Mental Health Matters - Sports and Mental Health

Hi, welcome to Mental Health Matters. I'm Shannon Eliot. Today we'll be discussing the link between sports and mental health. Dr. Cory Nyamora is a psychologist and certified USA Triathlon & USA Track and Field coach. He is the owner and director of Endurance -- A Sports and Psychology Center. The company provides programs for experienced athletes and people who want to improve their mental and physical health. Josh Lampert is a mental health advocate and competitive cyclist. He was diagnosed wi

th psychotic depression in 2004 and credits athletics with playing a large role in his recovery. His story is featured on RealTime Health, a mobile app that highlights first-hand accounts of people living with depression. Josh has also been featured on NPR's "Morning Edition." Josh, what kind of mental health issues have you faced in the past? And were they caused by sports or were they present in the absence of sports? >>I dealt with something called psychotic depression, which actually wasn't

diagnosed until I was 23 or 24, although my onset was around 19 or 20 following drug use. And it was partially caused by sports but more because of extreme sports. I lived in Lake Tahoe and I was connected with sort of a ski bum lifestyle, snowboarding, and that's a pretty hard party scene. I used hard drugs and after that had some symptoms that didn't go away and I started to know something was wrong. >>Cory, how common are mental health issues in competitive athletes? >>So mental health issues

are as prevalent in athletes as they are in the general population. >>So what are some common mental health issues faced by athletes? >>Common mental health issues are depression, anxiety, some substance abuse, and also eating disorders, specifically anorexia and bulimia. >>And are those disorders in particular more prevalent in certain sports compared to others? >>The only differences I found are with the eating disorders, with anorexia and bulimia showing up more in the sports that are weight

-dependent. Things like gymnastics, figure skating, some dance, and in some of the endurance sports like running, cycling, and cross-country skiing. Some of those are showing up more. And actually as I go on, somewhere you have to meet a certain weight, like in wrestling and some of the horse racing sports. There is a much bigger percentage of people with eating disorders there. Not everyone, but more than the general population. >>So how does pressure play a role in mental health issues and the

pressure to perform? I'm sure that's something you both can speak to as athletes but also you as a psychologist and coach as well. >>Definitely pressure can impact mental health conditions in terms of the pressure to perform at a high level. An athlete who feels like they are not able to reach those goals may start showing more anxiety and that could become something bigger. Also it's easy to feel depressed if you're not attaining your goal. It's harder to recover from a performance that you do

n't think went as well. So those are some of the things that can happen with pressure. >>For me, I find pressure as a positive thing although I compete as an amateur. I don't know if it would be the same if I was a professional. But I find that pressure causes adrenaline and kind of pushes me to forget about my illness and put it on the backburner. Although it is hard if you're depressed to let go of a bad result or if something goes wrong. If you crash, you were robbed of an opportunity. And it

also is hard to keep your temper under control sometimes when you feel like people are pulling away from you because you're having a bad mental health day. >>If you're having a bad mental health day or week or month (because it does vary from person to person), has that affected your training in the past? That in turn can affect your performance. Have you ever had issues with that? >>I have had more of those issues in training than in competition because in competition you have all those endorp

hins and competition is exciting. It's a form of travel for me so I kind of get away from my world. But when I'm hang a bad day and I have to go out and train -- especially if I'm by myself -- to push myself without all those thoughts racing through my head can be difficult. >>So how do you manage the pressure to perform? Every cyclist, every runner, and every swimmer wants to go out and be number one -- actually any competitive athlete, really -- so how do you manage that pressure to perform wi

thin yourself? >>I self-coach by reading books and I find knowledge helps me a lot. And I also keep a journal so I record my training and I record by thoughts. And sometimes even a good method is to say what are my potential pitfalls today before I go out and train. So I'll take 10 or 15 minutes and just write down my thoughts and say, "What's bothering me? What am I going to start thinking about when I'm on the bike? And how can I resolve that now so I can just focus on my body when I'm out on

my bicycle?" >>That's really smart, planning ahead. >>Thank you. >>So we've been talking about athletes. There are some people out there, though, who aren't athletes and have may never kicked a ball or done a sport in their life but sports and athletics may be beneficial to their mental health and might make them do better. Could you talk about that a little bit, Cory? >>Yeah, I get excited thinking about this because I think sports and exercise in general can have huge positive effects for ever

yone -- anyone who can physically do it. So that's one thing I encourage clients to do and just other people I know because it definitely helps mood. You were talking a little about being able to focus on something that's physical actually helps people manage other stresses in their lives. The structure of having to train for something or prepare for something helps people build structure in other areas. You have to sleep at a decent time in order to be able to work out in the morning. Eating ge

nerally has to be pretty good. Just having the routine can be really helpful. So those are some good pieces of the sports for everyone. Research also shows that it helps reduce depression and anxiety and has reduced substance use for people also. And the combination of exercise and therapy is actually really effective for dealing with depression. >>From both of your experiences, would you say sports can help people be more resilient in life and to life's challenges, and if so, how? >>I would say

yes because it takes not just a lot of physical strength but a lot of mental fortitude to train as an athlete. Like Cory said, the structure and the discipline and I also think what sports causes me to not do is equally important as what it causes me to do. Some of the things I don't do when I'm training are go out for a beer after work and make those decisions to choose a healthy option over something that could potentially get me in trouble. And sports has its own little world with rules. And

I think the rules are very important because you learn to follow rules in a game. It allows you to transfer that to following rules in society and sometimes in life. >>I was going to add also with the resilience. I think of the lessons learned through sports. Specifically with running or any longer distance sports, one of the things that I coach and help people focus on is really noticing the ups and downs when you're out. If you're out on a long bike ride or run, your mind may do all types of

things during that time. Sometimes you're having a great time. Sometimes it's miserable. Anything happens along the way. But focusing on being able to ride the ups and downs in your actual training day or competition and earning that I got through this moment and it was fine. I didn't get attached to the positive or negative thing happening. It's really a metaphor for the rest of the stuff that happens in life. Anything happens. People die or you win something really great. There are lots of ups

and downs. So I think the lessons we get with sports can be applied pretty easily to the other stuff in life. >>And how about defeat? >>Yeah, how to deal with that in competitive sports where if you're playing one team against the other, winners and losers or however you want to think about that. Dealing with doing well or not doing as well as you'd like. And learning to deal with other teams, coaches, just people around you. It's a small part of life but I think all those lessons apply to othe

r parts. >>And it's safe. If you lose a game or a race, what happens? You get back up and try again. There's no ultimate consequence. >>Cory, would you say athletes are any less prone to seeking help with their mental health issue than the normal person -- or the average person -- because of the expectation to be mentally tough? >>Yeah, I think it's harder for people to reach out. From my experience, I've seen people mostly when they're at the stage where their mental health condition is impacti

ng their ability to play. So if they've maybe gotten kicked off the team or they're injured and can't participate anymore. It's usually when things are feeling extreme rather than the earlier stages where it may have been easier to do more. >>Josh, did you get support for your mental health condition from the athletic community, such as teammates, coaches, and folks like that? >>I did in a sense. I didn't have a strong network around me when I was dealing with mental illness because part of the

effect was when I was being treated, a lot of the medications caused me to gain weight and I couldn't compete at that time. But I did have a little episode when I got back into cycling where I had a para-manic episode and I wrote some angry emails. And a woman who was a coordinator in the national cycling organization wrote me, "Hey, you need to stop writing these emails." And I eventually said I was struggling with my health, my mental health. And she said not to worry and she sent me a ruleboo

k. She said we've all done things we're not proud of but not to be too hard on myself. And she hoped I would keep racing. So it was a support system, definitely. >>Have you been open with your coach about what you struggle with? >>I have a lot of stigma because what I dealt with involves psychosis. And it's easy to say depression, so if I bring it up I say I've dealt with depression and it brings me down sometimes. But I very rarely actually tell people I've dealt with psychosis because that's a

whole other can of worms. >>Another level. >>Yeah. >>What do you generally hear about mental health in the locker room or with other racers? Or do they ever talk about it? >>I don't hear too much. Sometimes you hear jokes and in high adrenaline activities like snowboarding, I heard more about it, but more in the sense of "that guy's crazy" or "he's psycho, I would never do something like that." >>Like in a good way? >>In a good way. >>Interesting. >>Yeah. And there's the same mentality with des

cending on a bicycle. You can get going pretty fast. And it's common to think, "Wow, that guy's lost it. Look how fast he's going." But I found competitive cyclists are a little bit more down to earth and more understanding than the extreme sports community, who likes to throw those terms around. >>Cory, how supportive is the professional or amateur athletic community of athletes' mental health, would you say? >>I'm seeing more and more people coming out and talk about mental health issues or wh

at they've dealt with, which I think is going to start changing how people respond and how knowledgeable people are. Because I think there has been a lack of knowledge, lack of taking about things, and a lot of stigma. So there are more professional athletes coming out. And also there's a lot more training in college sports anyway around mental health issues and making sure athletes are supported. >>And that's a relatively new development. >>Yeah, definitely. >>Do you guys feel that peer support

exists in sports? Maybe you might not have support from the coach or the coach might be ignorant because this education is sort of a new thing. Do you feel that teammates have your back or have athletes' backs when they talk about it? >>I do. I, in an individual sport, have more of a network around me of mechanics and people at shops and friends that I ride with. I have a friend I ride with who is sort of a mentor to me because he is more the age of my parents, but he runs a clinic in Rhode Isl

and. And I'm actually going to go there and speak. And he's very supportive and listens to me. I was out riding with him the other day. He just lets me get things off my chest. Sometimes peers are a lot easier to talk to than a coach. >>My perspective has been more...obviously in the sports I coach there is a lot of support because we talk pretty openly about what's going on with people. In my experience from people coming in, there's been a lot of shame and not really sharing at least with othe

r people. So part of the therapy process I think sometimes gets people comfortable and actually sharing with their peer also what's going on. So there's been a lot of folks just keeping things to themselves and trying to work on it somehow. It's hard to deal with. >>Where would each of you say the line is between having to be touch for competition -- because competitive athletics are hard, it's going to be tough -- and needing to seek help? >>My take on that is that it's mentally tough to seek h

elp right when you know something's wrong or something's not right. It's really reframing how we think of mental toughness so that people can get help early and have the support they need. I always talk about the mental and physical aspects really being linked with each other. People aren't just pieces. It's not thaty're just functioning machines with no mind that goes with it. So having coaches and athletes -- and actually surrounding the teams or the people -- to really address the person as a

whole person. How are they doing physically? What's going on mentally? And just keeping an eye out for that and getting help early when things don't feel good. >>I think just as much as your body needs a physical rest, sometimes your mind needs a rest. And if you're putting too much pressure on yourself, sometimes you just need to back off a little bit. >>So there's often an issue of self-worth and identity wrapped up in being an athlete. Once an athlete, always an athlete is what I hear a lot.

What happens when you might have a career-ending injury or retirement? How can an athlete work through that and work through those issues that will inevitably arise? >>It's a huge change in people's lives. So many of the athletes have been going their sports since they were kids. There's been a lot of focus from family or friends. And even if you started at a later age, it's something most people love and feel really connected to so it's a huge life-changing event. And there's a lot of grief an

d sadness about that loss and anger. And even the loss of what you were saying was identity, the central sense of who you are. Everyone knows you as this person who does this thing. So through the therapy process, it's really helpful to go through all the grief and really work on what's happened, what's lost, and what are the next steps for you. One of the things I try to do as a preventative thing is talking to young athletes about planning for the future even as you're playing your sport becau

se most athletic careers don't last forever. Or you may have to change gears and do something that's easier on your body. So just kind of thinking about the future, trying to see what else would be fun, and planning for that, saving money if you ware making money, and just being really smart about knowing that it may end early or it may end suddenly. So that can help with the grief process and being able to switch to something else. >>How often do athletes actually do that and plan ahead? I feel

like that's a relatively rare thing. >>I actually don't know. That would be some good research for sure. >>I thought about that also because I wanted to be a professional for awhile while I was in my early 20s. And I thought I only have a couple years to really do this because you hit your physical peak at about 28 or 29 and then you have to start thinking about what you are going to do later in your career. And I see you obviously have to make a transition and be more mature and say, "Hey, you

know what, maybe I'm going to start looking out for some of the younger people. I've been through this and I'm going to start giving back and try to coach some of the other people." And on the other token, just accepting I might have to slow down and do something that's easier on your body. But I had decided I love being athletic so much that I'm never going to stop doing something. But I may...just like when I gave up snowboarding and switched to something else, I'm going to have to slowly evo

lve. Maybe I'll be playing bocce ball someday, but at least it will be something. >>Yeah, definitely. I think that's an important point for people to know, that they can always stay active, no matter what age. Again, most people are capable of doing something, whatever that is. I like the planning idea so it's not such a shock to the system. >>And triathlon and cycling in particular I know have over-50, over-60 leagues and things. >>You can do those events for a long time. >>Yeah. >>So Cory, wou

ld you say female athletes are more likely to seek out help than male athletes, in your experience? >>In my experience, I actually haven't seen a difference and I'm thinking about this more because in the general population there is a difference in gender, in terms of men being a little less likely to show up for therapy. But being a male therapist -- I think there aren't as many male therapists -- so I see pretty equal numbers of people showing up. And I think also, my guess again with female a

thletes also are in the same culture generally in terms of being taught to be tough, to sort of fix things yourself, to keep pursuing things. So I, my guess is that the numbers might look similar in general. >>Do you ever carry internal shame? >>I did at times and then I told myself I'm probably tougher for the experiences I had. And I try to translate that into a competitive attitude. And you can't look back and you can't change the past, so all I can really do is try to make lemonade out of th

e experiences I've had and move forward as a better person. >>Josh, what kind of things did you learn about mental health growing up? >>I had a hard experience when I was 11. My uncle committed suicide and that was my first experience with any kind of mental heath. I was told he was mixing antidepressants and alcohol and that has something to do with it. And they had been trying to get him to the hospital but they couldn't do it. And I didn't understand that until I was older. I heard my friends

joke about it but really when I started having symptoms that was my first real experience with any kind of mental health. I got the child's version when my uncle committed suicide and then we didn't talk about it too much after that. >>And how long had you been doing sports -- competitive or otherwise -- before you began to realize what an effective role that was playing in your recovery? >>I had done sports for most of my life and I always had a bike. I taught myself to ride a bike when I was

in preschool and then I played hockey when I was in high school and snowboarding. It turned into extreme sports. BMX was my primary thing. And then when I got sick I envisioned that I was competing in the Tour de France, so there was always a mental aspect of sports in my recovery. When I got back on my bike and when I was properly diagnosed and stopped having side effects from the medication, it was the primary aspect of my recovery because it allowed me to mentally clear my mind and physically

blow off steam. It's been the major aspect in me getting better to this day. >>So what do you do when it's in an off-season or in a recovery week or when you're not at peak performance or peak racing period? >>In the off-season, I go to the gym so I'm always doing something, especially when the days are really short. I have to remain active. But when I'm physically resting I enjoy arts and culture. I go to museums and I try to enjoy music and stuff. >>Cory, what are some tips for coaches, athle

tes, or teammates that help should be sought as soon as possible? >>In general, I would have athletes and coaches and teammates actually look out for someone who just changes, basically. They may seem really angry all of a sudden. They may be drinking or using other drugs, abusing drugs, if anyone is talking a lot about death or an unexplained sort of weight loss or huge weight difference showing up. And just knowing your peers. If there's any difference that stands out to you, I would check in

with them. And also coaches specifically should have some referrals and people available that they can consult with or talk with if it's over their heads and they're concerned about someone. They should have a set network to which to refer people. Just like they have a team that hopefully deals with any physical injuries having a good support person next to them to send people to. >>And speaking of physical injury, how common is it for mental health issues to come about from an injury? >>That's

pretty common, especially if someone is out for a long time or can't participate. It's hard going from being pretty active to not. And again, it depends on how much support they have. It doesn't necessarily mean they need to come into therapy unless they know it's something that they know is not their regular way of dealing with things that happen. >>So to wrap us up, what would each of you tell someone who might not be an athlete, who is struggling with a mental health issue and is considering

entering the world of sports but might be a little bit intimidated? >>I would say don't be scared and also don't try to take on too much at once. If you want to go out and take a walk and get started by doing that, all you have to do is take the first step and that's the most important thing. >>And I agree with that. Just really finding what they love. Trying things. Maybe having someone who does it with them. Try new things and there's always something for everyone out there. And it can be pret

ty life-changing if you find what you love. But give yourself time to actually get used to it. And don't compare yourself to others. You shouldn't be somewhere that you're not. It takes awhile. >>Well thank you so much, Josh. And thank you so much, Cory for joining me today and talking about what I consider a fascinating topic. Best of luck in both your racing careers. >>Thank you. >>Thanks. >>To learn more about Dr. Nyamora, visit his website at http://www.corynyamora.com. To learn more about t

he Endurance -- A Sports and Psychology Center, visit www.endurancecenter.org. "The Bipolar Athlete" is a blog written by a competitive triathlete with bipolar disorder. You can read it in full at http://bipolarathlete.blogspot.com. You can download the RealTime Health app on iTunes.