Managing Mental Health in Competitive Sports with Dr. Sarah Pospos
Show Notes:
Whether you are an aspiring, current, or retired athlete, your mental health is something to always prioritize. Dr. Sarah Pospos, a practicing sports psychiatrist and passionate former athlete, understands the complexity that comes with competitive, high-pressure sports. Her goal is to empower athletes, optimize their sporting abilities, balance their lives, and prescribe and manage medication if needed. Dr. Pospos discusses what to expect in a sports psychiatry appointment, how to recognize mental health red flags, coping mechanisms to deal with your time away from sports, and why we need to remember that your mental well-being is just as important, if not more important, than your physical well-being!
Key Points From This Episode:
What sparked Dr. Pospos’ interest in concussions.
The different layers of a concussion injury.
Why someone should consider seeing a sports psychiatrist.
Why athletes may experience unique challenges.
What a concussion-related appointment with a sports psychiatrist may look like.
Dr. Pospos’ experience with patients’ common misconceptions.
Dr. Pospos’ tips for athletes going through depression and anxiety.
Two mental health symptom-related red flags.
The role of loved ones and coaches in an athlete’s struggle.
Dr. Pospos’ experience with treating retired (planned or unplanned) athletes.
Advice for athletes going through unplanned sports retirement.
Coping mechanisms to fill the time when you used to be playing sports.
Dr. Pospos’ closing advice.
Work with Dr. Sarah Pospos
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[INTRODUCTION]
[0:00:05.2] BP: Hi everyone, I’m your host, Bella Paige, and after suffering from post-concussion syndrome for years, it was time to do something about it. So welcome to The Post Concussion Podcast, where we dig deep into life when it doesn’t go back to normal. Be sure to share the podcast and join our support network, Concussion Connect. Let’s make this invisible injury become visible.
[DISCLAIMER]
[0:00:32.9] BP: The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussion and post-concussion syndrome.
[INTERVIEW]
[0:01:16.6] BP: Welcome to episode number 81 of The Post Concussion Podcast with myself, Bella Paige, and today’s guest, Dr. Sarah Pospos. Dr. Pospos completed her psychiatry residency as chief resident at UCLA. As a support psychiatrist and former student-athlete, she is devoted to helping aspiring, current and former athletes with depression, performance and general anxiety, insomnia and other psychiatric challenges associated with injury, concussion, retirement from sports, over-training and others.
Dr. Pospos also empowers athletes to optimize and balance their lives by incorporating exercise, nutrition, sleep, stress management, and division time management, especially as the mom of two under two and other lifestyle changes in her telepsychiatry practice. Welcome to the show Dr. Pospos.
[0:02:06.5] SP: Hi Bella, thank you so much for having me today. I really appreciate it.
[0:02:10.3] BP: So do you want to tell everyone what created your interest in concussions?
[0:02:15.1] SP: Yes, absolutely. So hi everyone, as a sports psychiatrist and a former student-athlete, I think it goes about saying that sports have always been a big part of my life and one of my favourites is football. So as you all know, in football, concussions are very common. Most recently, we learned about what happened to two off, from the Dolphins as well for example.
But unlike other injuries, with a concussion, there are so many layers, right? So for instance, there’s so much unpredictability that goes with it in terms of you know, the timeline of symptoms, timeline for recovery, the list goes on and this unpredictability of course just takes away that already limited sense of control that an athlete may have and not only that, to make matter worse, it also takes out the coping skills to deal with this stress with the concussion itself.
So as a sports psychiatrist, I, you know, just recognize and realize how much of this could affect someone’s mental well-being and ultimately, someone’s mental health as well and you know, it goes without saying that I think it’s a very, very important topic, yet very much under-recognized unfortunately, which is why I truly appreciate your podcast, Bella, which significantly helps shed so much light on all things concussion.
[0:03:37.3] BP: Well thank you so much for coming on. I really do like the under realization about it as well because, for myself, we’ll talk about it later on the show but the anxiety of getting hurt again got really big for me after a couple of my concussions. So I actually did get help with that because mentally, I’d be good and then all of a sudden, I’d be like kind of really off riding and I’d feel not like myself and it was like that fear that would set in once in a while.
So there’s a lot to go over but I just wanted to ask, why should someone consider seeing a sports psychiatrist, to begin with, other than you know, like me being terrified but you're going to go and get setbacks in your health again?
[0:04:22.6] SP: Yeah, such a great question. So just as a preface, a sports psychiatrist is a medical doctor who specializes in psychiatry and mental health and where they’re specialized in treating athletes, focusing in athletes’ mental health.
So, why is a sports psychiatrist might be a better fit for an athlete? When and why should someone consider seeing a sports psychiatrist, right? A couple of things. First, as an athlete, you may experience some unique challenges that others just won’t, simply won’t understand.
So things like choking or performance anxiety, perhaps burning out from overtraining. Of course, a lot of injury issues, including concussions. Most sports psychiatrists are former athletes themselves like yours truly. So, from that standpoint, we understand firsthand some of these unique issues that you may face.
Second, as an athlete, we’re trained and almost conditioned to always tough it out that at one point perhaps becomes a knee-jerk reaction and with that, it may come with mixed feelings, mixed emotions about seeking treatment. So sports psychiatrists do understand these nuances, these mixed feelings, mixed emotions and more importantly, we would love for you to feel seen, feel heard, feel understood, feel validated a lot of these emotions that may go into your mind when seeking treatment, including psychiatry treatment and then lastly, if and when medication is indicated, an athlete may have a lot of concerns. For instance, will this medication affect my athletic performance, right?
Because there are subtle nuances when selecting a medication. For instance, some medications may have potential side effects that just waking up and of course, is going to affect an athlete’s performance, especially if it’s a sports-related to aesthetics like gymnastics or sports that are related to weight class, such as rowing.
A medication for instance might improve fine motor movement or tremors to the point that it’s banned or it’s considered doping in certain sports, such as archery or shooting. So all of these nuances need to be considered when treating someone or managing an illness for athletes specifically.
[0:06:39.3] BP: I really like the fact that you mentioned being an athlete yourself, it really does make a difference. I find for myself, I really understand people through concussion because I’ve lived through it and that perspective is one that you can’t get through reading a book. You can only get it when you’ve done it and for myself, I strongly believe that as an athlete, my brain ran a lot differently than most.
Depends on the level of your competitiveness and your obsession but mine was very intense when it came to sports. Like, there was nothing else, nothing else mattered, sports were my life and so when you are in that mindset, a lot of people don’t understand that like, “What do you mean? Like, you're giving up every weekend of your life? Every morning to train or to be at an event? Those types of things?” and yup.
Yes, I am and it’s totally okay with me but can you take us through kind of an appointment with a sports psychiatrist when it is related to a concussion?
[0:07:41.2] SP: Yeah, absolutely and I 100% agree with what you’re saying as well. You know, sometimes, if not, most times it’s very hard to understand what being an athlete may look and may feel like on a day-to-day for someone who is not an athlete too.
So in terms of the first appointment with a sports psychiatrist, it’s probably not the same as what we used to see on TV. The appointment itself could take place in an office or for those that offer online therapy, it could be done virtually, so it could literally be done in the comfort of your home.
It may go up to an hour and the psychiatrist would just like to get to know you better. So we’re going to have a chat, I’m going to be asking you several questions. You know, for instance, questions about what brought you here today, what’s going on in your life right now. Questions about who you are as a person so for instance, what do you do for a living outside the athletic world?
Of course, how far do you go to school, your current family life or living situation, your support system? Questions about your lifestyle, so your perhaps sleep habit, your general stress level and how you easily cope with stress, things like that.
Questions also about your medical history, mental health history, what worked in the past, what didn’t work in the past just so we don’t go towards the same path if it’s unaffected and questions about your family history because there might be a role, a genetic role for some, if not most mental illness, as well as medical conditions too.
In addition, if you're seeing a sports psychiatrist, we would also be interested in learning about your training, and your competition. So take a look at your performance or your diary in regards to that, your sleep, your nutrition, your energy level, your history, your personal history of concussion, of injury and things of the like.
So after taking all that into consideration, we’re going to name the problem so we know what’s going on and together, we’re going to go over the diagnosis and answer any questions that you may have. After that, we’re going to go over treatment options, right? The pros and the cons of each option and then together, we’re going to decide what would be the next step moving forward.
So it could look like more tests for example if we need more clarification, it could look like talk therapy with or without medications and it could also look like, if you’re seeing me for example, talking about tips and ways to optimize your lifestyle just to get the biggest bang for your buck in terms of improving your mental wellbeing too.
[0:10:11.5] BP: For sure, which is so important especially when you’re going through this because I find emotional instability after a concussion is very frustrating and so is there any common misconceptions you get a lot when it comes to athletes coming to you for the first time?
[0:10:29.0] SP: Yeah, so I think again, because of you know, that training or conditioning, right? That we always have to tough it out in order to win and succeed as an athlete, there’s I think the stigma, in terms of mental health stigma is still out there. That’s number one I think and then the second thing is, it’s really hard to know that we’re having a problem when we don’t recognize that problem, right? Recognize the symptoms.
So I think the common misconception especially with regards to mental health and psychiatry is, if someone has been feeling down for a while for example, is this “still normal?” Is this just normal sadness or is this already considered clinical depression? And that misconception in terms of “naming the problem” I think tends to happen a lot as well.
[0:11:18.3] BP: That makes a lot of sense. I found it really hard, I used to just tell people that I didn’t have depression because it would go away the second my head pain went away. I was like, “It’s circumstantial, it’s only there. I only feel like this because my headaches hurt.”
That’s what I used to tell myself, was that, the second the headaches went away, the depression will go away because it match, that’s why it was there, the feelings of sadness and anger were related to that.
So I’d be like, “It will all be okay because once that pain’s gone, that will go away” but it’s not really how it worked because when said pain went away, the mental health and mental illness was still there.
So it was really tough but I do really want to talk about depression and anxiety and athletes after a concussion but we’re going to take a short break before we get to that.
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[INTERVIEW CONTINUED]
[0:13:42.6] BP: Welcome back to The Post Concussion Podcast with myself, Bella Page, and today’s guest, Dr. Sarah Pospos. So depression and anxiety in athletes are something. I think we miss but it’s getting better.
We talk about mental illness and things are a lot more than we used to but for myself, the anxiety of getting hurt was really high and the depression of one having to take a break was significant do you have any tips for athletes that are going through things like this?
[0:14:12.8] SP: Yes, that’s such an important point to make. I think first and foremost if you’re experiencing, you know, depression or anxiety especially after a concussion, please know that it is very common. It happens to a lot of us despite perhaps doing everything right by the book. It’s as common as it is in athletes as you know, versus non-athletes.
In fact, I just wanted to throw some statistics out there that anxiety is the most common mental condition in the US and only about a third of those with anxiety go on to seek treatment. Depression also is the number one cause of disability in the US and only about two-thirds go on to seek treatment.
So in terms of tips for those who are experiencing that right now, if you are in the middle of a depression, depressive episode or if you’re in the middle of feeling very, very anxious, it is very hard to see it objectively in terms of that’s, I mean, the symptoms are interfering with your life, your day-to-day but I want you to remember two key red flags.
One, if the symptom starts to cause severe intense distress in yourself or two if the symptoms in any way interfere with your day-to-day function. So that may look like, you know, if you are an athlete, it impacts your athletic performance. Perhaps it impacts your relationship with your family, friends or loved ones. Perhaps it impacts your work or your grades if you are a student as well.
If these red flags are occurring one or the other, please seek professional help. You don’t have to suffer alone and you know, for those with loved ones, the parents, the coaches, the support systems that maybe listening to if you are noticing these symptoms and these red flags in your athletes, in your loved ones, please nudge them in the direction of seeking help too because mental health is just as important as physical health.
Even though that recognizing symptoms part might be a hurdle at times because of the nature of the symptoms not being as visible as a physical injury per se.
[0:16:18.5] BP: Yeah, I wish it was visible sometimes, only sometimes. Sometimes I feel like I’d probably be afraid to walk around me when I was really depressed because I feel like this dark cloud was just like looming around me everywhere I went.
[0:16:31.8] SP: Right.
[0:16:32.8] BP: But I think it is really important to mention loved ones because I think we kind of forget but we can really help people when we start to notice like, you know, you are not acting like yourself and as coaches. I think coaches forget their role when it comes to mental health. They think, you know, “Oh you’re limping on the field. Okay, physical therapy, I am sending you there.”
But they forget that you might notice that your athlete is all of a sudden is really snippy with you or argumentative or really down on themselves every day. All of these tips of things are so important to recognize in them because if you are not recognizing it, you are kind of missing a big part of what is going on. So I think that’s really important to talk about and depression and anxiety in athletes is something really complicated.
Because your depression and anxiety when you are playing can be very different from when you are for example retiring. Have you done a lot of work with athletes who have had to retire from concussions and how has that gone?
[0:17:37.4] SP: Yeah, absolutely, a hundred percent agree because like you said, it’s a different season of life, right? In an athlete’s life, if I may put it that way and especially I think in terms of retirement from sports, it’s already a big change on its own. If it’s planned, plans like just you know, you’re going perhaps from high school and then you are going to college to be one level and then from college, you’re going to go to the pros.
Even with such “planned retirement” that changes associated with that, it is already so big. Imagine if it is unplanned, right? So perhaps a season-ending injury, perhaps not working with your personal coach because of a variety of reasons, perhaps just having to be forced to retire from sports because of post-concussion symptoms perhaps or another reason.
So it adds the complexity in layers in terms of life stressors that of course can affect someone’s mental state, mental well-being and mental health and it could go in the direction of making someone feel depressed or anxious as well, just increasing that likelihood of having this mental challenges down the road too.
[0:18:45.9] BP: Yeah and is there anything that you think athletes should really kind of consider or what they should do because, for myself, retiring was probably one of, it is on the list of hard things that I’ve done for sure and the mind like taking a break from it was really hard. Sometimes I recommend getting into the sport in a different way even if you are injured like you could coach or be a ref or somehow participate.
But sometimes you just have to walk away from it completely because being around it can be really emotional. So do you have any things that you kind of advise athletes when they are being forced to retire due to their health?
[0:19:25.1] SP: Yes, it is a very tricky place to be, right? Like you mention, it could go different directions in terms of being surrounded in that particular sport that used to be our whole life essentially, right? Before retiring. So I think one key consideration is athletic identity, which just means, you know, the association of an athlete’s self-worth, self-identity, who they are with that particular sport.
So it’s really important though perhaps hard to practice to remember and recognize that if you are an athlete listening, you’re more than your sport, you know? You are much more than that. You are someone very, very important even outside your sport. So when that sport got taken away in the context for example of an unplanned retirement, then you still feel, you still remember that you have a lot of things that you can contribute.
That you can live for that you’re, you know, have a big impact, impactful impact to your loved ones and that the second key thing that I would like to mention is to I know for a lot of athletes doing that particular sports is their coping skills. So when it gets taken away, it makes it so much harder to deal with stress, right?
To not be able to do that particular thing that makes you feel better when you’re stressed but perhaps you can add to your arsenal, add to your toolbox some other coping skills, supportable coping skills that you can do outside of your sports, that would be really helpful. So these coping skills could be like mindfulness meditation, which would really, really help in terms of calming anxiety, improving your mood, and improving your energy level.
Your rest, your sleep, your ability to focus as well as biologically at that brain stimulation growth factor or BDNF that helps with the function of our brain. It could look like deep breathing, deep intentional breathing with your diaphragm. So you know, you could count to six while inhaling, count to six while pausing, count to six while exhaling and repeat it a couple of times to switch from that anxiety state, anxiety mental state or it could look like, you know, perhaps making time literally scheduling time to do your hobbies.
Whether it is journaling, reading a book or what have you outside sport and incorporate it to you day-to-day routine or your weekly routine so that you have more options to de-stress whenever the sports for any reason gets taken away.
[0:21:55.6] BP: Yeah, so important that life after sport is huge and when you are a teenager, it really doesn’t feel like there is anything else but I promise you there is. There is a lot more to your life left and it doesn’t have to do with sports or it can just in a different way but I love the coping mechanism idea because that was something I really struggled with was number one, time.
My health wasn’t great, so it wasn’t a big issue at the start because I could just sleep all day because I am so tired because I had a lot of chronic fatigue but after that it was okay. Well usually, I would go riding all day all weekend. Every weekend was taken up, every morning was taken up. I was studying in the day, while I was at school what I should be doing next for sports.
Making nutrition plans, physical plans, all these types of things, so not having that all of a sudden, you have all of this extra time in your life. You’re like, “Well, how do I fill it?” or “How do I handle my stress now?” because for me it was a big stress relief. It’s like you can turn your brain off from everything else going on in your life when you are on the field in your sport, whatever it is.
Even if you play musical instruments that could be the same thing, where your brain just kind of turns off from the rest of the world and I really like those safe zones or I call them escapes. Like it is really nice to have an escape from your regular life because we all need one despite how amazing your life could be but I really like those and trying to find one that isn’t related to sports is really good because for me, I just kept looking for a new sport.
It’s like, “I’ll try this and this and this and this. This doesn’t cause symptoms for my headaches, let’s try this” but I love all the breathing apps. Headspace is one of my absolute favorites, I use it, if not daily, every second day at some point in the day or at night before I go to sleep or in the morning when I can’t get up and I find it really helpful because I am not great at doing it myself because I just sit there and then I ended on my phone texting or doing something like that, scrolling through social media.
So those can be really helpful because you just like put the app on your screen and then don’t touch your phone. It sounds bad but like, I don’t know, I am addicted to my phone and I can admit it. So it’s good to have a lot of different things for that and reading audio books are a great escape too if you have trouble with eye sensitivity and things like that. I really like them or this podcast, you know, I just have to put it out there.
But I think it’s really good to find coping mechanisms and remember it’s going to take time. The first thing you try might not work like I tried crochet, painting, I tried a few different things that I was terrible at like crochet is one of them. I still have a blanket that is half done from COVID that I think is at my parents’ house, those types of things. So it’s okay to try 30 things and then find the best thing.
Maybe you just keep trying new things because nothing works but maybe it is the exploration of trying new things that helps you but anything that can help, I strongly advice it because the stress is really hard and all of a sudden you have that time, you need stress relief. Like for myself, I talk about a lot on the podcast that I dirt bike now for my stress relief but I also have straight, like, safe coping mechanisms.
For example on Sunday, while we’re recording this, I was supposed to go and couldn’t because I woke up with a headache that morning and so instead of dealing with excruciating pain while riding a dirt bike even though I know I would be able to ignore the pain, I did other coping mechanisms to kind of handle my day. So it is important to have things that you can just do at home and not go out of the house because sometimes we need those too.
But I love that advice, I’m kind of obsessed about coping because we really need those and life after sports is huge. Don’t forget it, despite the fact that your brain’s telling you that there isn’t one and so I did want to ask, is there anything else you would like to add before we end today’s episode?
[0:25:53.5] SP: Yeah, absolutely. So if you're an athlete, you know, current athlete, aspiring athlete, a former athlete who just retired perhaps and you’re listening and you’re suffering right now, you know, I just want to highlight one more time, although we’re conditioned almost to always tough it out but at what expense, right?
At your well-being and I know, you know, as an athlete, time is literally a luxury, right? You may not have time right now with all that’s going on, the practice, you know, hitting the gym, the competition, what have you, life in general but if not now, when? Until things just snowball and get out of control?
So I’d like for you all, the listeners out there, to imagine with me. Imagine if you could feel your best again. Imagine if you could enjoy your sports, not just on the outside, not just superficially but truly, truly enjoy it on the inside like when you first started.
Imagine if you can feel your best again, perhaps outside your sports, feeling just fulfilled and content with everything in your life, with your relationship, your family, your work, your friends, your loved ones, your life in general. Please remember that your mental health is worth it. You are worth it and help is just a click, an email, a phone call away.
If you're struggling and you're in California and you don’t have any local psychiatrist right now, feel free to contact me at lifestyletelepsychiatry.com. If you're not in California but still feel that you might be benefiting from this steps that we talk about earlier, I also do offer additional free resources at my website, lifestyletelepsychiatry.com/subscribe or either in a way, you can always get in touch on Instagram at lifestyletelepsychiatry.com and also if you're experience concussion, please go ahead and check out all of Bella’s episodes on the podcast. It’s very, very helpful.
[0:27:50.1] BP: Well, thank you so much and we will have links to everything in our show notes and episode notes today. So thank you so much for joining us today and sharing your work with concussed athletes.
[0:28:00.3] SP: Thank you so much.
[END OF INTERVIEW]
[0:28:05.3] BP: Need more than just this podcast? Be sure to check out our website, postconcussioninc.com, to see how we can help you in your post-concussion life. From a support network to one-on-one coaching, I believe life can get better because I’ve lived through it. Make sure you take it one day at a time.
[END]
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