Clinical Relevance: Your athletically-minded patients can benefit from mental prep techniques

  • Elite gymnasts and other top athletes use cognitive techniques to improve performance and manage stress.
  • Personalized mental routines, such as visualization and mantras, enhance focus and confidence.
  • Studies show significant performance improvements for athletes of all levels who practice mental preparation.

“I always had headphones in, I always had music that I liked that would get me into the zone,” recalled Houry Gebeshian, an Olympic Gymnast who represented Armenia at the 2016 Summer Games in Rio de Janeiro. “I never really liked to watch the competition, because you can’t, you can’t control what everybody else is doing.”

Elite gymnasts like Gebeshian rely on mental rituals for peak performance just as much as their physical gifts.

For Gebeshian it was having a playlist and redirecting her attention away from the action. For other top competitors, it could be a prayer, a thought loop, or even pancakes for breakfast. Athletes, coaches, and experts agree that whatever the habit, the right cognitive approach helps make performing on a big stage like the Olympics – with millions of people watching – more manageable.  

Psyched Up For Success

Valorie Kondos Field, the former head coach UCLA gymnastics team, has worked with 15 Olympians, including several gold medalists. She told Psychiatrist.com that coaches often work with their athletes to develop a custom psychological routine.

“Athletes establish the habits and the mindset that works for you, you establish the mnemonic devices that work for you, the words, your mantra,” she said. “The best athletes that I coached eat the same thing every single day because food is not fun. Food is fuel. And so they reframe everything in their lives and the things that work for them, they stick to them.”

Multiple studies back up Field’s support of the pre-performance routine, also known as a PPR, including a 2021 International Review of Sport and Exercise Psychology meta-analysis of 112 studies looking at their effectiveness. The mental skills the researchers reviewed covered a wide array of  thoughts and actions top athletes follow before performing in both low-pressure and high-pressure situations. 

The analysis indicated a small but significant effect in sports performance with PPRs, translating to about a 31 percent improvement. Compared to control groups that skipped mental prep, athletes using PPRs showed a 64 percent improvement in low-pressure conditions and an impressive 70 percent improvement in high-pressure conditions.

Benefits were consistent whether the PPR was simple or elaborate, the researchers found. 

“The meta-analytic results support the benefits of the PPR intervention in practice regardless of the type of routine. Both extensive and stand-alone PPRs are effective in optimizing sports performance,” the University of Vienna researchers concluded.

Crafting Winning Mindsets

Jeff Brown, chief psychologist for the Boston Marathon, assistant professor at Harvard Medical School, and author of The Winner’s Brain, underscored the necessity of a strong psychological routine, especially for athletes competing at an elite level. 

“I like to think of it as a funnel. The funnel is kind of a wide mouth at the top that brings you down to a narrow point where the best performance happens,” Brown explained. 

Some athletes develop their routines through years of practice and competition, Brown added. It helps them “lock in” and put aside the pressure.

“They have the same thing that you do every day, before your performance, before your practice,” he said.

While keeping the mental process specific and consistent is important, Brown cautioned that athletes should maintain the ability to shift gears when necessary. When thinking becomes too rigid, it can hamper the ability to respond to deviations or unexpected obstacles. 

“You want to have flexibility so your pre-performance routine doesn’t create anxiety…” he suggested. “But somebody could say, oh, my pasta has to be bow tie pasta. Well, if you go somewhere, and there’s no bow tie pasta, it’s not a terrible thing to go with rigatoni — it’s still pasta.”

Field agreed that relying too much on fixed mental routines might backfire.

“In gymnastics, you start from a 10, and then all it is, is deduction, deduction, deduction, deduction, deduction,” she said. “So the first thing that I talked to them about, and I speak about this with the Olympians… is that perfection does not exist, and so when you strive for perfection, you will always fall short,” Field continued. 

In other words, mental routines should accommodate a mistake or setback.

One high profile example: Olympic gymnast, Simone Biles. Her struggle with “the Twisties” during the last Summer Olympic games caused her to largely withdraw from competition despite her obvious physical talents. Fortunately, she seems to have regained her psychological footing by working with her coaches and a team of sports psychologists.

Staying Focused Under Pressure

The cognitive strategies that will be on full display during the 2024 Summer Olympics in gymnastics and other sports next month might also benefit average athletes, research and real-world scenarios suggest.  A good head game can help sharpen focus, confidence, and overall performance, even for those in the middle-and-back of the pack. 

A recent Chinese study found that soccer, basketball and track participants with moderate abilities who practiced ritualized behavior showed a 15 percent improvement in self-control compared to those who did not. The discipline they gained was associated with better overall performance, including faster reaction times and higher accuracy in tasks requiring quick decision-making. Additionally, those who engaged in mental prep achieved better scores in simulated competitive scenarios.

Psychiatrists can help their patients learn visualization, goal setting, and mindfulness exercises in the clinical setting. These cerebral tools can help them stay calm and maintain a winning mindset, whether they’re running their first 5K or qualifying for an Olympic final.

Gebeshian implied that, with enough practice, a good “mind rehearsal” can become so second nature that it feels like autopilot.

“I remember my routines because I’ve watched them a million times, but honestly, I think I can’t remember physically doing the routines,” she said. “I can’t really remember what happened in the 30 seconds to a minute and a half of each one of my routines, because I think I was just so zoned in and in my own bubble doing my thing.”

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