Under pressure, the body executes what it has overlearned.
Acceptance and Commitment Therapy maps well to sport because it reframes discomfort as a passenger, not a problem to fix right now. The thought I might choke is allowed to ride shotgun. The hands still pick a spot, the body still swings. That separation restores choice.
Biofeedback turns the invisible visible. Hooking an athlete to a simple heart rate variability monitor and letting them watch how breath pacing changes the heart rhythm is often more powerful than any lecture. Five to eight sessions are enough for most to self-regulate without the device.
Somatic approaches and why brainspotting helps under lights
Talk therapy alone often stalls when the nervous system is the bottleneck. Many athletes can describe what is happening, but their body keeps firing the same alarm. Somatic methods work from the body up. Brainspotting is particularly well suited to athletes because it accesses stored activation using eye position and precise attention, often with far less cognitive load than recounting the entire injury or failure narrative.
In a typical brainspotting session, we identify an activation target, such as the moment before release when a basketball player feels her chest clamp. We track where in the body that sensation lives and test eye positions that intensify or ease the felt sense. Holding the “spot” with a gentle gaze while the athlete mindfully notices body sensations allows the nervous system to process, often with tremors, warmth, or waves of relief. It looks subtle from the outside. Inside, previously stuck survival responses loosen. Many athletes report that the same cue in competition no longer spikes them, or that they can recover within a breath or two.
Compared to EMDR, another effective trauma therapy, brainspotting can feel less structured and more attuned to micro-shifts in performance states. EMDR follows a set sequence of bilateral stimulation and cognition. Brainspotting can be integrated more easily into sport contexts, such as brief sessions during rehab or in the week before an event, because it does not require reciting a long narrative and can zero in on the somatic edge.
Trauma in sport is common, even if no one uses the word
Trauma therapy belongs in sport not only for athletes with obvious histories, but for the “minor” hits and humiliations that leave a residue. A freshman gymnast who falls twice on beam at her first meet and sobs under the bleachers may tell herself to toughen up. Her nervous system learns a different rule: beam equals exposure and danger. A linebacker who plays through a stinger and loses grip strength for a week files the experience away as grit. His body records electric pain and a near miss. Over a season, he flinches a hair early on contact. Multiply small events across years, and you have a system predisposed to threat activation under stress.
Good trauma therapy for athletes sticks to the body, pacing, and function. We do not need a confessional. We need to find the loops that hijack performance and discharge them. When we do, anxiety drops not because the athlete repeats soothing mantras, but because the body stops overestimating risk.
The perfectionist trap, and what replaces it
Many high performers grow up praised for being the hardest worker in the room. Perfectionism initially looks like an advantage. Then the athlete reaches a level where mistakes are non-negotiable features of competition. Trying not to miss paradoxically increases misses. The mind searches for the perfect feeling, and the body tightens.
Here attention training helps. Rather than control every sensation, we pick controllables that matter at that moment: visual target, rhythm, and one technical cue that reflects an external focus. An archer thinks “expand through the clicker,” not “keep scapula down.” A pitcher thinks “tunnel to the glove logo,” not “don’t yank the front shoulder.” External focus widens the attentional field. Muscle recruitment cleans up without micromanagement.
Depression hides behind grind
Anxiety and depression mingle in athletes more often than many realize. When a season ends, the daily scaffolding of practices, film, and treatment vanishes. If their identity rests entirely on performance, the drop can feel like falling through a trapdoor. Depression therapy in this context is practical. We start with sleep regularity and sunlight within an hour of waking. We rebuild routine around values beyond the sport, often two to three anchors a day that persist year round. We screen for under-fueling and iron deficiency, since both can mimic low mood and apathy. If a past concussion lingers, we collaborate with a sports neurologist because vestibular issues can look like anxiety or depression when the real problem is sensory mismatch.
Talk therapy targets the shame loops that follow a slump or injury. “If I am not starting, I am nothing” is a heavy thought that seems logical under stress. We test it against evidence, but we also help athletes tolerate the hollow feeling without sprinting back to numbing behaviors. Over weeks, meaning widens, and the sport fits inside a larger life.
When to look for therapy instead of just more reps
Coaches are a first line. Teammates are a lifeline. If anxiety persists despite good coaching and reasonable rest, therapy closes gaps that reps cannot. Warning signs that suggest a focused intervention is worth the time and cost include:
- repeated breakdowns under pressure after successful practice reps
- intrusive memories or body jolts tied to a past injury or event
- rising avoidance of situations that used to be routine, such as specific drills or venues
- sleep disruption two to four nights per week tied to performance worries
- reliance on “perfect prep” rituals that keep growing in length or complexity
A therapist who knows sport will spell out the plan, expected number of sessions, and how progress will be measured. For many performance-focused cases, six to twelve sessions, with a review at session four, creates a meaningful shift. Complex histories or active trauma might need longer work or a phased approach.
The case for intensive therapy blocks in season and off season
Standard weekly therapy fits most schedules, but athletes often need flexible formats. Intensive therapy can compress progress into two to four half-days, especially during bye weeks or off season windows. The structure allows deep somatic work like brainspotting or EMDR without the stop-start of 50 minute slots. It also enables on-field or on-court integration, such as rehearsing the reset sequence at the venue where anxiety spikes.
Intensive therapy is not a magical fix. It works best when the athlete and therapist have a clear target, such as resolving the body’s response to a specific injury or shoring up a pre-competition routine that keeps collapsing. After an intensive, we schedule brief follow ups, 20 to 30 minutes, to keep gains sticky.
Building a performance reset you can trust
On competition day, athletes do not need a dozen tools. They need a simple sequence that survives adrenaline. The following compact routine works across sports with minor tweaks for position and timing. Practice it precisely during training so it becomes the brain’s default under pressure.
- plant the feet and feel contact points, ten seconds
- take three slow nasal breaths, five seconds in and five out, with a soft belly
- widen gaze to the environment, find three non-threatening details in the periphery
- name one external cue that matters for the next action
- execute, then do a micro-check: did I follow the plan, yes or no
Each step is built for crowded, noisy environments. The physiology matters. Feeling the feet lowers the center of mass and grounds proprioception. Slow breathing raises vagal tone. Widened gaze interrupts threat tunnel. The external cue pulls attention out of rumination. The micro-check avoids analysis mid-play, yet collects feedback after.
Travel, rehab, and other predictable stressors
Travel multiplies anxiety: early buses, late meals, different beds. Two habits blunt most of the impact. First, keep wake time constant within 60 to 90 minutes across time zones when possible. The body tolerates bedtime drift better than wake time drift. Second, decide your wind-down kit in advance. A 10 minute contrast shower, two minutes of box breathing at four by four by four by four, and a light snack with complex carbs can be enough to cue sleep even when the circadian clock is off by hours.
Rehab adds its own mental load. Athletes worry about falling behind, and the quiet of the training room leaves more space for fear. Good rehab integrates graded exposure not just to physical loads, but to the moments that trigger anxiety. A wide receiver returning from an ACL might feel fine sprinting straight, then freeze at the thought of a hard plant and cut. We assign https://jsbin.com/xudiyixico a hierarchy of cuts, under supervision, paired with breath and gaze resets, and we sprinkle in brainspotting for the body’s protective flinch. Done right, the athlete’s confidence rises one notch ahead of capacity, not behind it.
Working with coaches and staff without oversharing
Privacy matters. The best arrangements set clear boundaries. With the athlete’s consent, I share two to three functional targets with coaches, such as “we are anchoring a between-plays reset” or “we are resolving body guarding from last year’s shoulder subluxation,” along with simple ways to support the work, like adding 10 second pause windows in certain drills. I do not share personal history unless the athlete asks me to, and even then we stick to the minimum necessary.
Strength and conditioning coaches are invaluable allies. They control a massive portion of an athlete’s weekly arousal. Swapping a late-week high-intensity lift for submaximal tempo sets before a road game can pull an anxious athlete back into the sweet spot without losing adaptation.
What progress looks like, by the numbers and by feel
Athletes like metrics. So do I. Early wins often show up as:
- faster recovery between spikes of anxiety, measured in breaths rather than minutes
- heart rate variability nudging up three to five points on average across a week
- fewer pre-competition bathroom trips or urge surges
- sleep efficiency improving by 5 to 10 percent, even if total duration changes little
- subjective ratings shifting from “panicky” to “amped but clear”
Feel matters too. One linebacker told me, after four sessions that mixed brainspotting with attention training, “I still get lit up before kickoff, but it feels like electricity I can steer.” That is the quality we want, not sedation. A gymnast said, “The beam looks the same size again.” Often the sport gets quiet in the head, even when the arena is loud.
Edge cases and cautions
Beta blockers can help with tremor in precision sports, but they are banned in many disciplines and blunt adaptation if used as a crutch. Short acting benzodiazepines reliably reduce subjective anxiety and reliably harm coordination and reaction time. If medication is on the table, partner with a sports physician and test effects well away from competition.
Mindfulness gets sold as a cure-all. It is powerful for many, but for athletes with prominent trauma histories, eyes-closed body scans can spike distress. Start with eyes-open, movement-based attention, like mindful walking or gaze anchoring, then expand as tolerance grows.
Beware superstition disguised as routine. A five step reset is good. A 25 minute ritual that must be performed in a specific bathroom stall is a trap. The line is simple: if the routine makes the athlete more flexible across contexts, keep it. If it narrows options, strip it back.
When the season ends, keep the gains
Anxiety is state and trait. You can lower the volume but not erase the wiring. Off season is the time to deepen the work. For some, an intensive therapy block targets the last stubborn triggers. For others, broadening identity is the main job. Volunteer coaching twice a week, a community class that has nothing to do with sport, a regular hike with no GPS watch - these are not luxuries. They are buffers that make next season’s stress easier to carry.
Finally, keep one micro-skill sharp: a two minute breath and gaze reset practiced daily, not just when overwhelmed. Skill degrades without reps. Two minutes is short enough to do after brushing teeth or before a lift. Athletes maintain hips and shoulders with mobility. Maintain the nervous system the same way.
A brief, honest checklist for getting started
If you recognize yourself in these descriptions, the right next step is smaller than you think. Pick one of the following and commit for two weeks. Do not stack all of them at once.
- one daily two minute breath practice at six breaths per minute, eyes open
- one practice block per day where you insert your reset after every rep, no exceptions
- one 45 minute consult with a therapist experienced in brainspotting or other somatic work to map triggers
- one conversation with a coach to align on a single external focus cue during pressure moments
- one travel wind-down kit that you repeat on every away trip
The aim is not to eliminate nerves. It is to convert arousal into usable energy and to recover quickly when you tip over the line. Anxiety therapy, trauma therapy, targeted depression therapy when needed, and, in the right cases, intensive therapy blocks, are not admissions of weakness. They are part of modern performance. The nervous system is trainable. With the right tools and a bit of stubbornness, athletes can feel pressure, channel it, and compete with clarity when it counts.
Phone: 650-387-2578
Website: https://www.drkatrinakwan.com/
Hours:
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Monday: 9:00 AM - 6:30 PM
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Wednesday: 9:00 AM - 4:30 PM
Thursday: 9:00 AM - 4:00 PM
Friday: Closed
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Dr. Katrina Kwan, Licensed Psychologist provides online therapy for adults who want support that goes deeper than talk-only work.
The site presents Brainspotting, trauma therapy, somatic therapies, nervous system regulation work, Accelerated Resourcing, the Safe and Sound Protocol, and intensive therapy as core offerings.
This virtual practice serves adults across Washington, Utah, and Florida, making it easier to access care without commuting to an office.
The practice appears especially relevant for adults navigating trauma, anxiety, depression, overwhelm, nervous system dysregulation, and some neurological or health-related concerns.
The overall approach is body-aware and regulation-focused, with an emphasis on helping clients build safety, self-understanding, and steadier functioning over time.
Weekly or bi-weekly 50-minute sessions are available, and the investment page also lists intensive therapy for people who want a more concentrated format.
To ask about fit or scheduling, call 650-387-2578 or visit https://www.drkatrinakwan.com/.
For a public profile reference with hours, see https://maps.app.goo.gl/WRgYvvbdvkT2C1my8.
Popular Questions About Dr. Katrina Kwan, Licensed Psychologist
What services does Dr. Katrina Kwan offer?
The official site lists Brainspotting, trauma therapy, anxiety therapy, depression therapy, nervous system regulation therapy, somatic therapies, Accelerated Resourcing, the Safe and Sound Protocol, and intensive therapy.Is this an online or in-person practice?
The site presents the practice as online therapy, with location pages for Washington, Utah, and Florida rather than a published walk-in office address.Who does the practice work with?
The about page says Dr. Katrina Kwan provides mental health treatment for adults experiencing trauma, anxiety, depression, overwhelm, nervous system dysregulation, and related difficulties.What states are listed on the website?
The official site says services are offered online in Washington, Utah, and Florida.What therapy methods are mentioned on the site?
The site highlights Brainspotting, somatic therapies, Accelerated Resourcing, and the Safe and Sound Protocol, along with broader trauma-informed and nervous-system-focused care.Does the practice offer intensive therapy?
Yes. The site includes an intensive therapy page and describes 1-day and 2-day intensive options alongside ongoing weekly or bi-weekly sessions.What does the investment page list for standard sessions?
The investment page says individual sessions are $250 for 50 minutes.What public hours are listed?
The accessible public listing shows Monday 9:00 AM to 6:30 PM, Tuesday 9:00 AM to 4:30 PM, Wednesday 9:00 AM to 4:30 PM, Thursday 9:00 AM to 4:00 PM, and Friday through Sunday closed.How can I contact Dr. Katrina Kwan, Licensed Psychologist?
Call tel:+16503872578, visit https://www.drkatrinakwan.com/, and use the public profile at https://maps.app.goo.gl/WRgYvvbdvkT2C1my8.Landmarks Across the Online Service Area
Seattle Center — A major Seattle arts and events hub and a recognizable anchor for clients in the Puget Sound region. If Seattle Center is part of your regular area, this practice serves Washington adults online through https://www.drkatrinakwan.com/.Pike Place Market — One of Seattle’s best-known downtown landmarks and a practical point of reference for central Seattle coverage. People near Pike Place Market can access the same virtual therapy options without an office commute.
Riverfront Spokane — Downtown Spokane’s Riverfront Park is a strong Eastern Washington landmark for service-area copy. If you are based near Riverfront Spokane or the Spokane Falls area, online sessions are available across Washington.
Temple Square — A central Salt Lake City landmark and a helpful anchor for Utah coverage. If you live near Temple Square or downtown Salt Lake, the practice’s Utah telehealth service area may be a fit.
Utah State Capitol — Another widely recognized Salt Lake City reference point for clients in northern Utah. Adults near Capitol Hill and surrounding neighborhoods can reach the practice online through https://www.drkatrinakwan.com/.
Lake Eola Park — A well-known Downtown Orlando landmark and a practical Florida service-area anchor. Florida adults near Lake Eola or central Orlando can explore virtual therapy options through the website.
Tampa Riverwalk — A major downtown Tampa landmark that helps illustrate statewide Florida coverage beyond one metro alone. If you are near the Riverwalk or nearby Tampa neighborhoods, the practice’s online format keeps access simple.