An Introduction to anxiety and Sports Performance

Anxiety is a feeling of uneasiness and worry, which is often a reaction to stress.1 This will likely occur when an individual is anticipating a new or stressful situation, for example, starting a new job, giving a public speech, or when starting a competitive sport. Oftentimes, this will lead to physiologic symptoms such as a fast heartbeat, sweating, and shakiness.2 All of these symptoms can make it very difficult to focus. Experiencing anxiety can leave many individuals feeling fearful and nervous when encountering new situations. Although it is normal to feel anxious when anticipating an event or facing a challenging circumstance, there are times when stress can negatively impact an individual’s performance – especially in sports. Fortunately, there are many ways to manage anxiety and sports performance. 

Aside from lifestyle changes at home, one of the more recent and innovative methods to potentially reduce anxiety includes the use of cannabidiol (CBD). Although there is not a conclusive study that has determined that CBD can improve sports performance, there are various studies that show that CBD can improve symptoms of anxiety. Therefore, by reducing the symptoms of anxiety with CBD use, individuals can indirectly improve their sports performance. 

What is CBD?

CBD is one of the two major chemical components found within the cannabis plant species.3 The other major chemical component is called delta-9-tetrahydrocannabinol (THC), which is the chemical that will produce euphoric effects.3 CBD is the component that has been used for possible therapeutic benefits, and it has come a long way in terms of popularity amongst users because it does not produce the same euphoric effects of THC.3 There have been many studies conducted to determine the range for therapeutic potential of CBD. One of the many benefits includes improvement in symptoms of anxiety. CBD use can be beneficial for many additional reasons including the management of symptoms causing chronic pain. Additionally, this is a product that can be found in various formulations including creams, oils, and ointments, which makes the product easy to use. 

Anxiety and Sports Performance

Anxiety, in relation to sports performance, can be classified into three categories: cognitive anxiety, somatic anxiety, and behavioral anxiety.4,5 Cognitive anxiety pertains to negative expectations about success, worries about performance, negative self-talk, images of failure, and inability to concentrate.4,5 Somatic anxiety results in nervousness, elevated blood pressure, increased heart rate, and many more physiologic symptoms.4,5 Lastly, behavioral anxiety relates to avoiding eye contact, covering face with hands, fidgeting and defensive mannerisms.4,5 

Anxiety is an issue that can negatively affect sports performance. Many athletes may consider anxiety to be debilitating towards their performance.4 As mentioned, any sports game or competition can induce anxiety when an individual’s perceived ability does not stack up against the expectation or demand. Sports psychologists suggest that high levels of anxiety during competitions are detrimental.4 They can decrease performance levels and even lead to athletes dropping out of competitions or their sport all together.4 It is often natural to experience stress and anxiety prior to intense training or prior to the start of a sport.4 Nonetheless, when one experiences any of these symptoms of anxiety, athletic performance can be negatively impacted. 

A study done in 2017 highlighted this cause and effect by demonstrating how anxiety can lead to physical impairment. 4 For example, sometimes anxiety can cause individuals to have gastrointestinal symptoms such as an upset stomach.4 Anxiety can also cause tremors which can be detrimental to performing many sports, such as tennis and basketball, both of which require moving or holding items.4 Additionally, these symptoms can cause rapid breathing which can result in hyperventilation and increased production of sweat.4 This can lead to experiencing shortness of breath which can be debilitating in any high intensity sport which requires running.4 

Another study completed in 2016 assessed the relationship between competitive trait anxiety and collegiate powerlifting performance.6 The study involved 36 collegiate powerlifters (26 males, 10 females). Prior to competitions, the athletes were given a survey containing questions about powerlifting performance history along with a 15-item Sport Competition Anxiety Test (SCAT). The SCAT total score was negatively correlated to the athletes’ percentage of best total achieved in the competition.6 And with the individual lifts, the SCAT total score was also negatively correlated to the percentage of personal best for the bench press and the deadlift.6 These results show that increased SCAT scores were associated with decreased powerlifting performance. The study concluded that competitive trait anxiety negatively impacted performance.6

Data on Anxiety and CBD Use

A recent retrospective case series published in 2019 looked at CBD use in treating patients suffering from anxiety and sleep deprivation.7 This study was conducted with a total sample of 72 adult patients that suffered from anxiety and an inability to sleep.7  Nearly all individuals were given a CBD dose of 25 mg per day in capsule form.7 However, depending on the severity of their symptoms, some individuals had dose increases of up to 50 mg per day or 75 mg per day.7 All individuals participating evaluated themselves using a scale called the Hamilton Anxiety Rating Scale.7 Follow up was done every month and participants were required to complete assessments to determine if there were any changes in their anxiety symptoms.7 This study determined that over a 3 month period, anxiety symptoms decreased fairly rapidly with the use of CBD capsules.7 The overall average anxiety scores decreased from 24 to 18 after one month of CBD use.7 By the third month, the overall average anxiety scores reached 17.7 This demonstrated that the individuals who used CBD displayed improvements in their anxiety symptoms by the third month of CBD use. As such, organizers of the study concluded that CBD may hold a benefit for anxiety-related disorders.7 

Another study completed in 2019 assessed the efficacy of CBD treatment on patients with social anxiety disorder (SAD).8 The study, which was done with 37 participants suffering from SAD, called for the participants to receive either 300 mg of CBD daily for four weeks or a placebo in place of the CBD for that same period of time.  SAD symptoms were, in turn, measured at the beginning and at the end of the 4-week treatment period using the Fear of Negative Evaluation (FNE) Questionnaire and the Liebowitz Social Anxiety Scale (LSAS).8 The end results showed that CBD significantly decreased anxiety measured by FNE and LSAS scores. The average FNE score decreased from 24.4 to 19.1, and the LSAS score decreased from 74.2 to 62.1 after four weeks of CBD treatment.8 As with the case above, this study concluded that CBD was effective in reducing anxiety.8

Also worth noting here is  a 2015 review of evidence from several preclinical, human experimental, clinical and epidemiological studies conducted to assess the potential for CBD as a treatment for anxiety-related disorders.3 One of the studies in this review determined that CBD use prevented increased anxiety amongst participants exposed to chronic but unpredictable stress.3 This was an important finding because the individuals in the study suffered from anxiety produced as a result of undefined and irregular stressful situations thereby demonstrating that CBD use could alleviate symptoms causing short term anxiety.3  Additionally, there were two studies that examined chronic anxiety symptoms as a result of PTSD.3 These studies both concluded that use of CBD significantly reduced the symptoms of PTSD.3 Overall, this review found that there was strong evidence suggesting that the use of CBD can improve symptoms of generalized anxiety disorders, social anxiety disorder and posttraumatic stress disorder. 

Can Improvement of the Symptoms that cause Anxiety Lead to an Improvement in Sports Performance?

There is evidence that symptoms causing anxiety can negatively impact the way an individual performs in a sport. Therefore, finding methods to manage these symptoms is essential in order to optimize the way one performs as an athlete. Although there is limited data that directly correlates CBD use with improvements in sports performance, there is sufficient evidence regarding CBD and its positive impact on symptoms causing anxiety. And because it has been demonstrated that anxiety can hurt sporting performance, one can surmise that CBD can have an indirect positive impact on the performance of athletes who choose to consume CBD as part of their program for managing anxiety and stress.

 

References: 

  1. What Are Stress and Anxiety? Healthline. https://www.healthline.com/health/stress-and-anxiety. Updated on March 29, 2020. Accessed on October 22, 2020.  
  2. Everything You Need to Know About Anxiety. Healthline. https://www.healthline.com/health/anxiety#:~:text=Anxiety%20is%20your%20body’s%20natural,to%20feel%20fearful%20and%20nervous. Updated on September 3, 2020. Accessed on October 22, 2020.  
  3. Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. doi:10.1007/s13311-015-0387-1
  4. Muhammad K K, Alamgir K, Sami U K, Salahuddin K. Effects of Anxiety on Athletic Performance. Res Inves Sports Med. 1(1). RISM.000508: 2017. DOI: 10.31031/RISM.2017.01.000508
  5. Patel, Dilip R et al. “Sport-related performance anxiety in young female athletes.” Journal of pediatric and adolescent gynecology vol. 23,6 (2010): 325-35. doi:10.1016/j.jpag.2010.04.004
  6. Judge, Lawrence W et al. “The Impact of Competitive Trait Anxiety on Collegiate Powerlifting Performance.” Journal of strength and conditioning research vol. 30,9 (2016): 2399-405. doi:10.1519/JSC.0000000000001363
  7. Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. doi:10.7812/TPP/18-041
  8. Masataka, Nobuo. “Anxiolytic Effects of Repeated Cannabidiol Treatment in Teenagers With Social Anxiety Disorders.” Frontiers in psychology vol. 10 2466. 8 Nov. 2019, doi:10.3389/fpsyg.2019.02466