“It’s ok to not be ok.” I saw this headline while looking through various articles related to Simone Biles’ withdrawal from participation in the Tokyo Olympic Games. There has been much discussion around her decision to withdraw – some criticize the fact that she backed out, while others applaud her ability to put her mental health first. No matter where you land on the Biles issue, performance anxiety is an important topic for anyone to explore and understand – for this life and for eternity. Managing it is integral to our sense of identity, our sense of purpose, and our motivation to perform.

Biles referenced “the twisties” as the reason for discontinuing her participation. The twisties is a phenomenon where the mind and body disconnect and a gymnast loses his or her awareness and spatial sense in the air, which can lead to significant injury. As safety is concerned, this is a completely viable reason to pull out of an athletic event. Protecting oneself and the team’s performance is legitimate. While it seemed like there was a lot at stake for Biles’ legacy, for Team USA, and for the citizens of the US who sent her to the Games, there was much more at stake for Biles from a mental and physical health perspective.

The idea of suffering a mental health crisis in a sport or in other high-pressure situations is compounded by the pressure that we and others pour onto the situation. This compounded stress can have significant negative consequences, including loss of confidence and identity, decreased self-esteem and worth, and increased fear and anxiety in and around competition.

Despite the big stage, Biles isn’t the only athlete who struggles with compounded stress in a sport. Many athletes, high level or otherwise, face the devastating possibility of “choking.” Choking is characterized by the lack of ability to perform due to high levels of anxiety. This often happens to athletes in high pressure situations when the responsibility is put on the athlete to perform. Choking is a form of performance anxiety and can be debilitating, resulting in mental and physical shut down. It’s the freeze in “fight, flight or freeze” reactionary behavior. Athletes who tend to choke often struggle to identify how or why this is happening and are at a loss for how to manage it.

World-class athletes (or really anyone competing in any way on a high level) likely have access to mental health professionals who help them walk through what’s happening and how to work through the situation. Those who are not at such high levels, yet take their sport or their work seriously, may not have these resources on hand, or may not even be aware that this situation can be remedied. The following are ways to deal with mental health issues or concerns related to performance expectations.

1. Check your perspective.

First, ask yourself a few key questions:

• Is this situation something that you believe might “make or break” your athletic career or other areas in your life? If you perceive the situation to be so, then you’re more likely to experience this kind of mental health crisis.
• Where is this pressure coming from? Is this an internal pressure (the risk of letting yourself down) or is this an external pressure (the risk of letting others down)?

Next, evaluate whether you are focusing more on the outcome of your efforts rather than the process of getting to that outcome. Understanding the difference between outcome and process is important: It provides your mind with important insights as to the purpose of your performance, the confidence you have in yourself, why you feel pressure, and how you interpret pressure.

If you have an outcome focus, you are thinking in terms of win or lose, right or wrong, good or bad.  Focusing solely on outcome is uncontrollable and unstable for an individual. An individual can train at the highest level, have the best performance, and still have an undesirable outcome. There’s always the chance that an individual will be out-performed despite his or her best effort, thus not achieving the desired outcome. Not achieving the desired outcome, when solely focused on it, can lead to negative emotions, anxiety and fear, decreased confidence, and decreased performance.

If you have a process focus, you are focused on the improvement of skills and techniques to reach a desired outcome. In doing so, an individual has more control over his or her performance, and ultimately has a better chance of achieving a desired outcome. Additionally, a process focus allows for concrete markers of improvement and can provide a roadmap to improvement, rather than merely hoping a desired outcome will be achieved. With a process focus, athletes and other such determined individuals can improve their performances, increase their confidence, increase feelings of security, and decrease fear and anxiety around competition or outcomes.

2. Identify and implement positive coping strategies.

It’s good to evaluate what has worked in the past to help manage symptoms of anxiety related to performance. Strategies such as deep breathing, relaxation, mindfulness, and visualization are all helpful to manage symptoms of anxiety and fear related to performance.

• Deep breathing and relaxation are helpful for regulating one’s physical reaction to stress and pressure by decreasing tension and allowing the mind to focus on what is necessary.
• Mindfulness (staying in the moment) is helpful to prevent beating oneself up for previous failures or worrying about what could happen in the future.
• Visualization is a helpful form of mental rehearsal and preparation for any pressure situation. Determined performers can visualize themselves in certain situations, certain environments, and certain conditions, and then visualize how they want to perform in those situations or environments. They can also visualize how they will respond if their performance doesn’t go as planned.

3. Know your limits.

Evaluate how hard you have been pushing yourself to perform. Have you checked in with yourself regarding your needs for sleep, food intake, or physical and mental breaks? Getting adequate sleep and nutrition and physical and mental rest are important to enhancing performance and in recovery after each performance. Training is a process, and through that training we want to build a healthy body and mind that is equipped to perform. Running yourself down physically and mentally only adds to the stress, anxiety, and fear that you’re trying to manage.

4. Seek help.

If healthy habits and maintenance come up short, it’s wise to seek help from a professional who can provide perspective and guide you through mental skills training. Mental performance coaches or sports therapists are trained in helping athletes or other high-performing individuals to manage their thoughts, emotions, and behaviors that affect performance. We help eliminate negative processes that impact performance and ultimately impact outcomes. Through mental skills training, a mental health professional can help individuals build the tools needed to manage performance anxiety and succeed in a particular activity or in any area of life.

Integrating mind, body, and spirit

God created each of us with a heart, soul, mind, and strength – aspects of ourselves to be used for his glory (Mark 12:30). So why not look to the Bible for advice on how to integrate each of these aspects for good outcomes? Let’s explore what the Bible says about anxiety and mental health issues.

It’s no secret that in this life we will have hardship and struggle – we’re promised that (John 16:33). Understanding the reason behind our hardship and struggle is an important step to understanding how anxiety, fear, and pressure affect us. When we’re too focused on an outcome, such as pleasing ourselves or others, we will likely feel anxious or fearful because of the outcome we visualize: the possible failure and judgment we might face. Conversely, when we’re focused on God’s promise of unconditional love and forgiveness, a certain outcome no matter what, then we are free to focus on the process of the activity we’re engaging in.

As we engage in this activity, fully focused on the process, we recognize that we don’t need to fear judgment of humans, because Christ has already been judged for us, and found worthy! The outcome is secure and unchanging. Our performance doesn’t need to be measured by outcome; rather, it can be a process of bringing glory to God with every move, motivated by Christ’s incredible love for us. His performance on our behalf. The sense of identity and purpose that brings us.

A few Bible verses remind us of this perspective:

• ^“Jesus looked at them and said, ‘With man this is impossible, but with God all things are possible.’” (Matthew 19:26)
• “Whatever you do, work at it with all your heart, as working for the Lord, not for human masters,since you know that you will receive an inheritance from the Lord as a reward. It is the Lord Christ you are serving.” (Colossians 3:23-24)
• “For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come.” (1 Timothy 4:8)
• “Everyone who competes in the games goes into strict training. They do it to get a crown that will not last, but we do it to get a crown that will last forever.Therefore I do not run like someone running aimlessly; I do not fight like a boxer beating the air.” (1 Cor. 9:25-26)
• “We do not dare to classify or compare ourselves with some who commend themselves. When they measure themselves by themselves and compare themselves with themselves, they are not wise.” (2 Cor 10:12)
• There is no fear in love. But perfect love drives out fear, because fear has to do with punishment. The one who fears is not made perfect in love. We love because he first loved us. (1 John 4:18-19)

While a high-level athlete like Simone Biles is in the spotlight given her status as an Olympian, let’s not forget that any individual who is in training for an athletic competition or any other high-pressure situation can be affected by performance anxiety and mental health crises. It is important to understand yourself in relation to your sport or activity, recognizing what steps need to be taken to ensure that you’re viewing your training and competition appropriately, implementing the necessary coping or mental training skills to keep you productive, setting limits for yourself, and seeking help and support if needed.

I wish you every blessing as you strive for excellence in life, focused on the process, knowing that an excellent eternal life is the ultimate outcome Christ won for each of us.

Amanda Cadwell, LCPC, LPCC, BC-TMH, CCTP, is a Licensed Clinical Professional Counselor based in Idaho for Christian Family Solutions. She works with teens and adults, incorporating Scripture with behavioral therapies to emphasize wellness through mental, emotional, physical, and spiritual integration. She also offers presentations on the topic of sports and mental wellness through Christian Family Solutions Educational Programs.