Performance Psychology or Therapy? How to Tell What You’re Working With

Someone who “chokes” in big moments might need a better pre-⁠performance routine. Or they might have an anxiety disorder that started on the field and now shows up at work, in traffic, and at 2 a.m. A sales leader who has lost their edge might need goal-⁠setting and focus strategies. Or they might be depressed.

From the outside, these can look the same. Getting it right matters, because mental skills training for an untreated mental health condition tends to stall, and treating a simple performance issue as a disorder can feel heavy and miss the point.

What performance psychology is

Sport and performance psychology applies psychological science to help people perform in the upper range of their abilities, consistently, and enjoy the process more. That definition comes from Portenga, Aoyagi, and Cohen (2017), and it applies just as much to executives, surgeons, first responders, musicians, and dancers as it does to athletes.

The work is usually skills-⁠based and forward-⁠looking: focus and attention, confidence, managing nerves and arousal, routines, imagery, self-⁠talk, goal-⁠setting, communication, leadership, and bouncing back from mistakes.

What therapy is

Mental health therapy assesses and treats psychological conditions such as anxiety disorders, depression, trauma, eating disorders, substance use, and ADHD. It looks at the whole person, including history, relationships, and patterns that reach well beyond any one performance setting. Diagnosing and treating these conditions requires a mental health license.

It’s a continuum, not two boxes

Researchers have argued for more than 20 years that performance and mental health concerns don’t sort neatly into two piles. One of the best-⁠known frameworks is Gardner and Moore’s Multilevel Classification System for Sport Psychology (2004). It sorts concerns into four categories, each with two subtypes, based on the person’s main issues, needs, and life circumstances, and uses that to guide the type and level of service they need.

The key point from this research is that the same complaint (“I can’t focus in competition”) can belong in any of these categories. The work starts by figuring out which one, because that decides what will help. The International Society of Sport Psychology takes a similar view, describing athlete mental health as a continuum rather than a simple “well” or “ill” (Schinke et al., 2018).

High performers aren’t immune

It’s easy to assume that people who perform at a high level are mentally tougher than everyone else. The data say otherwise. A meta-⁠analysis in the British Journal of Sports Medicine found that about 34 percent of current elite athletes and 26 percent of former elite athletes reported symptoms of anxiety or depression (Gouttebarge et al., 2019). The International Olympic Committee’s consensus statement on athlete mental health concluded that these symptoms are common, can show up in sport-⁠specific ways, and can hurt performance. They also raise the risk of injury and slow recovery (Reardon et al., 2019).

The same statement notes that clinicians need to tell the difference between traits that serve high performers well and patterns that have become a problem. That’s the line this article is about.

High performers can also be very good at hiding distress. Drive, discipline, and the ability to push through pain are strengths. They can also keep someone pushing through depression or disordered eating until it becomes serious.

How to tell what you’re working with

These questions are a starting point. They’re not a diagnosis, but they help point you in the right direction.

Signs it may be more than a performance issue

• Low mood, irritability, or loss of interest that lasts most days for two weeks or more
• Panic attacks, or anxiety that has spread beyond performing
• Restricting food, bingeing, purging, or over-⁠exercising to control weight
• Relying on alcohol or other substances to cope or wind down
• Nightmares, flashbacks, or avoiding places after an injury or scary event
• Mood or personality changes after a concussion
• Lifelong trouble with focus, organization, or impulsivity, which may point to ADHD

Side by side

Why who you see matters

Mental performance consultants can be excellent at skills training. The Certified Mental Performance Consultant (CMPC) credential, from the Association for Applied Sport Psychology, shows specific training in this area. But CMPC is not a license to diagnose or treat mental health conditions. Ethical consultants without a license refer clinical concerns to someone who has one.

That referral isn’t always easy. A paper titled “Blurred lines” in Frontiers in Psychology points out that athletes often bring mental health concerns to whoever they already trust, which is often their sport psychology provider. Stigma and sport culture can make them reluctant to see someone new. The authors recommend “referring in”: bringing a qualified clinician into the existing relationship so the athlete isn’t simply handed off (Roberts et al., 2016).

Licensed clinicians who are also trained in performance psychology can move between both roles. They can keep working on the mental game while treating anxiety, depression, or trauma, and can spot when a “performance” problem is something more. At WPS, our team includes licensed clinicians who hold or are working toward the CMPC, so you don’t have to start over with someone new if the work shifts.

It doesn’t have to be either/or

Most people don’t fit neatly into one box. A professional dancer might work on audition nerves while also getting treatment for an eating disorder. A collegiate athlete might learn focus routines and also be evaluated for ADHD. Someone coming back from a major injury might need help with confidence and with the fear and grief that came with it.

The right starting point is an honest conversation about what’s going on, on and off the field, stage, or job. From there, the plan can include performance work, therapy, testing, or all three.

The bottom line

If the problem stays mostly in the performance setting, mental skills work is a great place to start. If it follows you home, has lasted for weeks, or affects sleep, eating, mood, or safety, it’s worth looking at through a clinical lens too. Learn more about sport and performance psychology, therapy, or psychological testing for athletes at WPS.

Sources

1. Gardner, F. L., & Moore, Z. E. (2004). The Multi-⁠level Classification System for Sport Psychology (MCS-⁠SP). The Sport Psychologist, 18(1), 89–109.
2. Gouttebarge, V., et al. (2019). Occurrence of mental health symptoms and disorders in current and former elite athletes: A systematic review and meta-⁠analysis. British Journal of Sports Medicine, 53(11), 700–706.
3. Portenga, S. T., Aoyagi, M. W., & Cohen, A. B. (2017). Helping to build a profession: A working definition of sport and performance psychology. Journal of Sport Psychology in Action, 8(1), 47–59.
4. Reardon, C. L., et al. (2019). Mental health in elite athletes: International Olympic Committee consensus statement. British Journal of Sports Medicine, 53(11), 667–699.
5. Roberts, C.-M., Faull, A. L., & Tod, D. (2016). Blurred lines: Performance enhancement, common mental disorders and referral in the U.K. athletic population. Frontiers in Psychology, 7, 1067.
6. Schinke, R. J., Stambulova, N. B., Si, G., & Moore, Z. (2018). International Society of Sport Psychology position stand: Athletes’ mental health, performance, and development. International Journal of Sport and Exercise Psychology, 16(6), 622–639.