A psychologist explores the connection between sports and mental health

When I talk about mental health, one of the first things I hear from others is “Have you tried working out?”

I have. It works, at least for me. But why?

To understand the correlation between sports, or active living, and mental health I sat down with Marizabel Forno, a registered provisional psychologist with Shelly Qualtieri & Associates.

Forno grew up playing soccer, but after an incident that left her with an injured knee, she found an interest in psychology and a way to merge her love for sports and mental health. 

Now, Forno works with athletes to address mental health issues they might experience. She also supports retired athletes transitioning out of competitive sport.

Charlotte Vos: Can you give me a brief explanation of how sports and mental health are related?

Marizabel Forno: Sports and mental health are quite closely related. Oftentimes what we see in athletes is this whole acclimation to working within a team. Group cohesion is really important in managing different personalities, and managing our own experiences that we bring to the table and how those merge within a group setting.

We also have elements of performance anxiety and any sort of perfectionism that we bring to the table and how to manage those within our sport. We also have this whole other side of pre-diagnosed or pre-existing symptoms or conditions that we live with that seep into the sporting world.

Things like ADHD and hyper fixation, perfectionism, time management, those are things that seep into our sport and are things that someone like a mental health professional can help manage. Beyond that, we’ve got things like motivation. That’s a mental piece that is required in sport. And shifting our mentality within our sport because a lot of people become very outcome based. Things like process based goals and shifting to growth mindset, those are small snippets of how these two worlds merged together.

What’s the relationship between sports and social support?

There’s a lot of overlap between those. Oftentimes, depending on the sport, there’s that element of team cohesion and we’ve got the element of coaches. However, the experience of the athlete itself can be again very isolating. We’re working on our personal goals within the team and having social support that helps you with motivation, with keeping that positive growth mindset. Thinking about it from a different lens, keeping those social connections is really important in fostering the other elements of our identity that exist outside of sport.

Is there a difference between how competitive sports can impact and help mental health compared to non competitive sports?

It’s very dependent on the individual athlete. If we’re looking at competitive sports and non competitive sports at the elite level, there’s a lot of pressure that comes from potential fans, coaches, other teammates, ourselves. That added pressure will add to anxiety and increase performance anxiety. It can affect attention and focus. If we’re looking at less competitive or non competitive sports, that may still exist, but to a lesser degree, and so mental health is likely not to be as impacted. It’d be very dependent on the individual.

How can sports and physical activity aid in the recovery process for those people who have these pre-existing mental health disorders?

We know just based on research that physical exercise of any type is super important to our mental health. There’s a couple of different reasons for this. Physical exercise can actually help regulate your nervous system, which we know is taking part of that fight or flight process. So if there’s anxiety, if we’re feeling those depressive symptoms, that physical outlet is not only going to help you regulate your nervous system, but it’s also going to produce these happy chemicals that will increase a  positive mood. And we know that when we’re in that more positive fit space, we are more likely to recover from things like those depressive symptoms. It’s really important that we’re doing some sort of body movement.

Does burnout fall into the equation anywhere at all?

Burnout is actually a really big piece of the equation when we’re looking at elite athletes or professional athletes. We put so much work and so much time into our sport that sometimes we don’t see that there’s no balance happening in our life. When we neglect those other areas of our identity or of our being, we sometimes will hit that wall of burnout where we lose our passion for the sport. There’s more negative emotions that we tend to experience. We start to become very avoidant of the sport altogether and we start to question if we love this sport. ‘Do I want to keep playing?’ and ‘do I have it in me to do this?’ So burnout is huge. It’s really important that as an athlete, you’re not only putting time and effort into your sport, but you’re putting time and effort into friendships, into other interests that you have at the university level, making sure that you’ve got balance between school, sport, and home personal life.

Is there any way that burnout can be managed?

Absolutely. What I stress with my athlete clients is having that balance, but always focusing on your “why.” What we find with burnout is we feel like we have to engage in whatever it is that we’re working on. There’s that pressure of having to be perfect and having to do well in order to achieve our goals. However, being able to be aware of why we’re engaged in the sport and why it’s something that we love is fantastic. So we use that as a way to create that balance within your sport and that you’re doing what you need to do, but you’re also making room for those other areas in your life.

How about injuries, does that impact the mental health journey and the sports journey at all?

As athletes, there is risk for injury in any sport that we are playing. But what happens is we put a lot of pressure on ourselves. We’ve got to practice seven days a week, and then maybe an injury happens. Depending on where you’re at with your sport and what your current goals are, having to sit out for a practice or two can be really disheartening. If it’s a more severe injury where you’re having to look at surgery, or you’re completely taking out the ability to play, it has a huge impact on your mental health because now you’re feeling isolated, you’re feeling lost, you’re feeling symptoms of depression. Now we have this whole battle of having to heal our body and that’s a whole journey in itself. There’s so many different layers to injuries and we have no control over it either. That creates this anxiety piece.

When we’re ready to return to sport, there’s a lot of anxiety and fear over ‘what if my body’s not going to perform at the same capacity that it could?’ or ‘what if an injury happens again?’ We become more protective in our play, which overall impacts your kind of level of performance.

Is there a difference in the impact on mental health and performance between participating in solo sports and team based sports?

With solo sports, a different type of mental resilience is needed because it all falls on you ,things like performance anxiety, motivation, when it’s highly individualized, you don’t really have anybody to share that pressure with you. You often feel a little bit more pressure in those solo sports because there’s no one else to be accountable for the overall outcome. With the mental health aspect, it puts a lot of pressure on the individual versus if we’re looking at team-based sports.

In team-based sports, there’s the whole team that’s accountable for the outcome or to the overall team goals. When dealing with things like performance anxiety or recovering from burnout, there’s a social support system around that, and people that actually understand and share that with you. There’s a lot less pressure that I find for individuals, in terms of their levels of motivation and focus. Because sometimes the narrative is, ‘well, if I’m sitting and I’m not feeling focused, I’ve got six other teammates that can come in and tag in and it’ll be okay.’

Is there a difference in how male and female athletes experience the relationship between sports and mental health?

Typically what we see is that females are, off the bat, more susceptible to feeling a little bit more of those emotional pieces because it is more socially acceptable. Meanwhile, males tend to mask and they tend to take on that burden of ‘well, I just got to tough it out’ or ‘I can’t talk about this’ or ‘I have to be a man about it.’ So oftentimes what we see is females are more likely to engage in conversations around it. It’s easier for females to recover, to seek the support to recover from any sort of mental health processes that may be in place as they’re engaging in their sport.

There are definitely some differences in that social acceptability around how we experience mental health, especially in athletes. Which is why I’m so happy that nowadays is changing and we’re opening up that dream for them to be able to have those wonderful conversations.

Are there any other emerging trends in sports and mental health that you find promising?

I love that this is actually just a topic in general that’s popping up. You don’t see a whole lot of sports psychologists. Even within Calgary, there’s not a heck of a whole lot of us. I love that people are starting to understand that mental health isn’t something that’s exclusive to your personal life. It affects everything. And if we’re looking at athletes, there’s so much stigma around what it means to be an athlete, and I’m just so excited that we’re opening up the conversation, that we’re starting to put these pieces in place for athletes to have programs to help them.

There are programs that are starting to emerge to help athletes transition into professional athleticism, but also programs that are starting to slowly be a topic of discussion and helping them transition out. A conversation that I had a couple of years ago now with a retired professional football player was that it would be helpful if we have programs in place that help these professional football players transition out into the workforce, especially knowing that a lot of them have suffered many concussions in their lifetime, and knowing that returning to a traditional nine to five job may not exactly meet their cognitive needs. It’s also really hard to be going from using your body 24/7 for X amount of years to then transitioning abruptly out of that. That’s a conversation that’s starting to become a thing, transitioning to and from sport.

How can these programs be designed to promote mental health?

The biggest piece that is emerging from all of this is that we have a loss of identity. There’s grief and loss that is happening. There’s a lot of depressive symptoms because it is an isolating piece. For some people, they’re mourning this idea that they’re never going to be a professional athlete or that their career is over and they’ve achieved the most that they could have. It’s really important to have those supports in place to help breathe that loss, to reframe the way that they’re thinking of the world, to help them re-identify their strengths, to attend to that emotional fallout that tends to happen from that transition.

Beyond that, we know that, as humans, there could be a lot of pre-existing mental health conditions, and sometimes those emerge under high stress situations. So for transitioning to and from sport, or if we’re engaged at a high level of sport where there’s a lot of pressure, then those pre-existing conditions can be highlighted. It’s really important that we’re working with mental health professionals to support that.

What advice would you give to someone who’s looking to start a sport for mental health benefit?

Pick something that you really love. I know that sounds cheesy and obvious. Pick something that you love and make sure that every time that you’re practicing or getting on the field that you’re reminding yourself why you love that sport. Make sure that you are taking care of your whole being. Make sure you’re still connecting with your friends. Make sure you’re engaged in other hobbies. Really have that balance in your life. It’s gonna be really important if we’re doing sports solely for our mental health. It doesn’t have to be anything huge, you can go down in the basement and do a couple jumping jacks, and that’s amazing! You should be so proud of yourself for doing something for yourself.

How can individuals who don’t participate in sports because of something like physical barriers still find similar mental health benefits through physical activity?

If they’re injured and not physically able to do things that traditionally would be considered a physical activity, I would seriously lean on support like physiotherapists and chiropractors to see if there are any modifications that can be made. If you’re able to even just go for a brief walk, even just within your house, just to get that blood flow going, that’s also very helpful. If we’re looking at ways to regulate our nervous system that are physical, but don’t necessarily require you to be up and walking or running, there’s tons of different exercises that we can do for our body to get those similar neurotransmitters. We’ve got things like progressive muscle relaxation, where you’re tensing your body and then you’re relaxing it. Even deep breathing can give you some of the same benefits. It doesn’t have to be going out for a run or playing hockey. It can be very individualized to whatever ability the individual has.

Editor’s note: This transcript has been edited for length and clarity