 Welcome to the sports playbook where we discuss solutions to issues that impact sports. I'm your host, Angela Hazelett. Today's guest is Armand Tagizata, a Johns Hopkins trained psychiatrist who specializes in sports psychiatry in the Baltimore, Maryland area. He is often referred to as Dr. T. We are here to discuss sports psychiatry, improving athletes mental health. Welcome Dr. T. Thanks for having me. I appreciate it. I'm excited to be here. Oh, I'm very excited to have you and learn from you and I know our viewers can certainly benefit from your wealth of knowledge. So you're a former high school all-American and NCAA division one wrestler from James Madison University and now you are a board certified psychiatrist. So you really understand the mental health of athletes, but Dr. T tell us what exactly is sports psychiatry? The sports psychiatry is a relatively new field if you want. There isn't necessarily training programs designed for it, but fundamentally what I've done is taken my background as a medical professional, as a board certified psychiatrist, so a mental health professional and really work specifically with athletes, coaches, parents, organizations in helping provide mental health education, support and mindset training for that population. I love that. So you're really honing in on using your expertise in a specific field for a specific audience. And I know like in the college setting, there's many universities that offer student athletes access to sports psychologist, but you are a sports psychiatrist. So tell us what is the difference between a sports psychologist and what you do as a sports psychiatrist? So as a sports psychiatrist, I'm a medical doctor, so that to some extent is a different level of training, a different level of education, but the other thing that it allows me to do is when I'm working with athletes, I'm also able to evaluate in terms of other mental health vulnerabilities, depression, anxiety, ADHD, substance use, a variety of different things and really getting an opportunity to evaluate them, not just as an athlete, but also as an individual and then being able to treat those conditions if they're needed or necessary. I mean, all athletes are people first, and I think a lot of times in the field of sports psychology or sports performance, if you will, it's really focused on improving on the athletic field or on the basketball court or wherever, but oftentimes there's these other vulnerabilities that really interfere with their ability to be their best self. And so again, as a sports psychiatrist, I'm able to evaluate that, but also be able to treat that in context and incongruent with being able to work with that and help with the mindset training and the sports performance piece. So it's like the whole picture, you're doing kind of the diagnosis or identification of the problem, but also the treatment as well. And so how exactly do your services, psychiatric services, how are they different when you're serving athletes versus serving the general population? Yeah. I mean, I think on some level, people are people and it's important to treat them as such and help them delineate that. I think when I'm serving an athlete, part of what I do is helping them understand that they're also a person first, because they sort of identify very much with being an athlete and only an athlete, but the other part of it is really recognizing how important that athletic piece is as part of their identification, as part of their social network, as part of their educational experience. And so it's really become something that's so important. And so being able to help understand the context and the role that it plays, but also being able to help them delineate who they are outside of that, I think is an important thing. It's also, I think, having been a Division I athlete, it's extremely important that I understand that experience. I've been through that experience. I continue to train like a Division I athlete. I continue to train with Division I athletes. And so, again, understanding the grind, understanding the demands, the pressures, that's very important. And I think we can all understand it to some extent, but when you when you haven't gone through it, it's a lot harder. And so that's an important piece. Understanding the mental health piece as a mental health professional, again, allows me an opportunity to take another look at it from a different perspective. And then there's the medical piece that also understanding injuries, understanding biology, genetic vulnerabilities, all these things that really can impact the athletic experience and the human experience. And so fundamentally, I've got this opportunity through my experiences and my knowledge to take this unique skill set and really be able to serve a population that, in my opinion, is very much underserved when it comes to mental health. And it's interesting you were talking about the identity of these athletes and how they identify and many identify as an athlete, maybe athlete first rather than a person first. And so a lot of what you're doing sounds like you are helping them recognize their whole self rather than just the athletic piece. So if they get injured and aren't able to compete, then their whole life is not mental health is not revolved around just their identity as an athlete. What could you speak to that a little bit further? Yeah, absolutely. I mean, look, the reality is that at some point, all of our athletic careers end, right? And so for a lot of these high level athletes, you know, when they were recognized as having a talent where they recognize that they had a talent or an interest, people poured into them, right? When they've gotten to this level. And so people poured into them, they supported them. A lot of times people rallied around them were even interested in them because of their athletic experience. And so throughout that growth and development through adolescence and young adulthood, there's so much identification and support around them as an athlete. But the reality is that at some point, they're going to transition. And if they're not prepared for that, if they don't understand that, they don't have somebody that can help navigate how important this is, but that there's so many other things that, you know, that they bring to the table and that they can understand about themselves. It really puts them in extremely vulnerable situation. Again, even when their athletic careers don't necessarily end prematurely, but they have significant setbacks like an injury, adversity within their environment, right? A death in the family. Struggling academically, loss of a relationship. Again, all these other things where, you know, all of a sudden are human experiences, but they've been so sort of ingrained in, you know, showing up, working hard, practicing and everything will work out. A lot of the experiences I have with these athletes are saying, but I'm doing everything and it's supposed to be working out. Why isn't it working out? And it's because they're not prepared for life. So I think again, understanding that, helping them understand that allows them not only to be a better athlete, but a better human being, a better significant other, a better sibling, a better son or a daughter or whatever it is. If they can be the best version of themselves off the field, they're going to be the best version of themselves on the field. But if their only identification and source of happiness and growth is within the athletic realm, if anything rattles that with it, which at some point it will, they're going to have a lot of struggles. And I think we see this with professional athletes when their careers end or when they encounter a significant struggle or a significant injury is that now you've got grown adults who aren't prepared and then there's all the other mental health vulnerabilities, which nobody even spoke about or told them about. You know, and again, now they're thinking, well, I'm just supposed to show up and work harder or suck it up or rub some dirt on it and it's not getting better. So like now what do I do? And I think the ability to be able to help them understand that, help them be able to understand that this is going to actually help them with respect to performance. Because the other piece of it is, if we're being honest, an athlete wants to have a better performance, right? That's what they're going for. So if you can help them understand that helping them be a better version of themselves and address some of these vulnerabilities is not only going to help them outside of the sport, but it's fundamentally going to help them improve their performance within the sport, then you're going to get much more buy-in. But then again, they feel better about themselves and they really are more complete self. So you mentioned that a lot of milestone or life events or triggers incidents that happen in life that may lead to their needing some additional support. But I would imagine on a day-to-day basis, other than just athletic performance, there's a need for mental health care. And we have, let's look at Naomi Osaka, professional tennis star, Olympic gymnast, Simone Biles. They have expressed publicly that they wanted to prioritize their mental health and taking a break from their sport. We often support athletes when they have a physical injury and think that that makes sense. They're going to take a break from your sport to recover. So why is it so controversial to take a break from sport for mental health purposes? Yeah, so that's like the big question, right? And on some level, people say there should be no difference. But we also talk about it differently, right? And so when we think about physical health and physical wellness, we look at it in terms of, we need to take care of our bodies, not on terms of the training, but also in terms of the recovery, the nutrition, the sleep. Everybody can sort of identify with that, right? That recovery is key, hydration is key, nutrition is key, stretching, flexibility, mobility. All of that is just as important if not more important than hitting balls on the court or getting your reps in whatever your sport is, right? And we can identify that. And so we talk about physical health, physical wellness in the frame of mind of preventing physical injury or physical illness, right? We talk about that. But then when it comes to mental health, we sort of also talk about it as for mental health, mental illness, mental wellness, and we sort of like put it all together, like health, wellness, illness, and we sort of use these terms interchangeably. So I think there's also a lack of knowledge about how to articulate these terms, be able to understand what the true meaning is, use them appropriately, use them consistently, right? Again, I think when everybody's speaking a different language, it's very hard for people to understand what each other is saying, right? And I think when it comes to physical health, physical wellness, and physical injury, we've gotten better at sort of using a universal language and an understanding so that even if somebody hasn't had that injury or that illness or isn't even a medical doctor or an athlete, they can understand to some extent what that means. Oh, they've pulled their hamstring. Oh, they've torn this. Like they understand that there's gonna be some sort of limitation due to that. And they may not be understanding the extent of it, but they get it. But then when it comes to physical or mental health or mental wellness or mental illness, we don't quite understand what it all means. And we use these terms interchangeably. And I think then the problem is it's really even hard to understand what you're looking at if you can't define it. So define it for us. Mental health, mental wellness, mental illness. Are they the same? Are they different? How would you define those terms? Well, it depends who you ask. You're asking me, so I'll tell you my definition, right? Because I think people have different definitions. To me, mental health and mental wellness, I sort of think about them together. Like mental health is the ability to take care of your mind, right? But also to take care of your body because we know that our mind affects our body, right? So taking care of our health in terms of doing other things to make sure that we have balance in our lives. Make sure that we're managing our stress levels, making sure that we're taking care of ourselves, prioritizing yourself. To me, that's sort of under the mental health realm, but then wellness is really amplifying, right? Understanding it and then really saying, look, I need to manage these things. I need to take care of these things. I need to speak to somebody potential. I need to take time each day to really evaluate where I am, check my emotional temperature, check my psychological temperature. Are these things that I'm doing in line and consistent with my growth and development? That's sort of the wellness piece. Illness in the true definition from a medical professional is when it's really impairing your function, it's getting in your way. So if you really understand that you're having these experiences, you're having periods where you're getting really down or really sad, and it's now limiting your ability to enjoy your experiences with your teammates or with your friends or be able to do things you otherwise wouldn't, that's really when it starts to get into the illness range. I think we also use these terms like depression, anxiety sort of interchangeably and sometimes flippantly. And we're like, oh, I'm depressed or oh, I'm anxious or oh, it's my OCD. And again, we don't necessarily delineate is this part of sort of like mental health and wellness? Is this an illness component? So I think then we don't always know when we're struggling and we need to seek out kind of professional help or at least start to inquire about it or at least start to talk about a little bit more. So simply put, I think illness is when it really starts to get into your way of functioning and get into the way of you enjoying your experience or at least being able to do the things you typically would do. It also I think affects your sense of self. So a lot of times with these conditions we start to feel bad about themselves. We get down on ourselves. We feel guilty about ourselves. We're less likely to wanna talk about them. When we're noticing it's affecting the way that we think about ourselves and our interest level those are kind of a big thing. A lot of times we look at mood as sort of the primary indicator but again as an adolescent or a young adult your mood is gonna fluctuate consistently throughout the day. It might be because it's a Tuesday. It might be because you had a stressor the night before it might be of a big test or an exam or a game. And it just might be because it's cloudy and rainy and you're in a bit of a funk. And so if mood is our only gauge of how we feel that's not always gonna be the most accurate but when we start to identify we're getting down on ourselves or we're not able to enjoy our experiences those are big parts of this sort of adolescent young adult experience is being able to enjoy yourself being able to grow your confidence. Those are big indicators for me. So how many understand this a little bit further? The mental illness piece is, is this something that everyone could potentially have some kind of issue with mental illness or are we talking like a certain percentage of the population maybe susceptible to a mental illness situation? And then kind of thinking about mental health is everyone susceptible to have some kind of impairment or challenge with their mental health or is there only a certain percentage of the population potentially gonna struggle? So where do we all fall? We were looking out for this for everybody or a certain group? Yeah, so I mean, let me use the physical health, physical illness analogy, right? Like we all need to take care of our physical health and our physical wellness, right? Or we are all susceptible to some sort of physical injury, right? We can all get sick, right? Some of us are more prone to maybe tear an ACL if we're doing certain athletic activity, but there are people that tear their ACLs walking down the street and they take a weird turn, right? So to some extent we're all susceptible. Now taking that to the mental health, mental illness, I think we all need to be aware of it because we all have brains, we're all human beings, we all have experiences. And if we're not directly likely to have something, we're gonna know somebody, somebody in our family, somebody in our friend circle, somebody on our team, somebody in our, you know, one of our colleagues. So I think when you look at the statistics, that's where part of the problem too is it really breaks out that 20% of the population has this 33% of population has this. And then people like, well, then I'm 80% likely not to have it. So why worry about it when I have to worry about all these other things, right? Right, exactly. The reality is I think if we sort of understand that, you know, instead of one out of five or one out of six people are affected that five out of five or five out of six are affected, right? And that's a big kind of mantra that a lot of the organizations, you know, talk about, then we can understand that this is something we should all be a part of, we should all be inclusive, we should all support each other. Now, when it comes to our mental illness rather, I think there's certain vulnerabilities. There's a genetic vulnerability. So if it runs in the family, you're potentially more susceptible. If there's multiple family members with mental illness and kind of more severe forms of mental illness, if you will, they've been hospitalized, they've had some of the more significant ones. Then again, the genetically we're more loaded, but the other things that I think play into it that are important is our behavior, our choice, right? Like what we do, how we approach life, our personality or temperament, right? Some of us tend to run a little bit more hot or a little bit more cold. That's gonna affect the way we interact with our environment. Our environmental factors, right? We have life stressors. We may have death of a loved one. Other, you know, again, with athletes, we're talking about injury, pressure of performing at the highest level, but also managing other expectations, academic, personal, stuff like that. So these are all environmental factors that can also play into it. And then there's our development, right? We all process and learn information differently. So that's gonna affect how we interact with our environment. So there's multiple factors that play into our predisposition, but it is something that, again, you may not have a genetic vulnerability. You don't think you do, but there are gonna be life events that potentially hit you hard and as an athlete, I think that's where we notice the environment and the life events and even behaviorally how we approach things, right? There are very few athletes that can be this successful without having some level of anxiety, right? It's what motivates the show up early. Stay late, do the extra reps, like make sure we're doing all the right things. So there's that fine line where that anxiety ends up promoting growth and development. And then it kind of kicks you in the butt a little bit when things get a little too tough. So I think it's something that we all need to be aware of. We all need to understand it's gonna affect us or somebody we know. So preventively, we should inform ourselves, right? Because we can help ourselves or somebody else at the same time, I think some people are more likely than us. And I definitely wanna get into talking about some of the strategies that we can do to support athletes and their mental health. But I do wanna highlight that there's been several athletes who have died by suicide, including five college athletes just this past spring of 2022. So why has this happened and how did these athletes go under the radar or unnoticed until it was too late? Yeah, so I mean, why does it happen? I don't know specifically. I mean, it seems like it's happening more, but I also think that we're more aware of it, right? We talk about it more, we publicize it more. There's more awareness, there's more support. But I think that plays into it. I certainly think that over the last several years, COVID has played a huge role into it. And again, when you've identified as an athlete, your structure and your social network and everything that you do sort of has a place and that's completely taken away from you. And that's the way that you identify with yourself. It's really hard then to find your identity. And I think people get really lost. They get deconditioned socially. They get deconditioned athletically. A lot of athletes, that's their source of stress relief. That's their therapy, right? And so now when you don't have the ability to access it in the same manner, that can be very devastating. So I think there's a lot of things that go into it. Resource is a big deal, right? Like it's very hard to find appropriate resources and significant resources. And most of the resources, I think, are mostly sort of reactive, right? When something happens, then there's an influx of counselors or support. We're gonna do this, we're gonna do that. But again, it's very much in the realm of a reactive, form of support versus looking at these things and saying, look, as part of your athletic experience, we're gonna provide strength training. We're gonna provide nutrition. We're gonna provide advice on this and this. We're also gonna integrate that mental health piece and that mental wellness piece so that we can prevent the mental illness and we can allow you to be a happier, more fulfilled version of yourself. And so when you leave this experience, not only have you had a great athletic experience, you've had a great personal experience and you're really prepared for life and whatever life feels with you outside of the college experience. And it's not just about learning something in a classroom or on a field. It's about learning how to navigate life in this environment of support. And I think to some extent, there's support athletically and academically, but then when it comes to that mental health, mental wellness piece, again, a lot of it is sort of in the reactionary way. So I think that's a big part of it. Yeah, and I love that goal, that ideal of prevention. But if we've missed the prevention piece, how do we go about identifying which athletes are most at risk for inflicting self-harm? How do we intervene in a timely fashion before it's too late? Yeah, so I think, I mean, what if we look at it all that everybody's at? Because at any point, anyone could have an injury, right? Anyone could have a fellow teammate that dies by suicide and that's gonna affect everybody. And that's gonna bring to light a lot of like, well, I felt that way in the past. Does that mean this is gonna happen to me? What if this happens to me and all of a sudden there's a lot of anxiety? So why not look at it as instead of, hey, this is something we're all scared about that we understand that everybody is at risk. I think that's part of it. The other thing is really providing communication, not just, hey, if you have a problem, come talk to me. But really providing check-ins and support. So you and I've talked about this, but a lot of the universities that I work with and the athletic teams that I work with, I come in primarily for mindset training and sports performance. But when they see me coming back and they see me talking with them and they see the way that I communicate and the way that I integrate mental health and wellness within that sports performance realm, they start to identify that they're kind of one in the same and it provides opportunities for communication. And so I've had so many athletes whenever I've done a program, after the fact sort of reach out and say, you know what, like I've been struggling or this is something I struggle with. I just don't know who to talk to or how to talk about it, but the way you talked about it, I feel like it's part of this whole thing, right? And so again, it ties it in, it brings those things together. So it's not mental health, mental illness and it's sort of looking at it under the package of wellness, but we're trending more towards health, right? And so I think that's a big piece of it. The reality is when somebody dies by suicide or when there's a tragedy, I think it's important for the university to come together. Sometimes you can get liability driven, but it's important for everybody to come together, have conversations and make sure that you're not afraid to have the conversations for fear that it's gonna evoke other feelings. It's better to have them evoke those feelings in a more controlled environment so that people can feel free and open to talk and to navigate those fears and then to really even hear from athletes, like what can we do for you versus as an adult saying, well, here's what we're gonna do now because we're not in that experience, right? We've been detached, which is why we didn't recognize it. So why not hear from the athletes about what is it that you all need? How can we support you better? It's interesting, college athletes are so intelligent, but we don't give them enough credit, but they're so intelligent. And now this age and stage of college athletes, I remember talking to one of them, he said, look, we wanna have the conversation. We're talking about it all the time. We're posting about it on social media. It's the adults that don't wanna have it. So when we bring it up that we're struggling, they're like, great, get back to practice. You'll be okay, focused on the next game. And immediately we feel shut down and dismissed. So again, if we understand we want to empower them on the field or we wanna empower them in their sport, let's empower them as people. Ask them what they need, what they could use, how can we be better, helpful to you? And then I think you're gonna provide better opportunity. And this has happened in my practice, I've had athletes come to me because their team or organization said, we said, what can we do for you? And they said, I need mental health support. And then they made that connection, that link. And then we were able to support them, not only mentally and emotionally, but also physically. Speaking of what the systems are dictating, the NCAA does provide a waiver for students, a medical hardship waiver that they can apply for, for mental health purposes, if they qualify to give them a red shirt for letting them get an extra year of eligibility. But I'm curious from your perspective, is that strategy showing support for mental health or is it harmful? Because they're gonna have to get a sign off from a medical professional such as yourself. And they have to qualify for that within early, within the season. They can't have completed too much of their season. So is that actually supportive or in your opinion, is that harmful for mental health? I mean, I think it's a good idea. It's how you, I think all of these things have great theoretical basis, but it's how you apply them, right? And really integrate them. So I think it's something that the athletic department and the coaches really talk about is this is an option. Kind of like when you have a physical injury, you're able to use that hardship to get a red shirt. And it's talked about in the context of like, this is an option, it's always an option if you need it. Then sometimes when you know that that's an option, you don't have to take it because then you might, so let me work through this, let me get this, let me get this because I know that at some point I have to come to that, right? Time limited. But the other thing is how it's perceived, right? By your peers. I think I've had athletes where they've taken a hardship and initially their teammates, you know, called them lots of different names instead of a lot of different things and we're very much demeaning of the fact that they're not mentally tough and that they need to suck it up and that everybody's struggling and it really kind of demean that experience. And I've had other experiences where a lot of people said, wow, like I'm so proud of you, I look up to you. I think that I could have benefited from this and maybe I should have done it, but I haven't. And so I think it's how you word it and that you created as an option, not the only option, but an option of support that when it really comes down to it, you don't have to choose between walking away from your sport permanently or taking some time to really focus on yourself, your recovery. And that we're gonna welcome you back and we're gonna be checking in with you. Any other red shirt, typically, you're still a part of the team. You still go to practice sometimes. You still participate in everything you just don't play. That could be treated the same way and then it might have a lot of benefits. And tell us more a little bit. I know we're getting kind of close to the end of our time together, but this language of mental toughness, so harmful, helpful, how would you coach people on using appropriate language? Needs to be defined, right? Needs to be defined the right way. I think what's really interesting about mental toughness is when you ask coaches and parents, they say, they talk about mental toughness. You say, what does that mean? And they're like, well, you know, mentally tough. Like, but what do you mean? And they can't define it. To me, the ability to be vulnerable, the ability to ask for help shows a lot of mental toughness, right? The ability to prioritize this and do whatever it takes to make sure that this is taken care of is mental toughness. If somebody worked out on a torn hamstring and didn't tell anybody, we'd all think that they were stupid, right? And we would all make it very known that they were stupid, right? That's not physical toughness. That's just being stupid. So again, if we recognize that there is strength in vulnerability, the ability to ask for help, right? I think it's extremely tough to ask for help and it's extremely strong to get it. But if you can do those things, then that to me is true mental toughness because then you're more likely to return and be sustainable. I love that definition. And I think that's really a great perspective. So being vulnerable and asking for that help is actually being very tough and very strong. So I know there's several organizations and resources out there that people can go to to get support for their mental health, but can you tell us a little bit more about the work that you're doing and how people can get access to your services? Absolutely, yeah. And so I do work with some of those organizations. So I wanna give a shout out definitely to the Hidden Opponent, which does a lot of great work. Dame Here Global, they're the one that talk about five out of five, Morgan's Message. These are just some of the organizations and they've come together now to really work together and they've come up with this new text number that people can text if they're struggling and that's more recent that they've come out. As far as me and my access, what I do is you can find me, my website is mindsettraininginstitute.com. If you Google mindset training institute, it'll come up. I'm on Instagram, drt underscore sports like. What I did primarily do again is evaluate and provide not only a medical mental health sort of evaluation, but also an athletic evaluation. And then I work with teams and coaches and individuals in terms of providing mindset training, but not just in terms of like believe in yourself, visualize, do this, but really helping them understand the context, the science, the biology, the psychology so that they learn how to use these things which actually can really help prevent performance anxiety and help manage depression and along the way treating those things if need be. So it's been a privilege. My goal growing up was to be a teacher and a coach. That's what I really wanted to do. And now I'm a teacher and a coach with a medical degree and it really allows me the opportunity to help people in a level that I just don't think is necessarily provided enough and athletes have enough access and resources to do. So it's really a privilege to be able to do it. And it's great that you're combining all those wonderful skills and resources to really make a positive impact on people who desperately need it. And you made mention to a three digit code. I did wanna put that out there. The FCC has really elevated the need for access to a crisis hotline for national suicide prevention and mental health. So now you only have to dial three digits. It's much easier to remember than a 1-800 number. So it's 988 and that is now active. So 988 for those emergency resources that are available to everyone. So Dr. T, thank you so much for your insight into sports psychiatry, improving athletes' mental health and thank you for the work that you're doing. It's very valuable and important. I encourage everyone to tune in to the Mindset Experience podcast and check out the Mindset Training Institute. It's just really a wealth of resources. So thank you to our viewers for joining us today on the sports playbook. We'll see you next time. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. 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