3 questions for a cognitive behavioral therapist

What is CBT and why is it so great for athletes?

"At a fundamental level, cognitive behavioral therapy (CBT) is about changing the way individuals think. CBT teaches you to recognize negative thoughts and become aware of their impact on both your emotions and performance in your sport, and ultimately reframing that.

Changing negative thoughts to positive ones and reinforcing that over time literally changes the way an athlete thinks and optimizes their thought process. This is crucial because emotions are indelibly linked to performance. What's more, CBT is linked to goal setting and progress, which resonates with both novices and elites."

How do emotions affect performance?

"Going into a competition or even a workout, you want to be calm and focused, so negatively obsessing about what happened at the office today can send your heart racing and cortisol levels skyrocketing, which can throw off your whole workout. If you frame stress as a negative, you are much more likely to cope with it in an unhelpful way. You’re less likely to be motivated, more likely to skip out on exercising, and to reach for unhealthy comfort foods. 

Instead, viewing stress as a challenge rather than a threat can positively change your physiological reaction so that you have a healthier heart rate, blood pressure, and hormone secretion. This is really helpful in terms of disease risk and performance over long periods of time.

I believe that it’s only by having a healthy mind that you have a healthy body. But most people have to train their mind to think positively and to be kind to themselves. Personality to a large extent is genetic and the evidence shows that some people do just have a happy personality. But whether you’re naturally positive or not, CBT training is a chance to build on your natural outlook, and is relevant to absolutely everyone in every walk of life, from Olympic champions to recreational runners."

How can athletes minimize common unproductive thoughts?

"An essential part of CBT is for the client to do homework in between sessions which looks like this: First, I ask them to become aware of negative and unhelpful thoughts they're having in stressful situations in their lives. They’ll write down the negative thoughts in a journal along with the associated emotions and behaviors that follow. The goal is to raise awareness of their thoughts as well as their impact on behavior. Over time, the list creates a bank of common negative thoughts, and we then work through each one in our sessions, wherein the client comes up with more helpful alternative thought.

For example, say you’re at the gym and are trying a new exercise. You may think, 'I'm really bad at this,' and the resulting emotion is frustration and anxiety, and the behavior is to stop trying and go do something different. What would be more helpful is to think, 'I'm trying my best, and for my conditioning level, I'm doing great.' While it may feel unnatural at first, just like with muscle memory, your brain adapts and remembers and eventually it becomes effortless. Over time, this reframing has a really powerful effect on the mind and body.

Or, say you finished a marathon 20 minutes past your PR. Common negative thoughts might include, 'What was the point of all that training?' 'I’m never going to run that time again.' More helpful ways of thinking that could replace these are: 'I ran my best and that’s all I can ask of myself' and 'I have trained hard and it will show in my race times sooner or later.'

When injured you might think, 'I’ll never be able to come back from this,' or 'This is so unfair.' More helpful ways of framing it, though, would be: 'This is a challenge that I can overcome.' Look for a more positive aspect, such as how it can be an opportunity to learn and grow as an athlete and a person."

This interview has been edited and condensed for publication.