Q&A with Austin FC Sports Psychologist Dr. Hillary Cauthen

When we think of elite athletes’ visions of statuesque physiques and robust physical health, come to mind. But what about mental health?

Perhaps in the haze of amazement and kinesiological wonder we feel over professional athletes’ physical prowess, we tend to overlook what is going on mentally. Yet research shows up to 35% of elite athletes have a mental health disorder. The challenges of sustaining mental health and a high-level sports career are numerous but not impossible.

Dr. Hillary Cauthen, PsyD, CMPC renowned sports psychologist and Director of Organizational Wellness & Performance for Austin FC, is an expert at assisting players in succeeding psychologically.

This week I had the privilege of speaking with Dr. Cauthen about common psychological problems elite athletes face and what it takes to sustain mental health throughout their careers.

Lauren Hudson: What do you find is a common mental health problem specifically for athletes?

Dr. Hillary Cauthen: We see a large [amount of] anxiety and depression (research has shown this too). They’re the general common diagnosis we see across the board. Athletes are no different; they’re people first, but in these high-performance domains, anxiety and depression are two very heavily focused symptomology that is presented, if not fully warranted, as a diagnosis. We may see other sports populations bringing up…eating disorders or disordered eating patterns that are prevalent. We may see some trauma stuff that exists. There are some toxic cultures that exist as well. So, there’s trauma that occurs in sports, whether it’s from an injury or just a toxic environment.

LH: Do you think it’s difficult over the course of a long career to sustain a healthy mindset for athletes? What do you find in your practice?

HC: Sustaining healthy mental lifestyles is really hard for all of us. Systemically and socially, we could do a better job of teaching preventative mental health care and mental health as [well as] we do physical health. [From] zero to eighteen in the US, you bring your child to the pediatrician. It’s a standard well-check. We’re not doing that for mental health, but we could, and it could just be [about] checking in, teaching them, education around [subjects] like ‘What are feelings? What are appropriate coping responses?’ Prior to problems existing.

I think with athletes in general, depending on how long they’ve been participating in sport (most often, we see they participate in youth sports, and age 13 is the drop-off rate) if they’re continuing, this is a large part of their identity and identity formation.

There are ebbs and flows in a person’s career where burnout can definitely be prevalent and exit transitions [occur]. I think the hardest one we see is high school to college. When you’re used to being the best, and now everybody’s the best. How do you adapt to that? And if you make it past that hurdle, you go professionally, and the same thing happens again. Athletes have little control over the environment that they’re in. They show up, and they’re told what to do; they have to perform at this level, but there are nuances of who gets playing time, who’s starting, who makes rosters, and how much you make. It’s based on the organization’s system of evaluation. The player can do everything possible…and still not have the outcome that they’re seeking. It takes a mental toll to maintain the choice to keep showing up and fulfilling while trying to aspire to their dreams.

The other thing that happens in the professional realm [is that] men and women have different trajectories based on when they become parents. [Women may] have to have an early retirement [affecting] the longevity of what their career can be like. We see a lot more women that are coming back into sports post having children, especially with the women’s national soccer team – which is amazing to highlight. We also see women who are ending their careers because they want to have a family, whereas men don’t have those lifestyle situations. They can be a parent and still be a competitive athlete. They can choose to continue their career with longevity. There are different milestones of marriages, birth, death of partners, [these are] things that exist that also impact their mental health.

Transitioning after that is really hard. We need to set up this plan better. In the field, we are working on this, working on how we [can] assist athletes in transition – but the reality of it is athletes never want to quit.

There are identity crises that can exist. Is there any ideal way of retirement? It can sound nice, but it’s still a loss…whether it’s your choice or an injury that takes you out of it. So, rebuilding the sense of self is a large component that needs to happen. The aftercare that we can provide…for these athletes is much needed.

LH: What practices do you specifically do with your clients to help them overcome some of these things?

HC: I’m really big on mindful meditation work. I think that’s very important for them to learn to be in their thoughts and their feelings, utilizing breath work. Breathing is such an essential tool –  intentional breathing. It’s a game-changer. [Then] reflective writing, as cliché as a lot of people think journaling is, the process of reflection and writing is so powerful. It can reframe the way our brains think. Obviously, talk therapy is great for talking through the process. There are different skills in how we manage emotions. What are coping skills you might have? I like to work in frameworks, [for example] we all have these buckets in our life that we have to sustain, and sometimes we pour more into one, like work, and we forget about the social side of things. I might encourage someone, ‘Hey, go hang out with friends outside of here. Go have dinner…Enjoy life.’

LH: It sounds like there are a lot of different techniques that you can use with your clients. It’s not simply limited to talk therapy?

HC: No, and every athlete is a little bit different. Some prefer to just talk. We talk through things, and I help them make meaning of their work. While others, it’s much more hands-on, for example, ‘Let’s do some mental drills’. I teach them how to do concentration focus grids…and then we have a check-in. Mindful coloring is a new practice that I integrate because there’s a connection to the brain. When you color, in this present moment, it will signal the amygdala to decrease the fear of fight-flight response to your brain. This can help with anxiety. [There are] little cues that are preventative in nature, [the athlete] might not be anxious at that moment, but if they are coloring, eventually their brain can respond quicker and calmer. We may also do yoga, which is a part of experiencing emotion through the body and a somatic release. There are a variety of things that we work through.

LH: It sounds very person specific.

HC: Yes. Team-specific, person-specific, the journey is theirs, and the team and the culture we work through is theirs. There are educational moments, intervention moments, and free space and autonomy of the athletes I work with to bring me what they need to work on.

LH: Do you think that mental health is encouraged in the world of elite athletes? Or is it brushed off as more of a secondary concern?

HC: I think it’s been trending in the right direction since 2015 to have it be [focused] more permanently there. We see job increases. We see collective bargaining agreements within sports organizations that require either someone onsite or require someone at least contractually available as a resource. I think it’s just beginning. It’s not fully integrated. The roles I [occupy] have never been full-time; they’re still limited access and restricted by time, and there is the financial [component]. While the prevalence is increasing, we still have a long way to go to make it normal and accessible to all populations.

LH: Do you have any advice for athletes looking to improve their mental health in the future?

HC: I think they can…start by reaching out to someone or exploring it. There are tons of online resources for them to start with. There are podcasts, books that they can read, and YouTube videos. There’s a lot [of information] that is readily accessible to learn about [mental health]. I think the first phase is to check in with yourself and explore how to improve this. The best advice I give is – there doesn’t have to be a problem that is existing that warrants you to get help. You can utilize this idea – I always say, ‘The heart and the brain are muscles that we have to train no different than our body. If you’re going to train your body physically to improve, you need to improve the whole aspect of the body. That includes emotional and mental capacities as well.