Speaking of Psychology: Sport psychology, peak performance, and athletes’ mental health, with Jamie Shapiro, PhD

The mental health of athletes has been in the news a lot this year, thanks to Olympians Naomi Osaka and Simone Biles. The attention may be new, but the field of sport psychology is not. How do sport psychologists work with athletes? How might athletes’ mental health affect the public perception of mental health? As a mental performance consultant for the U.S. Paralympic team and a former competitive gymnast, Jamie Shapiro, PhD, understands the challenges athletes face.

Jamie Shapiro, PhD, is an associate professor and the co-director of the masters in sport and performance psychology program at the University of Denver. She is president of the Society for Sport, Exercise and Performance Psychology, Division 47 of APA. She also works as a consultant with Sport & Performance Excellence Consultants based in Denver, Colorado, where she consults with youth, collegiate and elite athletes from a variety of sports, including gymnastics, skiing, snowboarding, soccer, and more. She has a particular interest in working with athletes with disabilities and has worked as a mental performance consultant for the U.S. Paralympic team. She is also a former competitive gymnast and gymnastics coach.

Kim Mills: The mental health of elite athletes has been much in the news this year. In May, tennis star Naomi Osaka withdrew from the French Open, and then from Wimbledon, saying she needed to focus on her mental health. At the Olympic games in Tokyo, gymnast Simone Biles, the greatest of all time, skipped most of the competition because of a mental performance block. And sprinter Noah Lyles, who won a bronze medal in the 200-meter dash, spent much of his post-race interview discussing his battle with depression and anxiety. The world has noticed. One media analytics company found that in the week following Biles' withdrawal from the Olympic competition, more than 9,000 news stories generated more than 2 million social media interactions that mentioned the gymnast and her mental health.

This media attention may be new, but the field of sport psychology is not. Psychologists were on the ground with the Olympic athletes in Tokyo and an increasing number of professional and college sport teams and athletes at all levels now hire sport psychologists to improve their game.

So what is sport psychology? How do sport psychologists work with athletes to improve their performance and their mental health? Is there a role for sport psychology outside elite athletics? How does it relate to performance generally? And how might the discussion around athletes’ mental health affect the perception of mental health in the United States and around the world? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.

Our guest today is Dr. Jamie Shapiro, an associate professor and the co-director of the masters in sport and performance psychology program at the University of Denver. Dr. Shapiro is president of The Society for Sport, Exercise and Performance Psychology, a division of APA. She also works as a consultant with youth, collegiate, and elite athletes from a variety of sports, including gymnastics, skiing, snowboarding, soccer, and more. She has a particular interest in working with athletes with disabilities. In 2018, she traveled to Pyeongchang, South Korea, as a mental performance consultant for the U.S. Paralympic Team. As a former competitive gymnast and gymnastics coach, she understands from personal experience many of the challenges that athletes face. 

Thank you for joining us today, Dr. Shapiro.

Jamie Shapiro, PhD: Thank you so much for having me. I'm honored.

Mills: Let's start by talking broadly about what sport psychologists do. I mentioned two different things in the introduction, athletes’ performance and their mental health. How are those two things related and how do sport psychologists deal with both of them?

Shapiro: Sure. So what I want people to know is that sport psychology isn't simply doing therapy with athletes, there's more to it, and a lot of that encompasses the mental performance that you mentioned. And so what we're trying to do with enhancing performance is helping athletes to perform consistently at the upper level of their capabilities, and we work on various mental skills to help them do that. Everyone has mental health, it's on a continuum. So we might say everyone has mental health, not everyone has mental illness. And then there's some places in between. So there might be clinical mental health disorders where someone would fit the diagnostic criteria, for example, in the DSM-5. And then there could be subclinical mental health issues where someone is severely distressed, but maybe they don't fit the criteria for say, depression, anxiety, OCD, et cetera. And then there are just stressors of the human condition. As you know, we all experience stress and then athletes experience specific stressors to their athletic realm.

And so people are trained in sport psychology also on a continuum, where there are some people who are trained in that sport science, some are trained in that mental performance aspect, and there's actually a certification called a certified mental performance consultant through the Association for Applied Sport Psychology. And those folks focus primarily on mental performance. And then there are licensed mental health practitioners, and some people have all of those credentials and some people have one of those credentials. And so someone's education and training in this field would really help determine what they're competent ethically to work on with athletes and performers. So someone like myself, I have a master's in counseling, I'm a certified counselor, but I'm not a licensed mental health practitioner. I am a certified mental performance consultant.

And so the role with the teams and athletes that I work with is focusing on that mental performance, helping someone try to excel. They might have some anxieties or struggles in athletics, so I'm trying to get them back to baseline, but I'm really trying to get them to excel above what their baseline functioning was. Whereas when we're thinking about mental health, or mental illness, or just some of those subclinical issues, we're really trying to do some therapy to help someone get back to baseline. So you could think of that continuum, where are we trying to restore them to their baseline functioning, where they were before the struggle, or are we trying to get someone to excel above that baseline level?

Mills: So I get that you're working on the excel part, but if an athlete also has some performance anxiety, can you counsel around that even though you're not licensed in that area? How do you stop yourself? You know how to do it.

Shapiro: Absolutely. So it's not just helping people excel, I think I wanted to mention that because a lot of people think, well, if I'm working with a sport psychologist, or someone in the field, or a mental performance consultant, there's something wrong with me, and that's not necessarily it. There's this educational part where it's almost like coaching the mental aspect, we call it consulting in our field, but consulting on the mental aspect and nothing has to be wrong with you, it could just be, we're helping you excel even more. However, of course, there are performance issues, or performance deficits, or anxiety, tons of performance anxiety as you know, and then, so we are trying to get them back to baseline and hopefully a little bit beyond, but it doesn't mean we can't address these deficits—just if it gets to that clinical point of those clinical disorders, we would want to refer to someone who's a licensed mental health provider.

Mills: Right. That makes perfect sense. So let's dig a little deeper into the mental performance aspect of sport psychology. How do sport psychologists work with athletes to help them prepare for competitions? What are the techniques that you use, and are they different for different sports?

Shapiro: Yeah. And it's going to depend on someone's theoretical orientation, of course, but there are some cardinal mental skills that we work on in sport psychology, and I'll give some examples of some of them. I would say a lot of work we do is actually around self-awareness with athletes and helping them understand what works for you and what doesn't work for you, and how do we build on those strengths? So some of it is, you're the expert on yourself, how do you become aware of what works and keep using it, become aware of what's not working and tweak what you're doing to help those things that aren't working? So self-awareness is huge, but some specific techniques, one, of course, is goal setting. So we want someone to have specific goals. It helps direct your attention and your efforts. And so we want goals to be good, or effective goals—I don't like the word "good"—but effective goals, as we say. So some people set goals, I want to win—

Mills: That's a good goal.

Shapiro: And that's an outcome goal, and that's good, and we want people to want to win, and we want them to have goals beyond that. So I focus a lot with athletes on what I call process goals that aren't necessarily, I want a podium, or I want a certain number of medals, or I want to win this game. It's well, okay, how do you make sure you do your best performance? And then the outcome is what it is. Maybe you have a best performance and you still don't get that gold medal. And so we want athletes to still feel a sense of accomplishment, even if the outcome isn't what they want. So we focus on, what do you want to do along the way? What are the processes or techniques you need to do in your sport in order to have your best performance?

So setting effective goals—and you've probably heard of smart goals, I know it's very catchy, but specific, measurable. You'll hear very differently depending on the person, I like adjustable, because I think goals should be flexible, realistic and time-based. So goal setting is one thing. Of course, helping athletes with their motivation, sometimes obviously motivation waxes and wanes. And so helping them connect to motivation so that they can have the most effective practice, or we call deliberate practice, where they're practicing with a purpose and getting the most out of their practice, is important as well.

I would say arousal regulation. I like to use the term energy management, because some athletes laugh at the word arousal, but it's basically being aware of both physical and mental energy, and how you're spending it. And so for this particular sport, or event, do you want to be really hyped up and excited, or do you need to be really relaxed and focused? And helping athletes realize where they want to be, but then giving them techniques such as deep breathing, or relaxation, or managing their self-talk to help get them to that level that they want to be at. And so I just mentioned self-talk, I'm someone who focuses a lot on athletes’ self-talk. So I'm asking them what they're thinking, where's their mind? And is that, I like the word productive versus positive, is that productive for your performance? So we talk a lot about what are your thoughts? How is that affecting your performance, but also your wellbeing? There's the counseling aspect of it in there as well.

Focus and concentration is huge, especially during competition, what are your focus cues? I help athletes develop simple focus cues to help keep them present and focused during their performance. And obviously at big games, Olympic games, Paralympic games, there's a lot of distractions. It's a different environment maybe than they're used to. And so how can they still focus so that they could do what they're trained to do despite all of that extra, what I call noise, in that environment that they're in?

Routines are really important as well, although they should be flexible, because things happen that people can't always predict, like a pandemic, but pre-race, or pre-competition routines are something we work on to help an athlete feel really prepared and focused. And then I mentioned cue words, that's the—during performance routines, where do you want your mind? What do you want to be thinking? And then also post-race, or post-competition routines are important. I think people think a lot about the pre and the during, but not the post routine. So what's your recovery like? And I'm also big on reflection after training and after competitions.

So I like athletes to think about what went well, often they go right to what went wrong. So what went well and also what's worth improving for next time. So it's a constant learning experience, even if they didn't have the performance that they wanted, they could still learn something from it and still gain something from it. And so that way they don't feel like that was a complete waste, or that was a complete failure. No, that didn't go the way you wanted. You could always learn something from it that can help you improve for next time. In terms of team sports, I would say, so a lot of those are individual techniques, but we also work with groups and teams.

So team building, we want to build team cohesion so that people can work effectively with each other, working on communication, working on leadership for those who are leaders on the team. And the same with coaches, we don't just work with athletes. We work with coaches on coaching education. And the coaches are the ones seeing the athletes all the time. So I actually think it's even more effective to educate the coaches on how can you implement these mental skills with your athletes on a daily basis? Because that's how they're most effective, is if they're consistently integrated. So helping the leadership, whether that's coaches, or leaders on the team, that leadership training is also something we work on. Recovery from injury mentally. So often, there's, of course, the physical rehabilitation that athletes are doing, there's also a mental aspect of recovery and building that confidence again, an injured body part, but also that they're able to do the skills that they were able to do pre-injury.

Mills: These all sound really logical, like they would cut across all kinds of sports, whether you're a figure skater or a football player, there are commonalities.

Shapiro: Absolutely. And I would say in terms of differences between sports, they can be applicable to all sports, but different sports have different needs, they have different cultures, they have different languages. And so it would be important for the sport psychology professional to assess what are the needs of this particular team? And that's going to be different for everyone, or what are the needs of this particular individual? And, of course, we can't be experts on all sports. I did gymnastics most of my life, so I know the language really well, but I work mostly now with Paralympic athletes. And I did not know much about most of these sports. So from observation, from videos, from talking to my athletes, they're the expert on their sport, I'm the expert on the mental skills. And so it's a collaborative effort. We work together in order to work on and address their mental performance, but it is important for the professional to learn, again, the culture, the language of the particular performance area that they're working in.

Mills: Well, speaking of terms, one of the terms I think we learned during the Olympics was the “twisties,” right? Which affected Simone Biles, and in other sports something very similar to that is called the “yips.” So what is happening when athletes experience this? Why does it happen and what can sport psychologists do to help people work through them?

Shapiro: Absolutely. So I call it a mental block in gymnastics, the twisties, I had actually never heard the term before Nastia Liukin used it on NBC and made it go viral, but the twisties are a specific form of a mental block for twisting skills, but there could be other mental blocks in gymnastics. I've seen it with many teammates where all of a sudden they just can't tumble backwards, and it's something they've been doing for years and years. I would have something on the balance beam where I just couldn't get my body to go backwards sometimes. So it's very common, I want to put that out there. And then in other sports the yips where, say. a pitcher all of a sudden can't throw a ball to where they want it to go. It happens in golf. And it seems bizarre, right? How can someone, all of a sudden, not be able to do something they've been able to do for many years?

And I'm not going to pretend to understand all of the psychophysiology behind it. There are some physical theories, there's something called focal dystonia where it's a neurological condition, they say, where your muscles are overworked, and so all of a sudden they just stop working. But what I would simplify it to, is there's a disconnect between the brain and body, where the brain for some reason is not accessing the motor programs that are stored there for specific skills. And also just getting a little bit more into the neuroscience—again, this is not my area of expertise, but when there's a flight or fight response, when we're stressed, our cerebellum kicks in, that's our survival mode. And so that's the dominant part of the brain that's working and not the cerebrum where our higher order functions are and things like logical thought and motor programs. And so there's just a disconnect between the cerebrum and the cerebellum, as well as brain and body.

So that's what's really going on. What I would say and what I've seen, and I can't speak for Simone Biles, I don't know her, and I'm not going to pretend to understand what was going on with her, but just in general, in terms of mental blocks, sometimes they come out of the blue. And I did see an interview with Simone where she said, I thought it was just a fluke. I just lost my sense, her proprioception, or her sense of where she was in the air. She thought it was weird, and she's like, let me just do it tomorrow. She came back and it happened again. And so that's really common where it's like, oh, that's weird, and then it happens again, and then happens again, and then it just exacerbates and gets worse. And stress does all sorts of things to our body, which do not help our performance, especially as an athlete. And so the more the mental block happens, the more stress we get and the less we're able to access that part of the brain and body that knows what to do.

Mills: How does your own background as a competitive gymnast influence your approach to helping athletes?

Shapiro: I think I can relate a bit to what athletes are going through, have compassion for them. I could think of things that worked for me, but I've studied this for a long time, so it's not just about what works for me as an athlete, that wouldn't make me a professional, that would make me a former athlete trying to help athletes. But it is helpful to think back and reflect on what worked for me and what didn't, but also know different things work for different people. So I really, if I'm working with a gymnast, I need to check myself, because I have so much bias as a former athlete and as a coach, that I have to be careful to keep that mental performance hat on versus jumping to coach mode, things like that. So it's actually easier for me to work with sports that I'm not as familiar with, because I can really stay in my lane and focus on mental performance. But it's also helpful to work with gymnasts because I do understand what they're going through and understand the language and the culture of the sport.

So I can think of maybe what would have been helpful for me as an athlete. I didn't have sport psychology services, even through college, as a college athlete, I did have a coach who was very psychologically minded and would talk to us a lot about these topics and not call it sport psychology, but now looking back, I know that's what he was doing. And I think that's ultimately why I had an interest in all of this, because I found it really fascinating. And fear is a big part of gymnastics. So understanding that fear and how to work through that is really important, but I think being a mental performance consultant and having been an athlete in this role, I'm one of the few people in an athlete's life that, I don't want to say doesn't care about the outcome, but that's not the only thing I care about. And I do care about their wellbeing and themselves as a whole person, not just an athlete.

And so even when I worked with my Paralympic athletes, I say, I don't care if you medal. I'm like, I care because you care, of course, and I'm going to be here to support you no matter what happens. And that's a relief to them, because a lot of people in the system, their jobs depend on medals. I don't think mine does. And if it does, I probably don't want to be in that system. I do want to help them, again, achieve their best, but I think it's a comfort to them knowing that someone in my role is there to help them and support them no matter what. And I'm not saying coaches aren't, parents aren't, but I hope that they feel that, and me being a former athlete, I think that support no matter what the outcome is comforting and hopefully helpful to them.

Mills: So let me ask you, how is sport psychology related to performance in other realms? Say I'm a CEO about to oversee my first shareholder meeting and I'm terrified of making a mistake, or I'm a concert pianist and I've suddenly forgotten how to play a Rachmaninoff concerto, right? That I have to perform in concert. How does a performance psychologist help in those areas?

Shapiro: And that's what we say, I think the broader field should actually be called performance psychology, and sport psychology should be under that umbrella. Unfortunately, it's like performance psychology is different than sport psych, but sport falls under performance, business falls under performance, as you mentioned, performing arts. And also a large part of our field now is what we call high-risk occupations, including military, firefighting, police, obviously those high-stress jobs, which have similar issues that we've been talking about, and similar skills can be helpful in all those domains. So again, if someone forgets how to play a piece, or has stage fright, I think that's another psychological thing that many performers talk about, we could do some of the same techniques that we would do with athletes, specifically you have to rebuild someone's confidence. So start with basics. So they've suddenly forget to play. Let's go back to basics, let's build up the skill and the muscle memory, and it should happen quicker because it's there somewhere. But you basically start from the beginning and gradually increase the performance until they can get it back.

And it would be similar with gymnastics, or diving, or any other sport where it's like, got to go back and relearn it from the beginning and then slowly build that confidence that they can do it again. I would say another technique to help with mental blocks no matter what the performance area would be if someone can watch video of themselves doing it successfully, or in the case of a musician, listening to it and doing imagery at the same time. So feeling themselves playing that piece, imagining where they're pressing the keys, or feeling their body go through a twisting movement as they're watching the video. And again, we're just trying to reconnect that brain body connection that's missing.

In terms of a business professional who's nervous, or scared of making a mistake, it would be using similar confidence building skills, maybe again, doing imagery, helping them with that arousal regulation of, what's your pre-performance routine when you're speaking to your employees, or whatever it might be. So it's not just, get up there and talk, no, there could be a pre-performance routine for that. I'm a professor, so I have to teach and I try to do some things to help prepare before I go teach, teaching's performance, psychology, any public speaking. And obviously many people struggle with public speaking. So having those routines, practicing, getting feedback, video imagery, are just a few things that can help in multiple performance area. And, of course, the stress management, the arousal regulation also just applies across many performance areas.

Mills: So as we've said a couple of times, you work with the U.S. Paralympic team. Can you tell us more about that work and how you got involved in it, and what are the special considerations when you're working with athletes with disabilities?

Shapiro: Sure. I'm so happy to talk about Paralympic athletes. The Paralympics are coming up August 24th to September 5th and they're getting more TV coverage than ever. So I hope people check that out, but I actually didn't have much training in working with athletes with disabilities during my graduate training. I had some classmates who did it and then as a supervisor of students here at the University of Denver, I had some students actually working with athletes with disabilities, but this opportunity fell in my lap from being in Denver, that some of the sport psychologists at the USOPC, they couldn't manage all the sports and all the Paralympic athletes. And the high-performance director of Paralympics at the time recognized that they needed more sport psychology support. So they reached out to myself and some of my colleagues here at the University of Denver and said, will you meet with us? We want more support.

And so we met for coffee—and I always tell students, take the coffee meetings, see where it goes. It may go nowhere. It may go somewhere. For me, it changed my career. I've been working with Paralympic athletes since 2014. After that coffee meeting we got connected with some coaches—and my colleague, Artur Pocswardowsky and I, we work a lot together with several teams, as well as individually with teams and athletes. And so it took off from there. And like I said, it's changed my career. I've been able to present on it and bring more attention to work with athletes with disabilities. So, we go to training camps, some competitions, I do a lot of distance consulting. So when the pandemic happened and people had to do this tele-consulting or teletherapy, I was quite used to it because the athletes I work with are all over the country.

And so we did a lot of that video consulting already, although I haven't seen them in longer than I ever have. So that's a little bit strange, but I'm also supporting them remotely while they're in Tokyo. And it doesn't, aside from the large time change, it doesn't feel strange at all to talk to them through a computer. But we do some of the skills that I already mentioned, goal setting, arousal regulation, certainly with the games coming up, just talking about what that environment might be like at the games, how to manage those stressors or distractions that are specific to a games environment. And I always talk to them about, if you can just execute the plan that you've been training to do for those few minutes, or few hours of your life, depending on the sport, then the outcome is what it is.

And it's so much easier said than done, but we work, what are your plans? Again, the pre-competition plans, what are your cues for during the competition? What are you going to do afterwards to reflect? And if you can get to that, that you've been training, and that's what we call it, mental training. It's not like, oh, I'm going to meet with you, teach you imagery, and then it's magic. It's things that should be integrated consistently and trained consistently. And that's when it makes a difference. Just that—I don't think I've mentioned this, another big part of my philosophy in theory, and many professionals in our field, is the relationship aspect, I call it client-centered, or student-centered, or person-centered, where I am showing care for them as a whole athlete and not just talking to them as an athlete, but what is going on in your life that could be affecting performance? And just supporting them as a whole person. But that rapport building, we call it, or relationship building, I think is an essential foundation before just jumping into skills that they could use.

And if you don't have that trust and relationship from clients, and this is general, this is counseling 101, but if you don't have that rapport, any fancy techniques or skills that you throw at them is not necessarily going to be effective. And so it's been great with Paralympic athletes as I've worked with them for a number of years, and we've built that trust and relationship so that hopefully they are integrating the things that we're talking about and they become effective hopefully.

Mills: Have you seen an increase in recent years in interest from professional and collegiate sports leagues and teams in working with sports psychologists?

Shapiro: I believe so, and we have students, and so I hope there are more and more jobs for them, but there are certain, certainly organizations have increased their resources here, and I would say especially with that mental health. The USOPC now added a mental health director who happens to be one of my good friends and colleagues, Dr. Jessica Bartley, and she hired a fantastic staff. So they basically added a whole new department for mental health. They already had sport psychologists who focus on mental performance, but also mental health. And they realized, you know what? We need some more extra support for this mental health aspect, especially with so many athletes speaking out about it.

And then other professional organizations, such as the NFL, also now require every team to have a licensed mental health professional on staff. And so that's been, it's increased jobs in the field, but that's been wonderful to see in terms of support for the athletes. And I don't think colleges require a licensed mental health professional to be embedded in athletics, but we are seeing more and more departments as a result of some of the studies that the NCAA has done increase their mental health and mental performance staff.

Mills: That makes sense. Certainly if you see results that speaks very loudly. I spoke a little bit in the introduction about the tremendous media focus on athletes’ mental health in the past year. Why do you think this is happening now? Why might athletes feel more empowered to talk candidly about the mental aspects of their sports and about their mental health generally?

Shapiro: And I'm not sure it's so new. I think athletes have been speaking out about this, there have been blogs, there have been interviews. I think these really prominent athletes have come out and spoken about this. And there was a documentary, The Weight of Gold, that many Olympic or Paralympic athletes spoke out about the mental health struggles that athletes go through. And so I think through these mediums of documentaries, of blogs, of interviews, that more athletes are speaking out about this. And they're seeing this modeling from other athletes and saying, you know what? I struggle with that too. And I think it's important to discuss this, and so that people don't feel ashamed or like something's wrong with them, and that they do hopefully seek help, and know that they're not alone.

So I just think more and more of these prominent athletes are coming out and disclosing some of their mental health struggles. And I hope that trickles down to the youth levels where they see, oh, that athlete struggled and I'm struggling too. And so where do I go for help? And hopefully someone in their life can connect them to the resources they need. If it's a more of a mental performance issue, going to people trained in that. And if it's more of a mental health issue, or mental illness, going to a licensed mental health professional.

Mills: So in watching what happened with Simone Biles and Naomi Osaka, my impression from what I saw and read was that they were treated very differently in the mind of the public—that somehow Naomi Osaka was seen as more of a prima donna with a problem that people didn't understand, and Simone Biles, everybody got that, oh, she's the greatest of all time and no wonder she's terrified, look at the things that she can do. But was that also your reading? Why do you think that would have been that people saw them in different lights?

Shapiro: I don't know, and I don't know if Naomi Osaka speaking up actually helped normalize it for Simone Biles, and by the time Simone Biles came out and talked about her issues, they were like, oh, wow, this is been happening more frequently. I'm not sure of the difference, or there were certainly different reasons that were given for backing out, Simone Biles with the mental block and Naomi Osaka cited, she cited just mental health issues and depression, and the media, media pressure versus, oh, there's a dangerous mental block going on where if Simone continued, she could have broken her neck, or something worse. And so maybe that perception of, oh, there were more dangerous consequences of this stressor for Simone Biles than Naomi Osaka maybe affected the reaction.

And I don't want to dismiss also the socio-cultural and political aspects of all this, they are women of color, and is there a different reaction for them versus if it was a white male, like when Michael Phelps came out and talked about his mental health issue? So it's interesting to think about, I don't have necessarily an answer to that, but I think that's an important perspective that people need to think about, is how they're reacting to people of color, or minorities versus people in the majority.

Mills: So last question, do you think these discussions around athletes’ mental health will have a lasting impact on mental health stigma, both inside and outside the world of sports?

Shapiro: I hope so. And so many people look highly at athletes as celebrities, and look at what they're doing and model what they're doing. So I don't think this is going to go away. If anything, I think it's going to keep getting bigger. Just looking at the media attention it got during the Olympics, I think it's just going to keep increasing in terms of media attention and more and more athletes feeling comfortable speaking out about this. And like I said before, I hope it trickles down to youth, or less competitive levels of sport that there are stressors there too, and pressures there too, and that hopefully the stigma does reduce and people are more comfortable asking for help and knowing where to go for help. I think that's hard too, is knowing who's trained in what, and I know we had talked about this, the licensed mental health professional versus someone who's trained for mental performance. And there are people who are trained in both.

And so it's just important for people in the public to know what professional is appropriate to help my child, or help myself in this situation. So I do hope it reduces stigma, all this talk about mental health, and I hope it doesn't go away, because it's such an important part of humanity and performance.

Mills: Well, thank you for joining us today. It's been a pleasure talking with you. I think this is a really interesting conversation. Thank you, Dr. Shapiro.

Shapiro: Thank you so much for having me again.

Mills: You can find previous episodes of Speaking of Psychology at speakingofpsychology.org or on Apple, Spotify, Stitcher, or wherever you get your favorite podcasts. And please leave us a review. If you have comments or ideas for future podcasts, you can email us at speakingofpsychology@apa.org. That's speakingofpsychology, all one word, @apa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan. 

Thank you for listening. For the American Psychological Association, I'm Kim Mills.