The essence of it is that athletes elicit one kind of neurological response when they feel that their careers are threatened, or the outcomes will severely threaten their reputation. They don’t feel like they have resources. Their brains then trigger the dual sympathetic nervous system with which we’re all familiar: fight, flight, freeze, fawn. Many terms apply. Fundamentally, a sympathetic outflow happens. Then their hypothalamus, pituitary, and adrenal access get triggered, and their cortisol levels shoot up. So, the combination of epinephrine, norepinephrine, and cortisol leaves the threatened person in either a freeze modality or sprinting away. The central nervous system blood flow diminishes. and the social engagement disappears. It’s all about immediate reactive activities. Athletes under that threat-based neurological response perform poorly.

Their performance deteriorates—contrasting with the neurological response to a high-stakes challenge. This is still pretty early evidence; however, evidence that they have thus far suggests that when facing a challenge, the sympathetic nervous system gets triggered in athletes. However, instead of the anterior pituitary pushing out cortisol, the posterior pituitary pushes out oxytocin. And then neuropeptide Y is also secreted. The combination of oxytocin and neuropeptide Y calms down our amygdala and brings us to a lower anxiety state. In that state, the athlete’s performance improves. I thought that was an important finding upon which we might reflect.

We have often devoted a considerable amount of time to primary care during our Salus forums. This is understandable given that many of us are involved [I think psychologists are primary care of the mind and behaviors] Our shared concern is that primary care is grossly under-resourced. We’re constantly under a threat mindset. We have all this work to do. Studies have been conducted showing that if a family physician did all the things we’re supposed to do in the clinic, it would take us like 22 hours a day to get it all done. So, we’re constantly feeling inadequate. We tend to believe that we’re not meeting the needs out there. Yet we’re so under-resourced that we feel like besieged. How can we hold it together?

Despite all of that, we have great evidence regarding our benefit to society. We’ve been struggling, while saying that we have the evidence. “Look at the evidence. We’re really helping” Yet this pronouncement has led to absolutely no new resources. In fact, we’ve seen a diminution in investment in primary care during that same period. So, it may be helpful to adjust our strategies of change (as we considered in a previous Salus forum). We must consider ways in which we might move out of a threat kind of state and into a high-stakes challenge state. So that’s my trigger topic for today. What comes to mind is our work during a previous Salus session on allostasis.

Bill B

If we look at allostasis, the assumption is the human body is adjusting–based on its predictions, what it anticipates, and then adjusting to what it anticipates. So, Jeremy, does someone frame the anticipation as threatening versus framing the anticipation as challenging?  You’re suggesting that this is the case. So, the question becomes, how do we interpret things as a challenge rather than a threat? And how do we modify our frame?