Published March 2016


It’s normal to be anxious before a basketball: there’s a chance of physical injury, poor performance could lead to embarrassment and the team might fall short of its goals and lose. Many players harness this anxiety and use it to boost their defensive intensity or explosiveness towards the basket. But it’s not normal for the anxiety to become overwhelming and prevent a player from participating at all.

Unfortunately, anxiety disorders have derailed many basketball careers and there is not much awareness and acceptance of the issues. Players such as Larry Samders, Jason Caffey and Royce White have received counselling but have been unable to resume their careers after suffering from severe anxiety. So many athletes push through symptoms of cognitive and somatic anxiety that it can be puzzling when someone is unable to do so. More understanding, patience and flexibility in the process can lead to more positive outcomes.

Although anxiety is normal, an anxiety disorder is diagnosed when the symptoms of anxiety create severe distress and functional impairment in performing daily activities. Anxiety disorders affect about twelve percent of Canadians in a given year and it is the number one mental heath issue facing children and youth. Anxiety disorders include Social Anxiety Disorder, Post-Traumatic Stress Disorder, Panic Disorder, Obsessive-Compulsive Disorder, Acute Stress Disorder, Specific Phobia and Generalized Anxiety Disorder (Centre for Addiction and Mental Health, 2012).

Symptoms of Anxiety

Symptoms of anxiety disorders are more intense and irrational than what the situation would normally warrant (taking a deep breath before a free throw is normal, feigning an injury as not to shoot is excessive). People may experience physical, emotional, cognitive, psychological and behavioural reactions.

Note: Signs and symptoms for each anxiety disorder differ slightly. If the anxiety seems unduly severe or persistent, it may be necessary to seek professional help, including cognitive behavioural therapy or in-patient treatment at a local clinic. Coaches can provide guidance to athletes but they are not a substitute for emergency services.

Emotional Symptoms

Emotions can range from mild apprehension to terror. People may also display irritability, restlessness or tension. Many individuals suffer from anxiety and depression and the two conditions can aggravate each other, necessitating treatment for both disorders (Centre for Addiction and Mental Health, 2012).

Physical Symptoms

The body’s reaction part of the sympathetic nervous system – the fight or flight response – and is caused by stress hormones such as Adrenaline, Cortisol and Norepinephrine (Mumford, 2015, p. 103). Effects include rapid heart rate, shallow breathing or shortness of breath, perspiration, light-headedness, muscle tension, trembling and nausea (Centre for Addiction and Mental Health, 2012).

Cognitive Symptoms

The person focuses on the potential danger and may experience anxious thoughts (“I’m not in control”), anxious predictions (“I’ll make a fool of myself”) or anxious beliefs (“I’m such a loser”) (Centre for Addiction and Mental Health, 2012). These ideas may distract the individual or prevent them from performing a task, for example executing the team’s play.

Psychological Symptoms

Stress hormones are designed to help humans deal with dangerous situations but when the hormones are released as a result of everyday events, executive functions may be impaired. Overloading the hypothalamic-pituitary-adrenal axis for long periods of time can lead to psychological problems in youth, such as poor self-control, lack of focus, memory loss and depression in youth (Tough, 2012, p. 15).

Behavioural Symptoms

People may also develop behavioural symptoms such as avoidance of feared situations or subtle avoidance (Centre for Addiction and Mental Health, 2012). A player who is anxious about physical contact might avoid boxing out or driving to the hoop. Subtle avoidances on the basketball court could include removing themselves from play (asking to sub out or offering to sub out when a squad has an extra player), zoning out during the huddle as to not worry about the next play and speaking softly or evading eye contact when speaking with the coach.

Supporting Student-Athletes

If coaching an athlete, caring adults should do their best to welcome that player to the team and empower them to succeed. Coaches can be an ally who can alleviate the anxiety that stems from school, social situations and sports.

Eliminate Stigma

After winning the N.B.A. championship in 2010, Metta World Peace thanked his sports psychologist publicly, later acknowledging the stigma of mental illness faced by athletes. Other players later came forward to express their appreciation of World Peace’s gesture to make it more acceptable to talk about it (Holmes, 2015). Sometimes basketball players want to compete and hate displaying weakness so coaches can help by modeling tolerance for diverse groups and being non-judgmental when approached by an athlete.

Jared Casey struggled with the stigma of anxiety disorder when he collegiate basketball in the United States and Canada. For an athlete, it was acceptable to be sidelined with a physical ailment but mental illness was perceived as a sign of weakness. Coaches were constantly demanding more and more on the court and he was unable to cope (Casey, 2015).

High standards are paramount but a coach would never ask that an athlete with an injured ankle improved their performance on the Yo-Yo Recovery Test until they had addressed the underlying issue. Likewise, coaches have to support players who suffer from anxiety disorders and provide them with the coping skills that they need to alleviate their symptoms first.

When Jason Caffey suffered a panic attack and missed a Milwaukee Bucks charter, he was fined $63,000. Later, the team expressed support and helped Caffey obtain treatment (although Caffey later claimed that the fine was never rescinded). Caffey had been taking medication for anxiety but he had discontinued the medication because he felt that the side effects were impacting his performance on the court (Hunt, 2001). Anxiety – and the reaction of the rest of the league – was one of the factors that drove Caffey out of the league at the end of the next season.

Avoidance Learning

Mowrer’s Two-Factor Theory often contributes to anxiety. Firstly, a negative outcome is associated to a particular action, such as spraining an ankle while leaping for a rebound or missing a foul shot after driving to the basket. Secondly, a person begins to avoid the activity in order to relieve stress and reinforces the anxiety about the action, leading a player not to chase boards or play aggressively (Goldman, 2014). Avoidance learning increases the level anxiety because in the athlete’s mind, stress is always associated with the event and relief is attributed to avoiding it.

Avoidance will never address the anxiety so athletes cannot avoid the sport or action that causes stress (Goldman, 2014). Coping strategies that maintain an anxiety disorder should be discouraged. For example, Mike Krzyzewski was not an effective public speaker when he first arrived at Duke. North Carolina State coach Jim Valvano encouraged Krzyzewski to speak more and hone his skills. Valvano congratulated Krzyzewski on his sense of humour and pushed him to practice and develop his speaking skills (Feinstein, 2016). Now Krzyzewski is a highly paid and popular speaker for groups and businesses.

By sheltering youth from being uncomfortable, many parents also shield their children from the experiences that promote character growth (Tough, 2012, p. 83). Sport should be treasured because it can provide countless occasions to try and fail in a safe situation. Basketball coaches can delegate many little opportunities for overcoming anxiety, such as a 3-on-3 game where everyone must be involved with a play, leading the pregame warm-up routine or diagramming a play in a scrimmage.

Coaches must also be mindful of the physical component of sport. Before he begins to train with any athlete recovering from injury, Tim Grover insists that they perform a depth jump from a forty-eight inch plyo box and jump on to a second box of equal height. If they have been cleared by a doctor, he is not concerned about whether the player is able to jump on to the box but whether they have overcome the fear of landing (Grover, 2013, p. 48). Building confidence, acknowledging small success and creating spots for role players to succeed and enable athletes to meet even greater challenges.

Examples of slight avoidance in a basketball environment include athletes who joke in a training session because they feel like they cannot perform the exercises or the movements or someone who misses a challenging workout because they do not want to make a mistake. In these cases, coaches should balance the discipline that holds players accountable with the encouragement that empowers them to succeed.

Locus of Control

Ray Allen suffered from Obsessive Compulsive Disorder during his N.B.A. career but the condition dovetailed effectively with his desire to become a great shooter because it provided motivation for his meticulous pre-game routines. Allen demands that coaches show game film multiple times so that teammates can pay proper attention and encourages others to take more care in their personal appearance, a trait that he acquired as a teenager watching how Michael Jordan dressed.

From his days as a young player, he could get frustrated if he could not finish his routine. Allen’s teammates tolerated his lengthy and detailed pregame routines; many teammates over the years were inspired to adopt his custom of showing up hours before the game to work out. This dedication honed his accurate form and precise footwork. Routines and rituals also instill a feeling of control before an uncertain event like a basketball game (Lang, 2016). Basketball players must balance practical training with calming rituals during their preparation.

But players and coaches also help Allen keep things in perspective, in case a workout is disrupted by a scheduling change or another factor beyond his control. Even Doc Rivers had to remind the veteran that his role had changed and he had to adapt. Allen’s interactions with Paul Pierce during his time with the Celtics show that teammates can disagree respectfully without becoming resentful. That championship Boston team showed how selflessness and compromise can bring disparate personalities together (MacMullan, 2008).

Little Things Matter: Allen was confident despite his anxiety because he was very diligent in taking care of the details. Due to his precise routine, he knew that he could execute every task to make a shot. During the 2008 N.B.A. Finals, he set his man up with a fake, faded a screen to the corner, reverse pivoted and drained a three with perfect form.

Royce White suffers from Generalized Anxiety Disorder. Despite the fact that the Houston Rockets drafted him sixteenth overall in 2012, White was unable to stay in the league due to conflicts about his condition and how he handled it. Nevertheless, his success beforehand can provide some lessons. Iowa State Coach Fred Hoiberg would compromise and let White drive to a particular game if he asked, instead of blindly enforcing a team rule, and would spend hours talking in his office to help resolve a dilemmas. White’s high school coach Ken Novak was the first person who encouraged him to seek counselling, which help explain some of his anxiety symptoms and understand his body better (Abrams, 2012).


When the sympathetic nervous system is activated, all of the symptoms of stress manifest themselves. The body’s reaction to this is the parasympathetic nervous system which relieves those systems. A neurochemical called acetylcholine is released to relax the body. Athletes can activate the parasympathetic system by practicing mindfulness (Mumford, 2015, p. 104).

Selective attention is necessary to cease focusing on past event and move on to the next challenge, a key attribute for basketball players. Failing to focus selectively and ignore emotional distractions can lead to chronic anxiety, depression or panic (Goleman, 2011). Basketball players can work on a one-pointed focus, such as their breathing or a key word: when they lose focus, they bring their mind back to the point of emphasis.

Awareness of breathing – concentrating on one’s breath in order to become attuned to one’s body – is an effective method to relax the body and lower the heart rate. Taking slow deep breaths (such as four seconds in and four seconds out, also called “square breathing”) allows one to focus on what is happening now (Mumford, 2015, p. 110). Athletes may also want to use other cues, such as positive self-talk, a spot on the gym wall or a key word to regain their composure. When frustration in games would boil over and lead to technical fouls, Larry Sanders began writing bible verses on his hands to glance in order to calm down (Arnovitz, 2015).

All athletes could benefit from meditation but it is a coping skill that is especially useful for those with anxiety. Meditation involves sitting still, conscious breathing and becoming aware of what’s around you. Players may choose to perform a body scan to observe how they are feeling or listen to their surroundings. They learn to identify how they are feeling and comprehend that their emotions are not permanent states (Mumford, 2015, p. 78).

Even fifteen minutes of meditation can be constructive. Start with a small amount of time, such as a couple of minutes and move from there. Creating a quiet place in a meeting room can remove athletes from the commotion and distractions of the gym. Larry Sanders describes the benefits of meditation, describing it as being the supervisor of one’s thoughts (Arnovitz, 2015).

Good teams experience about three good feelings for every negative one. Coaches should adopt a positive bias, discouraging anxious athletes from focusing on their weaknesses and emphasizing their strengths (Goleman, 2011, p. 173). For a player who wishes to play in the N.C.A.A., a coach can help create some concrete and specific goals along a path that would achieve success. The coach and player could discuss how each could contribute to the goals and achieve success, such as boosting marks in core subjects, improving athleticism or developing skills on the wing.

Coaches can also eliminate distractions for players struggling to do so. A player who feels uncomfortable training and making mistakes in front of others may benefit from private training sessions until they become more comfortable with their skills.

Supporting Athletes: After Christian Laettner missed the front end of a 1-on-1 early in his freshman season, Mike Krzyzewski consoled him and told him that he would never miss a big shot again and that he should keep his head high because he is a good player (Feinstein, 2016, p. 230). Krzyzewski prevented a single negative event from becoming a source of anxiety and Laettner would go on to make several big shots throughout his collegiate career.

Health & Wellness

When Steve Kerr became coach of the Golden State Warriors, he established an organizational culture that would help build a championship team and enable these extraordinary athletes to achieve peak performance. The team’s core values are joy, mindfulness, compassion and competition. By focusing on positive concepts, such as joy and compassion, Kerr is eliminating potential sources of stress (Boyce, 2015). When he became coach in 2015, Kerr decided to emphasize wellness, for example allowing the team extra rest by travelling the next day and using technology to monitor players for potential injuries.

Adolescents who reported disruptions in sleep duration and quality were found to be at a greater risk of anxiety disorders. There is a bidirectional between anxiety/depression and sleep, since stress may cause a person to wake up throughout the night or feel drowsy during the day (Alvaro, Roberts, & Harris, 2013, p. 1063). Coaches can emphasize the importance of sleep by planning schedules in training camps to allow players to sleep at least eight hours, improving sleep quality by limiting the use of phones at night and intervening when necessary.

Physical activity produces endorphins, which combat stress and enhance quality of sleep. In some cases, exercise is as effective as medication for anxiety disorders (Anxiety and Depression Association of America, 2014). An athlete who is feeling stressed would benefit from attending part of a practice: even a small amount of physical activity is beneficial and it would permit them to remain socially connected to the team. Setting small achievable goals helps grow their role and return to full participation.

Exercise can lower heart-rate variability and reduce some of the harmful effects of stress. Students who participate in a regular exercise program experience less stress during exam periods, indicating a healthier physical and mental response to anxiety (Hutchison, 2016). Even during a period of heavy academic, encouraging student-athletes to attend a vigourous sixty or ninety minute shooting or skill development session can improve focus and reduce anxiety.


Jerry West felt driven as a player, coach and executive because he worried as a young man growing up in West Virginia that he would never amount to anything. Despite his enormous success in all facets of the sport, West still suffered from anxiety and depression. He would push himself harder and become devastated by losses yet rarely satisfied by victory. Stepping away from the game became a relief (West, 2011, pp. 207-30).

Sanders cautions against labels: he was always a complete person – not just a basketball player – and could never be defined by a single characteristic. He loves basketball but there are other important factors in his life and he cannot find satisfaction solely in his work. Sanders walked away from a multi-million contract with the Milwaukee Bucks because of anxiety and depression. For him money or athletic success was not a path to wealth and happiness but his personal values and the people around him (Sanders, 2015).

All things considered, basketball coaches coach people, not players. Coaches always want to help athletes improve on the court but the priority is helping people off the court. Dealing with anxiety disorders enables coaches to do both but the priority is developing youth who are happy, independent and satisfied.

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