Brandon Brooks is a star, there’s no denying that. The Philadelphia Eagles’ starting right guard is a two-time Pro Bowler who was indispensable in the team’s first-ever Super Bowl victory. He’s also thrown up every morning before a game since his second year in the NFL, six seasons ago. Sometimes, this condition has elevated to the point that it’s caused him to miss games.
“I don’t remember good plays, I only remember bad plays, plays that I should have done right,” Brooks once said of what causes his unease.
For 40 percent of adults in the United States, this might sound familiar, if not at the same scale. It’s called “performance anxiety” and can affect anything in your life, from sports to work to things as routine as parenting and making dinner.
It can affect anyone at any time. The condition does not distinguish between elites and amateurs, seasoned professionals, or those just beginning.
“In general, performance anxiety can be described as a sense of apprehension in engaging in tasks in front of an actual or perceived audience,” says Lily Brown, PhD, of the Penn Center for the Treatment and Study of Anxiety. “At some point there will be an evaluation, and the fear of failing or not performing leaves a person feeling incapable of being around said activity. We tend to see this with athletes, those participating in public speaking events, and even those taking tests.”
So how does someone go from any level of confidence to being afraid of something they once loved?
“The source of performance anxiety varies from person to person,” Brown said. For many though, performance anxiety develops from encountering an actual event where the outcome is a negative one. “After a negative experience, that experience becomes paired with the activity going forward,” Brown said. Once this pairing has been established, the individual suffering from performance anxiety will do whatever they can to avoid the traumatic experience. “For example, an athlete might call out sick to avoid practicing or competing in a game or match. Initially, they’ll feel a sense of relief, but over time, the sense of trepidation towards engaging in that activity becomes even greater than before.” As people cycle through these actions of avoidance, the less confident and more anxious they feel.
Luckily, there are easy ways to treat performance anxiety that have practical uses for everyone. Cognitive behavioral therapy (CBT), a type of therapy that focuses on how our thoughts can affect the way we feel and act in certain situations, is one method. CBT is not only useful for performance anxiety, but over the last 50 years has transformed the understanding and treatment of a wide variety of disorders, including depression, suicidal behavior, generalized anxiety, panic attacks, and schizophrenia. The so-called “Father of CBT,” Aaron Beck, MD, now an emeritus professor of Psychiatry, pioneered this form of psychotherapy, which revolutionized the fields of psychology and psychiatry, moving away from the Freudian and behavioral theories that dominated the professions in the 1950s and 1960s.
Part of overcoming performance anxiety is also the examination of how an individual has stopped living their normal life, or exposing oneself to whatever the source of anxiety might be. “It’s really the act of getting back on the bicycle,” Brown says. Reducing sources of anxiety is also important. Once these steps have been taken, it can be possible for patients to rediscover the enjoyment and fulfillment in the activities they are passionate about.
Even for those who overcome their first bout of performance anxiety, many will experience a “return of fear” at some point. Brooks said he’s gotten help to avoid missing games, but still gets sick before every game. However, once patients have been empowered to address their anxiety, the extent of symptoms is typically less severe. Continuing exposure to these activities and continuing to work with a therapist can prevent a relapse.