Psychiatric Annals

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Cases in Visualization for Improved Athletic Performance

Thomas Newmark, MD

Visualization is a clinical technique used to assist athletes with overcoming performance anxiety. By engaging athletes in a mental rehearsal of their performance in their respective sport, it can sharpen his or her focus and restore confidence in their ability to follow through.

Visualization was first applied to sports performance after the 1984 Olympics, when Russian researchers studying Olympic athletes found that Olympians who had employed visualization techniques experienced a positive impact on their biological outcomes and performance.1

Since the 1984 study, the technique has been used extensively in the United States and has found acceptance by neuroscientists and sports psychologists who have found that subjective training can cause the body to respond more favorably to consciously desired outcomes.2

Case 1

The patient is a 17-year-old, white female, high school gymnast. She experiences high anxiety just prior to competitive meets. She performs fine in practice, but not in competition. Of note, her mother is one of the team coaches. The patient stated she does not want to take medication for her anxiety because she is afraid that it might have side effects such as weight gain.

The patient had heard about visualization and came to therapy, confident she would benefit. She described how during competition she would lose focus, feel her heart race, and start to sweat and shake. She believed that her mother was supportive, but over-involved, placing an added burden on her performance.

The patient described in detail her warm-up routine, including saluting the judges, as well as the various portions of the competition. Visualization therapy began with her doing progressive muscle relaxation, concentrating on tightening and then relaxing one group of muscles at a time until her entire body was relaxed.

Next, while in this relaxed state, the patient was instructed to employ her visual, auditory, and tactile senses to imagine a competitive meet. She described aloud each detail as she visualized herself in her team colors, hearing the sounds of the fans, and experiencing her body going through the movements for each routine.

It was suggested to her that upon “saluting” the judges, she would feel “calm and confident” instantly. This opening gesture was her cue to feel relaxed and focused. This visualization was done during a number of sessions; she was also instructed to practice at home

After 3 months, she had improved her performance/scores in competition and felt relaxed and focused. She also reported that she had more fun during competition.

Case 2

The patient is a 24-year-old, white male semiprofessional golfer who reported feeling “stuck” and unable to improve his game, which he described as “declining,” particularly his putting. Based on the interview, there did not appear to be any acute stressors in his life.

Using relaxation techniques typical in visualization therapy,3–5 the patient is asked to close his eyes and focus on letting go of any tension his muscles, beginning with the top of his head, progressing then to his forehead, face, neck, back, abdomen, stomach, legs, and feet. The suggestion to the patient is to become calmer.

Simultaneously, it is suggested to the patient to control his breathing, allowing it to become slower and deeper. Throughout this portion of therapy, the patient is sitting comfortably with his eyes closed.

Once the patient is relaxed, he is asked to describe what he would see if he were playing the round of golf: the green, the course, and golf clubs he is holding.

At this point, it was suggested to the golfer that when he putted, he would see the ball following an imaginary, dotted line to the hole. It was then suggested that as the patient drives the ball, it would become “laser-like” in accuracy, moving along a straight line. After 1 month, during which time the patient practiced visualizations at home, this intervention helped the golfer improve his focus and game. He reported that he was able to get much closer to the hole on long or lag putts.

Case 3

The patient is a 23-year-old, black former “star” college wide receiver trying out for a professional football team.5 He reported that during training camp he kept dropping passes thrown to him. The patient reported feeling frustrated, and had turned to visualization after hearing that it might help.

Initially, the patient reported that he believed he did not need to make any significant commitments of time and energy to train or practice to move to the next competitive level.

Clinical observation was that the patient was somewhat enamored of the social perks of being a star athlete. He believed that the technique of visualization alone would be sufficient to elevate him and enable him to achieve his goals. Ultimately, with the clinician’s counsel, the patient was able to accept that visualization techniques alone could not provide the motivation necessary to help him overcome his acute slump.

While seated, the patient was instructed to close his eyes, relax his muscles progressively; and to block out any distractions. He was then instructed to visualize glue on his receiver gloves, and that as he catches each pass, the glue keeps the ball stuck to his hands.

The patient applied the technique for approximately 1 month while in therapy. Over the course of a month, the technique helped him overcome his frustration and improve pass receiving. However, he did not make the professional team. The patient stated that he would continue to play as a semiprofessional.


According to McDuff, visualization involves imagining the performance of a task, resulting in a positive outcome.6 This technique has been widely used by athletes at all levels of play, in virtually all sports.

Functional MRI brain research supports this technique, since brain imaging has shown that during visualization, a shift in activity from the left to the right hemisphere occurs.6 The right hemisphere is associated with creative imagination while the left with logical thinking.6 This transfer from the logical to the creative enhances visual imagery and, thus, performance.6 This is useful in the mental training of athletes because the imaginative skill of the right brain helps make imagery sessions more vivid.7

Porter8 notes that internal visualization of specific movements creates neural patterns in the brain, improving neuromuscular coordination. Because the brain tells the muscles how to move, stronger neural patterns thus result in “clearer, stronger movement.” Results are then reinforced by gains made in actual practice, where real muscle activity occurs.7

Although visualization can help improve an athlete’s performance, it does have its limitations and will not turn an average athlete into an elite superstar.3


  1. Scaglione R, Cummins W. Karate of Okinawa: Building Warrior Spirit. North Clarendon, VT: Tuttle Publishing; 1993.
  2. McCormack F. Mind games. Scholastic Scope. 2006; 54(10).
  3. Tofler I, Morse E, eds. Clinics in Sports Medicine: The Interface of Sport Psychiatry and Sports Medicine. Philadelphia: Saunders Elsevier; 2005:973–976.
  4. Begel D, Burton R, eds. Sport Psychiatry: Theory and Practice. NY: WW Norton and Company; 2000:83–89.
  5. Fricker J, Butler J: Secrets of Hypnotherapy. London: Darling Kindersley; 2001:50–51.
  6. McDuff D. Sports Psychiatry: Strategies for Life Balance and Peak Performance. Washington, DC: American Psychiatric Publishing; 2012:41–42.
  7. Liggett DR: Enhancing imagery through hypnosis: a performance aid for athletes. Am J Clin Hypnosis.2000;43:(2)14–28. doi:10.1080/00029157.2000.10404267 [CrossRef]
  8. Porter K. The Mental Athlete. Champagne, IL: Human Kinetics; 2004.

Thomas Newmark, MD, is Professor of Psychiatry, Cooper Medical School of Rowan University; and President, International Society of Sports Psychiatry.

Address correspondence to: Thomas Newmark, MD, Three Cooper Plaza, Suite 307, Camden, NJ 08103; fax: 856-541-6137; email:

Disclosure: Dr. Newmark has no relevant financial relationships to disclose.


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