Therapy for Performance Anxiety
How can therapy help with performance anxiety in athletes and professionals?
Performance anxiety is a familiar challenge for anyone who faces high-pressure situations. For athletes, it may appear as pre-game nerves, shaky hands, or fear of making mistakes. For professionals, it can show up before presentations, meetings, or critical deadlines. While stress in these moments is normal, when anxiety starts to interfere with performance, therapy can provide effective strategies to manage it and improve results.
Therapeutic Approaches
Therapy for performance anxiety often combines various therapeutic approaches.
Cognitive-behavioral therapy (CBT) focuses on identifying and reframing unhelpful thoughts. For example, replacing “I will fail and embarrass myself" with "I've prepared and can handle challenges as they come” can reduce anticipatory stress.
Somatic approaches focus on the body’s role in anxiety. Performance anxiety triggers fight-flight-freeze responses (racing heart, sweating, muscle tension, shallow breathing) which can interfere with focus and execution of skills. Techniques like breathwork, progressive muscle relaxation (PMR), and grounding help regulate the nervous system, allowing the mind and body to work together more effectively.
Therapists often use goal-setting to break performance challenges into manageable, approachable steps. Instead of focusing only on outcomes like “win the game” or “deliver a perfect presentation,” individuals learn to set process goals. Process goals are controllable actions that can be practiced and tracked. These goals provide structure, reduce overwhelm, and build confidence through repeated successes.
Exposure-based techniques are also key. Gradual exposure to performance situations (starting with low-pressure scenarios and progressing to more stressful environments) helps desensitize the nervous system to anxiety triggers. Over time, repeated exposure reduces the intensity of anxiety and strengthens coping skills.
Top-Down and Bottom-Up Tools
When therapists are working with performance anxiety, they often use top-down and bottom-up strategies to support performance.
Top-down tools focus on the mind’s ability to influence the body. This includes visualization, self-talk, and cognitive reframing, which helps clients anticipate challenges and prepare mentally.
Bottom-up tools target the body first, using breathwork, movement, or biofeedback to down-regulate the nervous system. Once the body is calmer, mental focus and composure improve naturally.
This combined approach ensures that both the mental and physiological components of performance anxiety are addressed, allowing athletes and professionals to respond rather than to react under pressure.
Performance-Focused Therapy vs. Talk Therapy
While traditional talk therapy explores personal history, emotions, and patterns, performance psychology therapy is goal-oriented and skill-based. The emphasis is on building practical tools for real-time performance, not on analyzing past events or feelings in depth. With performance psychology therapy, individuals learn to:
Manage nerves during high-pressure moments
Improve focus and attention
Maintain confidence and composure
Recover quickly after mistakes
Talk therapy focuses on broader emotional and mental health. Individuals can typically expect the following:
Exploring underlying patterns, beliefs, or past experiences contributing to anxiety
Processing emotions related to stress, self-esteem, or relationships
Developing insight and self-awareness that supports long-term growth
This distinction helps individuals understand that both approaches are valuable. Performance psychology therapy equips you with the skills to perform under pressure, while talk therapy addresses emotional well-being and deeper personal challenges. Many clients find that integrating both approaches offers the most comprehensive support.
Taking the Next Step with Sport Psychology Services
At Health in Tandem, therapy for performance anxiety integrates mental skills training, nervous system regulation, and personalized support. Athletes and professionals work with therapists to develop strategies that improve focus, confidence, and resilience in real-world situations. Techniques like goal setting, exposure, cognitive reframing, and somatic regulation are tailored to each client’s unique needs and performance environment.
Performance anxiety doesn't have to hold you back. WIth therapy, you can learn to manage pressure, stay focused, and perform at your best, even in high-stakes settings. Mental skills and nervous system regulation tactics aren't just for elite athletes, they are tools anyone can use to navigate stress, build confidence, and achieve consistent results.
If you’re ready to perform with focus and composure, therapy for performance anxiety at Health in Tandem provides structured, evidence-based support, designed for both athletes and working professionals.