Athletes and Mental Health with Dr. Matthew Sacco

Podcast Transcript

Kate Kaput:

Hi, and thank you for joining us for this episode of the Health Essentials Podcast. My name is Kate Kaput, and I'll be your host today. We're talking to sports psychologist, Dr. Matthew Sacco about athletes and mental health. This year's Olympics have brought more headlines than ever about the need for athletes, from the elite to the extracurricular, to tend to their mental health as carefully as they tend to their physical health. Dr. Sacco is here to talk to us about the specific mental health concerns that athletes face, including what they can do about it, and how the rest of us can support them. Dr. Sacco, thanks so much for being here with us today.

Dr. Matthew Sacco:

Thanks for having me.

Kate Kaput:

So I'd like to start by asking you to tell us a little bit about the work that you do here at Cleveland Clinic. What kind of work do you do, and what sort of patients do you see?

Dr. Matthew Sacco:

Yeah. So right now I spend about 60% of my time at the clinic working with athletes in some capacity. So I spend two full days of working with young people through sports medicine, and then I work a full day as a part of the NFL retired players program. So it's a wide range. Then I spend some time in another center as well. And so I'm seeing young people, or athletes, I should say, from probably middle school all the ways up and beyond through retirement, occasionally a little bit younger than that. But that seems to be the catchment area of folks that I'm getting.

And so a lot of the work that I do, especially in sports medicine, really revolves around a couple topics. One is somebody who shows up because they're trying to recover from an injury and get back kind of to their sport. And then sometimes for one reason or another, they've been in front of one of our other sports medicine providers or athletic trainers, and they're just sensing something's off. And it's really coming in and seeing a sports psychologist that's attached to Sports Health is a lot less threatening than being told to go see the psychologist otherwise. So they usually come into my office, and then that kind of is a cascading event. We start to work on things that they may have been dealing with for a while.

Kate Kaput:

So it sounds like you're the perfect guy to talk to us about this today. I'd like to start by broadly talking about sports and mental health. A 2016 study showed that elite athletes are just as prone to mental disorders like anxiety and depression as non-athletes are. What factors may contribute to mental health concerns in athletes specifically as it relates to their participation in sports?

Dr. Matthew Sacco:

Yeah. Yeah. I think the first thing we have to remember is, and it sounds kind of cliché, but I mean, athletes are people. So they're going to experience very similar sets of mental health concerns as the general population to begin with. Then you add these other layers. Some of those come from the culture of athletics itself. So be they sexuality or gender issues, or hazing or bullying. Things that come from that environment that traditionally has kind of been viewed as more of a hyper masculine kind of environment as a whole in athletics. And those factors certainly can play a role.

But then there really are individual factors that are personality factors. We often hear of athletes who have kind of that perfectionistic mindset. And that can really serve people very well. They're more driven. They may be more likely to look for ways to improve their performances. Unfortunately, without a softer side to that, you get people that are never satisfied. You get people that might actually just be driving themselves to the point of sleep problems, or a whole host of other things that can come, over-training, other anxieties and stressors. All of that that might be exacerbated because of some of those personality factors. When the flip side, like I said, there're real benefits to those personality characteristics, that higher sensation seeking, sometimes less hastiness and anger that can come from people being associated with higher levels of athletics. So it's a mixed bag, but as you work your way up the level of competition, I think that what we're talking about has just kind of turned the heat up on some of these factors, and they can become a little bit more pronounced depending on the person.

Kate Kaput:

So it sounds like in some ways the things that make people great athletes are also the things that sort of, in overdose, can contribute to mental health concern.

Dr. Matthew Sacco:

Yeah. Absolutely right. And then they're constantly fighting that idea that there's a toughness associated with being an athlete. And then with that, it's been the stigma of getting help. Because if you're tough, then you should be able to just do it yourself. You don't have to get help. And that kind of creates a bigger problem. And in large part, I think what we're seeing kind of explode right now in the media.

Kate Kaput:

So let's talk about getting help. When we see an athlete get injured physically, whether it's a pulled muscle or a broken wrist, or whatever it might be, we understand that they need to take time to recover physically to heal their bodies. Why then is it so difficult for people to accept that an athlete may also need to take care of their mental health, even if that means stepping back from the sport? Where's that disconnect for athletes, and for those of us who are sports fans and viewers?

Dr. Matthew Sacco:

Yeah. I think that the vast majority of the problem lies with the fact that you just can't see it. So not that we need to specifically see the x-rays or whatever as people from the outside. But we just believe that if somebody has been diagnosed, if they tore their ACL, or they broke their leg, it's visible. And we can take an x-ray, we can look at it, and it can be fixed. And there's a timeline on it usually. They go it's, okay, yeah, your wrist is broken. We're going to put cast on it. Come back in a few weeks. We'll take an x-ray. We can see the progress of the healing.

And mental health issues don't work the same way. First of all, they're not as tangibly visible like an x-ray would provide. So we're left with looking at some of these things that seem like ancillary issues that might be relevant to a whole host of other issues. But sleep problems, or maybe irritability. Somebody has lower energy. Changes in eating. All of these things that are unique to the person, but we just can't necessarily measure it. And we also use the same measuring stick for recovery. So the expectation is that if a broken wrist takes eight weeks, then we'll, okay, so how do we measure someone who might be struggling with depression? It's not the same thing. And it may be that it requires somebody to be dealing with something like this over a longer term. And we just don't do a good job of appreciating the impact of that on athletes.

Kate Kaput:

And that's, in some ways, the issue with the stigma of mental health altogether, not just for athletes, but for everyone. So let's talk about how an athlete's mental state can affect their physical performance. A gymnast like Simone Biles, famously for example, have spoken about the twisties, which is a sort of disconnect between the mind and the body in competition that has been shown to be a danger to gymnast's performance. And other athletes have spoken about the ways that their mental health can impact their physical ability to play well. How can being in a bad head space make an athlete more prone to physical injuries?

Dr. Matthew Sacco:

I think at a very, very basic level, at minimum, it's a distraction. At the very minimum, if your mind is full of other things, then it can just be a distraction. So going from there, I think we have to consider that, in many sports, especially at very, very high levels, then these distractions can be magnified. And as the pressures to perform increase, it gets even worse. And now we also then need to consider the sport. So it can range from a poor performance, for instance, or poor scores.

So for instance, somebody who's a golfer, right? It's very unlikely that that distraction, that mental health issue, is going to be outright dangerous. It's just not the case with the sport. However, gymnastics, maybe downhill skiing, something like that where just the slightest kind of alteration in your mental state could lead you to not be as focused. And that lack of focus can be quite catastrophic. And again, I think that we get stuck because we are applying the same measuring stick to all sports. And it's not that anyone is better, worse, harder than another, but the consequences of not being focused for some are quite different.

And I've never been an elite athlete myself. So I can't even imagine what it takes, as a gymnast, to understand your body and space, and at appropriate sections, spinning and land. That happens so quickly. And I think we look at it from this kind of armchair standpoint where we think we can understand it, and they should just be able to figure this out. And I think it really lacks any kind of real awareness of what's really going on.

Kate Kaput:

That makes a lot of sense. I mean, mental health issues are hard enough for people who have a desk job. You're working a 9:00 to 5:00. And the world isn't watching and there's no physical risk. But mental health issues are hard enough to deal with on an everyday basis, much less when it's impacting your entire physical body.

Dr. Matthew Sacco:

Yeah, that's correct. And that's where it gets even further complicated. I think this is what we also see beyond athletics. We see this in health as well. Which is when people are exposed to kind of stressors, our body has a physical reaction. I think in popular culture, in many ways, we hijacked the term stress to think about these things in our lives that are stresses. When we look at it from a biology and physiology standpoint, stress is really our body's reaction to stuff. So it's that fight or flight response.

And when that's fired routinely in response to things that aren't really threatening, like if you're worried about something, or if you're afraid of something, it's kind of more of a thought or something in your head, the body responds in a very similar fashion and tries to go into this protection mode, which by default is not designed for health and wellness. It's just designed for the immediate moment. And so now you talk about athletes who have been training for years and years and years and years and years. And the consequences to this, be it risk for health, or we know people who have more realistically optimistic outlooks recover from injuries faster and more completely than those that don't. So that the data is there in many, many fields, it's hard, again, back to that seeing is believing, and that's what we're stuck with. And we don't necessarily think that it's as important when absolutely objectively it is. We see that in the data.

Kate Kaput:

So let's talk a little bit about that fight or flight, kind of when your body decides whether to fight or to take flight. A big part of sports is the idea of pushing through, of persevering, of achieving against all odds. It's kind of the perfectionism that you mentioned before. But conversations around mental health reveal that that's not always what's healthiest for athletes' minds. When an athlete is struggling with mental health concerns, what can guide their decision to play through versus sitting it out or withdrawing from competition?

Dr. Matthew Sacco:

Yeah. I think to begin with, we really do need to consider, as we're seeing right now, to have more of these public conversations about mental health in general. And then extending that to athletics. And our culture has not necessarily caught up to that conversation. Athletes are being told that mental health is a priority, and then not being supported, or it's not being prioritized in any way. So it kind of gives this mixed message. Like, yeah, you need to take care of yourself. Well, nobody's really doing anything to support that in meaningful ways. So we're still stuck swimming upstream against this idea that mental health is not perceived as a whole to be as important as physical health problems. Again, back to this idea, because we can't see them.

And interestingly enough, for the very same reasons, I'd say that mental health concerns more than likely have a greater impact on performance than some of these other things that we can see because we know. And so oftentimes athletes struggle through mental health issues and push and push and push and push because they can't see it. No one's listening. So I would kind of say that we need to step away from more of this reactionary response, and talk about this more broadly. And how do we start the process of having organizations, schools, coaches, et cetera, prioritizing these mental health needs along the way?

I can do this work with people when they come into the office on an individual basis. And it's one thing. But we're not going to see any meaningful change until it's prioritized across the board. So that athletes actually will come out and say I am struggling with this stuff. And until we get there, it's going to be case by case individual. Those people that might have some previous experiences, might have a family member, might have somebody who says, "Oh yeah. No, it's fine. You really should go talk to somebody." But most people don't live in that world.

Kate Kaput:

Yeah, I mean, I'm thinking about in recent years, some athletes like basketball player Kevin Love and swimmer Michael Phelps, who've begun to normalize those conversations around mental health in sports. Can you talk about how athletes can work to overcome or address mental hurdles? Sort of where can they begin? What can they do to focus on their mental health while remaining competitive in their sport? Particularly now when we haven't quite normalized it yet, but people are trying, right? What can athletes on an individual level, what can they do?

Dr. Matthew Sacco:

Well, it really starts with exactly, as you said, folks like Kevin Love and Michael Phelps. It's certainly a risk to them because of their persona, because of essentially their brands and things like that. Sometimes it can be hard for young people to relate to that directly just because it feels like the risk is far greater when you're 16, 17, 18 years old, and you're trying to deal with this stuff in the high school setting than when you're already established, making millions of dollars. It feels like it's a difficult leap.

However those conversations starting where it's cross culturally, at that point. Sports are very influential. It can at least get the conversation. And once that conversation starts, and I'm very lucky and very spoiled here at Sports Health because I have some very psychologically minded sports medicine physicians and athletic trainers who are in the trenches and notice this stuff. And can really do a nice sales pitch in terms of this is a really good thing. Which is why I believe so strongly about just starting those conversations and opening that door. And then identifying a landing spot for some of these folks.

And then at that point, it can grow into a bit of a word of mouth. And people find out that, okay, this isn't quite what I thought it was. This isn't so bad. But it really does take some allies in the other fields who respect and appreciate the impact of mental health. And I often when I see coaches, or when I do things with coaches clinics and things like that, the bottom line is truly when a person and an athlete is managing their mental health, and they're doing well and taking care of it, they perform better. So it's not a lot of gray area. When someone's able to do this stuff, they actually perform better. So that's kind of at times the selling point. Really, it is going to be a cultural shift in being a little bit more compassionate and understanding, and allowing people to space work on this stuff.

Kate Kaput:

So I'm guessing that the earlier athletes start understanding and valuing mental health, the better it can be for them throughout their career. So I want to talk a bit about athletes' younger years, right? From little league to college, sports are a really big part of growing up kind of in American society. They can teach us positive skills like teamwork and perseverance. Things that stay with us for life. But when kids get into sports at such a young age, how can the adults in their lives, their coaches, their parents, help ensure that kids know about mental health and feel supported in their mental health kind of throughout the duration of their involvement in sports starting really early?

Dr. Matthew Sacco:

Yeah, this is a really good question. This is something, I have three young kids myself, so I think about this quite, quite frequently as I watch and help in their endeavors through youth sports. I think first and foremost, leading by example. Get out of this mentality where it's the do as I say, not as I do. That doesn't work. Young people watch what you do. They're checking everything that you say. That is far, far more important to live by that example and start to create that open dialogue.

We have all these examples. Sometimes they're quite inspiring, but at the same time, it can be quite damaging. I think of how we all latched on years ago when Brett Farve, the day after his dad died, and he's had almost 400 yards passing, he had four touchdowns, and he was on Monday Night Football. We're all like, wow, how incredible. And it's like we somehow believe that our 10, 11, 12 year olds, and whatever age, should be able to kind of do that same thing.

And this idea of when you step on this field, or in this court, or in this pool, you should just leave it all behind you. And those are not messages that are doing any favors. And so I think as adults and as people working with youth, starting to lead by example. I think we need to take into consideration that just because it's something that's been done in the past, just because we did it that way... When I was young, you just toughened up, thicker skin, and you suck it up, you pull yourself up by your bootstraps, and move on. That doesn't mean that that's the most appropriate or best approach.

And I think that we're finding, in fact as times have changed, what most of us growing up never had to deal with, which is social media. And so you don't get a chance to take a break. You don't get a chance to go home and not be exposed to that stuff. And it's instant. And I think that we need to learn, we need to change, we need to try to do a little bit better so that we're not repeating these things, and then wondering why people are still struggling.

Kate Kaput:

Yeah. I mean, on the note of that social media point and kind of all of it, right, society tends to have these really high expectations, not just for elite athletes, but for child athletes, right? For little kids out on the field. And we can be very hard on athletes who don't perform the level that we expect from them. At an elite level, I'm thinking of tennis player Naomi Osaka, who recently declined to speak to the media after saying that press interviews started to make her doubt herself, and sort of seed that doubt in her mind. How can our expectations of athletes, whether they're Olympians or children, how can our expectations societally impact athletes' mental health?

Dr. Matthew Sacco:

Yeah. And this really ties into just kind of what we were talking a little bit about before. I think that we get stuck in this results driven, like successes about winning mentality, and especially working your way up from younger age, it's really focusing... To be clear, people, this isn't everybody gets a participation trophy kind of mentality, which people seem to kind of push back against. It's not that winning isn't important. It's really about focusing on effort and skill. Improvement over time. And then of course, developmentally, then you start to kind of create a bit of a skill set that after somebody fails, I'd rather have somebody walk away from something that they haven't been successful at, with the ability to assess what they did that was effective, what areas they can improve on.

And then that will then grow and further some of these skills so that, I look at things you said with Naomi Osaka, when you can get stuck. Everything's so instant reacting, some of it, the train has already kind of left the station. We're asking people to behave in a certain way that we deem to be appropriate based on whatever expectations we've placed. Yet there really isn't anything supporting the notion that they should be able to step away. Like we say, oh yeah, you're autonomous, you can do your own thing. And then we hear pushback like, "Well, they're professionals, and they're getting paid." Somehow that should make them more immune to, or not feel a certain way, or completely give up their right to say, "Well, listen, I don't want to do this." And that's a really big problem. That's a big problem that extends beyond just what we saw with the media.

Kate Kaput:

Talk to us a little bit about how athletes' identity can be tied to their sports performance, right? Again, we've seen it in Simone Biles during these Olympics, sort of saying that the response that she's gotten, the support that she has gotten has made her feel like it's okay to be not just a high-performing gymnast. How does that identity piece tie into athletes' internalized sense of pressure, and how can that impact their mental health, right? Because I would imagine if you're worrying about walking away from a sport, or sitting out a big game, but your self-worth and your identity is tied to your performance in that sport and that game, that can really have an impact on you. What can you tell us about that?

Dr. Matthew Sacco:

And not tend to kind of repeat too much of what I said a minute ago, but it really does come down to, from a very young age, helping people separate this idea of improvement versus performance, and that being the value of your worth. Getting out of these generalities, like people say things, "Well, I guess you didn't play very well." In many ways it comes back to the language and communication. This isn't going to create softer, less responsible children. We hear all this stuff. Rather this is where you give an opportunity for young people to develop more robust skills for coping as this stuff goes on. And when they're able to do that, when they're able to have some success, if you will, with coping with failure. We often kind of put these in black and white categories. And it's kind of like, if you lose or something, or doesn't go well, we label these things as failures.

And instead we miss an opportunity to look at both, like I said before, what were some things that worked well? What are some things in this... So that your performance doesn't become cemented as your identity and vice versa. It will actually help them develop, like I said, more robust skills, better self-esteem, and greater, genuine confidence. Not a false sense of confidence where it's not based on them having had some success in these areas.

And ultimately, we also have to keep in mind that developmentally where people are. You think about the age ranges that we're talking about, mostly adolescents and very young adulthood. It's chaotic. Our brains aren't fully developed. We're struggling through these things. Yet we somehow, again, put this measuring stick like they should be making adult life decisions. And to expect them to be able to figure it out is really an exercise in futility. Because not only do they not have the skill, but they don't have the hardware to do it. And then we get frustrated.

Kate Kaput:

So this is all kind of related, and I hope I'm not making you repeat yourself, but I'm thinking about the pressure that kids feel from coaches and parents. And also the fact that a lot of kids start playing sports when they're really little. They just start playing for fun. And then as you get older, it starts to get to this place where it's like, well, if you're not going to continue doing this, if you're not the best at it, if you're not going to be competitive at it, then maybe it's time to leave the sport, right?

I think about myself growing up, I was a dancer. And then at some point, I was like, I'm not really a good enough dancer to keep dancing at a certain level, right? And so when do we let kids leave the sport, or pull back from it versus having them push through and go elite, or go more competitive when a kid is like, I started this for fun, it's not that fun anymore? What do parents need to be on the lookout for in terms of that, and letting it happen? What tips do you have for parents?

Dr. Matthew Sacco:

Yeah. I think first and foremost, you have to check your own pride at the door. I mean, you have to if you're going to truly listen. Not just hear what they're saying, but listen to what they're saying. It doesn't mean that I'm saying that kids are whatever they say goes. That's not it. I mean, obviously there are a lot of other factors that come into play here. But first of all, be open and listen. Because if you want to have an honest conversation maybe with your child or a young person about what's going on and why they feel this way, they need to be feeling like it's going to be a conversation and not an exercise where you're just going to try to convince them.

Maybe there's something else going on. And this is in my experience, and I know I have, I guess, the privilege of sitting on the side of the desk that I sit on with all these young people that come in. And I hear that there's always more going on that is contributing to these decisions. But at a point kids are aware, and parents too, when maybe their skill isn't up to the place where it's going to take them to these higher levels and higher levels. There's the data in terms of who makes it to these elite levels from high school to college, it's staggering. Yet some of it is just kind of realizing that not everybody's going to do that and that there are other options. If they want to have fun and they want to play, find leagues that allow for that. And there's still competitiveness for sure.

But you got to be mindful that you could potentially be doing more harm than good when your belief is that you should forcing them to... I'm not saying that there aren't exceptions to this, but it could be doing more damage than good if you're just forcing them and there's really stuff going on because it's not healthy. And I think that I would argue I think that when we don't listen, and we're not paying attention to what's going on, I think you can see first-hand how it is that we're in the situation that we're in right now and the things that we've seen where you gotten, and this takes it to a pretty serious note, but I mean, how is it that medical professionals, trusted medical professionals, coaches, have been able to abuse people, assault people for years, for years, in spite of the fact that young people did say stuff at the time. A lot of this doesn't feel right, or it just doesn't seem right.

And when we get stuck in this, why we don't listen to what's going on, then that's the kind of stuff that can happen. Because we are stuck in this mentality, well no, you have to push through. You have to do this. And we are seeing, as we're seeing this in people who have become professional attitudes, whose voices we would assume are strong and loud. And Simone Biles, all these gymnasts who we look at it as very, very strong women, and it's like, it doesn't matter. If we're not listening to young people. It doesn't mean believe everything that they say every time, but it's using some discretion here and figuring out how do we give them a voice that people, that they feel heard so that we're not continuing these cycles. The risk, in my opinion, the risks of not is far greater than the risk of listening to them. And then as an adult having to go have a conversation with another adult to figure out what's going on.

Kate Kaput:

Yeah. And really not letting the pressure that we put on athletes breed the secret keeping and sort of shame that the rest of us, nobody's paying attention to you for a very long time until it kind of comes out in these very traumatic, devastating kind of ways. Which leads me into the next question, which is a question for kind of all of us who enjoy watching sports, whether it's we're loving the Olympics or our kids' high school football games. As fans, how can we best support athletes' mental health? And this is sort of on an individual level, right? What kind of changes can we make to our own understanding of athletes and competition in order to contribute to lessening the overall stigma around mental health and sports?

Dr. Matthew Sacco:

Yeah, it can be a bit of a tricky balance in many ways, because we do hold sports to such a prestige. And with that being the athletes, and it seems like all of the stuff that goes with that we all kind of look at as this is great. Similar to what I said before, some of it comes back to starting with the language that you use in your homes about mental health. That's one of the things that I myself try to be very passionate about, which is our language is meaningful. Words have power. And so being able to describe people in terms of the things that they're dealing with versus labeling someone who's experiencing, maybe with Naomi Osaka, for instance, maybe she was dealing with symptoms of anxiety and depression, and instead of labeling her as anxious and depressed. And just start to separate some of that out.

And it's television, it's entertainment. As adults, placing a little less emphasis on these outcomes. I mean, to be honest, especially when we're in a house with young people. I mean, knowing your audience, if you're watching, the language is still important, but when you have eyes on, and you have people watching, you have people paying attention, then it's even more important to be mindful of that. We often look at, again, back to that same measuring stick, right? We look at LeBron James, we look at Tom Brady, we look at these people who were famous and top of their game. And we look at all the power and the authority and the influence they have, and we put them on the same plane, for instance, as Simone Biles or Naomi Osaka. When clearly, while they're elite athletes, clearly they don't have the same platforms. Clearly they're not granted the same exceptions. And it just fails to appreciate that there are these differences, there are comparisons that are made, and that we're all human to be quite honest, and everybody's different.

Kate Kaput:

Can you say a word about fans' participation in social media, and just kind of checking ourselves, and thinking about the athletes who are humans on the other side of the computer? Anything that you can say there?

Dr. Matthew Sacco:

Oh, geez, yeah, lots to say. This isn't unique to sports. I mean, we see this in news and politics. And people just behind this keyboard will type and say all sorts of things that they would never do in person. So it's really hard. And I think, at least at this point, the easiest thing would be checking yourself in terms of what's the point? I say to my own kids all the time, don't be the reason why somebody else has a bad day. Try to think about that when you're doing stuff. And I think that the anonymity that social media can allow for, and of course under the free speech, all those kinds of things that people use to kind of, and rightfully so, to justify what you're doing, it's just messy.

So I think more first and foremost, I mean, yeah, check yourself, what's the need in doing this? But then, in my experience professionally, a large part of what I'm doing then is trying to help the people who are receiving those messages on the other end. And say, listen, shutting things off. How do you process that? This isn't somebody to email. All that kind of stuff. The impact is really profound at times when people... And again, people say, "Well, that's what they get when they put themselves out there." And it makes no sense because no one their right mind would want to have those things said to them. And so it's so complicated in our geopolitical climate that we're in, it's just inflammatory. So at a certain point, I just tell people, just turn it off period. Now my brand isn't based on my ability to get tweets or things like that. So I recognize that there's a business piece for many people, but most of us, it's not.

Kate Kaput:

And I like that advice though, don't be the reason that someone else has a bad day. That seems like a good kind of guideline for life generally for how we treat people. Dr. Sacco, is there anything that we haven't discussed today that's relevant to the topic of athletes' mental health? Anything that you think listeners should hear, whether they're sports fans or athletes themselves, or the parents, or the coaches of young athletes? Anything that we haven't touched on that you think is particularly important?

Dr. Matthew Sacco:

I think overall it would be remiss to ignore just the importance and the influence and the impact of coaches, and the team environment, the coaches, administrative, all the people who are associated, actually the amount of influence they have on young people. And at the same time, don't be afraid to ask for help and support as a coach when you're out of your depth. You may be great at coaching skills, which is awesome. Just because you see those coaches who played the sport, and they're really good at it. But just because someone has experience playing doesn't mean that they have the skills necessary to be a... I mean, they might be able to coach the skills, but understanding that relationship with the players. Developmentally there's a difference between coaching eight, nine, and 10 year olds and 17, 18, and 19 year olds.

So don't be afraid. Often people have to think that there's a pride issue, or they should somehow just know to do this, or asking for help is somehow a weakness, but coaches improving their communication, improving their ability to understand and work with young people is part of that equation. Being open to the idea that there are aspects related to young people and teaching, whatever it might be, that you may not be as skilled in. Just like you would tell your athlete, you need to work on this. Seek out those opportunities. Take opportunity to improve your own skills. And lead by example, demonstrate good sportsmanship, win or lose. People are watching. Maybe be a little bit more compassionate. Have a little bit more humility. And I think you'll find that your players will respond and young people will be much more open to ask for help themselves when they need it. And ultimately I think that it will lead to greater success on the field.

Kate Kaput:

Dr. Sacco, thank you so much for being here with us today. If you would like to schedule an appointment with Cleveland Clinic's Center for Behavioral Health, please visit clevelandclinic.org/behavioralhealth, or call 216-636-5860. Thanks so much for joining us today.