When we think of traumatic incidents, we think of near-fatal car accidents and natural disasters. But there is a demographic that is also unknowingly suffering from the effects of trauma: athletes. Placed in high-pressure, sometimes dangerous situations, athletes often endure physical and emotional traumas that wreck performance on a consistent basis. This Is Your Brain on Sports explores the issue of trauma and what can be done about it. It’s useful not just for athletes and coaches, but for anyone who is looking to understand how trauma works.

There is an epidemic that is quietly wreaking havoc on the performance of athletes in every sport at every level: Repetitive Sports Performance Problems, or RSPP. The timid goalie, the gymnast freezing before a backwards tumble, a pitcher struggling to keep pitches in the strike zone, the tennis player who can’t serve the way he used to: these are often dismissed as mental weakness or flagging will. The remedy from sports analysts, coaches, and parents is simply “suck it up,” “get your head in the game,” and “try harder.”

These glib responses fail to address the true problem. They often deepen the athlete’s self-frustration and worsen his performance. Even sports psychologists fail to dig deep enough. While retraining self-talk, cultivating mental toughness, and strengthening powers of concentration are important, the common sports psychology approach ends up reacting to symptoms instead of exploring roots. Thus, athletes practice mental techniques that provide temporary relief but ultimately fail them when confronted with circumstances that trigger a fear response.

What these athletes are suffering from is a form of post-traumatic stress disorder, referred to here as sports-traumatic stress disorder, or STSD. The fear that athletes suffer can be traced back to the injuries and near-injuries that they’ve sustained over the course of their lives. Players are often exposed to physical and emotional traumas. These accumulate in the subconscious and inform responses to similar situations. This can take the form of freezing, anxiety, dissociation, or withdrawal, but fear of “it” happening again is at the root—even when the athlete doesn’t know what “it” is. This STSD reaction cripples the natural, uninhibited style of play so critical to athletic success and leads to Repetitive Sports Performance Problems.

We’re familiar with the expression “deer in the headlights.” When placed in those high-pressure, high-risk situations, athletes with STSD-fueled performance problems tend to get that deer-in-the-headlights look. This is because humans often react to fear in the same way as their mammalian relatives. At the heart of the RSPP are the same survival mechanisms that all animals possess, namely, fight or flight. In the presence of fear, a series of neurological signals are sent to the body: adrenaline production increases, which elevates heart rate and breathing, slows digestion, and tightens muscles. This reaction makes sense when an organism is faced with real peril, but when it is tied to performance it’s debilitating. It ruins the athlete’s ability to stay relaxed, focused, and limber.

Most people are familiar with the body’s fight-or-flight response. Far fewer know that there is a third component of the body’s fear response: freezing. Psychologist Peter Levine has written extensively about this in his book Waking the Tiger—Healing Trauma.

Beneath the mammalian brain which controls the flight-or-fight response is a still-more primordial, reptilian reaction. When the options to fight or flee are no longer available to the animal, it will freeze. A predator will not attack an animal it believes is dead. This is a last resort, an attempt to trick the predator into walking away. Another benefit of freezing is that it numbs the animal’s pain receptors, minimizing suffering in the event that the predator does decide to devour its cornered prey.

Should the predator walk away, the nearly-predated animal will actually shake off the traumatic experience. It will tremble for a bit, and then return to its natural state, no worse for the wear, with no residual effects from the near-death incident.

Humans naturally fall into this frozen state, but, unlike our animal forebears, we don’t automatically shake off traumatic experiences. There are often physical and emotional  leftovers that linger on in the form of helplessness, panic, avoidance, and flashbacks—all of which are evident in any athlete coping with RSPP. Future incidents that mirror those original experiences will trigger the fight-flight-freeze response.

So what constitutes these traumatic experiences? For this discussion, the definition has been broadened beyond the life-threatening situations that most people think of to include physical injury (on or off the field), narrow evasions of hard hits, or witnessing someone else incurring a dramatic physical injury. These injuries can be anything from a sprain to a break to a concussion.

The emotional portion of the trauma can be the result of uncertainty, not knowing exactly what’s wrong and wondering if it could end a career. The meaning and weight of the incident is determined by the person experiencing it. Coaches, teammates, and parents can influence the interpretation of the event. The “tough it out” bravado of many coaches can also be damaging. Lack of empathy often compounds the emotional side of trauma.

These accumulated physical and emotional traumas are the base underlying an athlete’s repeated performance issues. An injury is often a blow to the athlete’s illusion of invincibility. For a person who considers physicality, fitness, and strength as marks of identity, this can be shattering.

A coach’s job (and the parents’) is not simply to create athletes who succeed, but to help shape kids into complete, well-adjusted human beings. They must be viewed as people first, and athletes second. Sports are a wonderful opportunity to learn perseverance, cooperation, and other important life skills. When winning becomes the only objective, athletes begin to evaluate their significance on the basis on their performance.

Some coaches operate from a win-at-all-costs paradigm. Players are expected not just to play hard, but to be willing to sacrifice their bodies for the success of the team. This thinking makes players subordinate to accolades. Obsessing over athletic performance exacerbates RSPP and is also part of the reason for the growing steroids problem.

We have to lose the one-dimensional view of athletes. They are people. Even when they are brought to therapists, it is not with the intention of restoring psychological and physical wholeness, but “fixing” the problem as soon as possible so the athlete can get back to performing well. Athletes come to sports psychologists about a current problem, so injury history is often ignored.

The pressure that some coaches put on players is a traumatic burden in and of itself, especially when coaches are prone to anger. Their use of goals may start as a structure for motivation, but it can often become a prison of pressure. The obsession with outcomes can make players slaves to their performance, and this is incredibly destructive. The thought “What if I’m not able to accomplish this?” is doubly paralyzing because it is unnecessarily future-oriented, something that is uncertain. This kills self-confidence, distracts the athlete from the challenge immediately at hand, and causes muscles to tense in conformity with previous traumas rather than remain in a limber, relaxed state, leading to further mistakes.

Perfectionism is a double-edged sword. It can push a player to perform at a high level, but it can also demoralize. The problem with aiming for perfection is that 100 percent of people fall short of achieving it.

It is important to understand how the brain processes and stores life experiences. Each of us has had numerous experiences, some positive, some neutral, some negative. Like any other organ, the brain does its best to heal and restore the individual to a state of equilibrium.

At its best, the brain takes the important parts of each of these experiences and integrates them into lessons learned. The brain “digests” experiences so we can respond to future similar incidents in a fitting manner. We don’t relive the experience and all its accompanying sights, smells, sounds, physical and emotional feedback. In a word, our past informs our actions, but it does not control them.

In the instances of trauma, however, negative experiences are preserved instead of “digested.” Thus, the distressful incident stays unprocessed, perfectly crystalized in harrowing detail. This nasty chunk of experience stays lodged in the system, relived every time similar circumstances arise in the weeks, months, even years to come. One professional soccer goalie from Sweden found anxiety rising and confidence dropping whenever there were stormy, overcast skies and slick ground underfoot. As it turned out, this goalie’s two traumatic injuries both occurred under similar conditions.

Athletes do not have an explanation for where the confusing, shattering feelings originate. There’s no rational explanation for them. Athletes feel “off,” but are unable to articulate why. This is because the feelings are linked to traumas that are embedded in the subconscious. There is no control over the feelings. This is why the typical counseling process of “talking it out” is unhelpful, because the athlete is drawing from the conscious brain. They miss what’s going on. They mistake the negative self-talk, nervousness, and anxiety as the causes of poor performance, rather than the results of deeper trauma for which no amount of talking can elicit an explanation.

The only way for athletes to truly get past their trauma-induced performance problems is for the trauma or negative moments to be fully processed, so they can compete without being hampered by past experiences. Instead of tampering with the fruits, though, treatment must get to the roots. Brainspotting Sports Work is an innovative new approach that avoids the pitfalls of traditional sports therapy.

One critical piece that many sports psychologists miss is the athlete’s body. Verbal reporting is not enough. To understand the athlete’s predicament, an exploration of bodily sensation is imperative. It is here that the clues to the individual’s RSPP are hidden. Brainspotting works through the traumas without bringing them to the fore of consciousness.

The process begins with the athlete discussing the repetitive problem, explaining what she feels and when she feels it. This is followed by an exploration of the roots, which involves a thorough investigation of individual histories, including an account of injuries and traumas as far back as can be remembered. Even if an event would be considered innocuous by the parents’ or a coach’s standards, what matters is how the player has internalized and interpreted the event. So even a humiliating comment from a teammate or getting shouted at by a coach may constitute trauma.

It’s also important to bear in mind that a memory might not be recalled by the mind, but the body remembers all the injuries it’s accrued. This is common in male athletes, who are told to brush off insult and injury as “no big deal.”

Brainspotting acknowledges that every case is unique and must be treated as such. The treatment is an exploration. Believe it or not, the most important Brainspotting technique is identifying location of trauma by observing eye position. The participant is asked to picture himself in fear-inducing situations, be that by trying to hit a fastball or attempting an ambitious tumble on the balance beam. Once the athlete has identified that situation and is envisioning it, he is asked to rate the intensity of the activation, on a scale of one to ten. What bodily sensations does the mental scenario elicit? What part of the body do the sensations affect? What is the texture of those sensations? Once in that state, the therapist will move her finger or a wand slowly across the athlete’s visual field, carefully monitoring the athlete’s eyes for freezing, as well as for signs of rapid breathing or gulping for air. Once that eye position has been isolated where activation is most intense, the therapist holds the wand in that position and asks the athlete to maintain his gaze. In this manner, the trauma uncoils and is resolved without retriggering it.