To close out the year, we’re talking to sports psych researcher Jill Colangelo. Jill’s thesis was on the prevalence of mental health issues in ultra runners and triathletes and she’s now a research affiliate at the University of Bern studying these issues. She’s studied and written extensively on common mental issues in our community (and about how common those issues are).
Given the time of year, it seemed like a good time to talk about how to navigate mental health pitfalls, issues to keep an eye out for as triathletes have a tendency to go to extremes, and how to have a healthy relationship with endurance sports.
A few of Jill’s recent studies:
A review of mental health issues in high-performance and elite level cycling
A comprehensive review of mental health disorders in ultra endurance athletes
Prevalence and type of psychopathy in ultra endurance athletes
You were an ultrarunner. Maybe you can start by telling us how you got interested in researching the mental health aspects of endurance sports?
I started off as a triathlete. Actually, first, I did some marathons and then I moved over to triathlon and then, from triathlon, I moved into ultramarathons. And the reason why this became interesting to me is that I went through a period of overtraining syndrome, where I was just training way more than necessary to achieve whatever goals I had at the time.
I’m saying this in retrospect, with hindsight. At the time I thought I was just having a great time running all up and down the trails. But really what was happening is I was using the sport to accomplish things over than physical fitness.
So I became curious what could lead a person to overdo it to the point where they actually physically harm themselves. And what I realized was that it was not a physiology question. It was a psychology question. There’s a decision-making process that has to go into play there, because the reason why my body broke down is why anyone’s body would break down. It’s not because your body is functioning incorrectly—your body is doing its job—it’s that your brain is telling you to do something that it shouldn’t be doing.
I became very curious about what would lead to that. Then that led me to go to graduate school and get a Master’s degree, then further in my research. Now I’m a research affiliate at the University of Bern, in Switzerland, in the department of sports psychiatry.
Your first thesis was on the prevalence of mental health issues in endurance sports, and you’ve done a lot more work on that since. What have you found in terms of how prevalent mental health issues are?
At the time, I did the research with 524 ultra-endurance athletes from different backgrounds, different sports.
There was a greater prevalence of mental illness in that popular vs. a general population, and in particular there was a greater incidence of things like depression and anxiety, eating disorder, in that population versus the general population.
And the second part was we found that the more hours per week an athlete was training the more likely they were to have mental illness. It did have a kind of dose effect—and it went straight up.
Was that surprising?
If you ask me, the ultrarunner and triathlete, I would say no. If you ask me, the scientist, I would say, ‘Goodness, yes, that was quite surprising.’
In the first part of the question, with regards to prevalence, I did have in mind that would be the case. But I did not know there was going to be this ramping up in prevalence with the amount of time one spent training, and that was a secondary finding, I wasn’t even planning to find it, but the data did show me that.
It’s also very interesting, as a commentary on the community at large, because a lot of us are under the impression that if some amount of physical fitness brings mental health benefits then a whole lot of it is going to bring more mental health benefits. And we see that’s not true. If it were, then those people training upwards of 25-30 hours/week, would be very very happy and blissful and feeling good about their lives, and that was not the case.
Well, the weeks I’ve hit 25 hours, I was definitely not happy or blissful. They’re quite miserable weeks, but you do them for some other reason or goal, right?
Sure, and it’s interesting because the impression that you get from the data was that those who were exercising at that high a level were not bouncing into a week like that and then bouncing out, they were kind of holding steady somewhere around that amount of training—so there’s something going on that we really should look at.
Have you been able to look at it more? Have you been able to separate out the issue of causation: Does someone have mental health issues and so they’re running to extremes as an outlet, or is the running causing those issues?
The chicken or egg question, right? It is a research proposal that I just handed in, 10 days ago. When a person is engaging in this type of physical activity, is there something about this activity that brings about this experience of mental illness? Or is it that people who are more likely to have mental illness are somehow more attracted to this type of activity? And is it that they feel as though it’s doing something for them, so they do more of it—or are there people for whom this type and level of activity really is the catalyst for mental illness? We just don’t know that yet.
Instinctively, I feel like, anecdotally, we know that there are some people who use running to extremes or whatever it is to substitute for something else, right?
Absolutely, but we also know that there are things where the neurotransmitters really create a beautiful environment in your your brain when you’re moving and exercising, for various reasons. There are things that happen, which kind of make it compelling for someone to go back and try to get that process to be induced again. We really just need to study more about it.
Unfortunately, we don’t know much about people who are exercising at those upper levels, higher amounts. We know a lot about what happens when people are in the sweet spot we always talk about, the 120 to 150 minutes/week. But to extrapolate out for 25 hours/week, we don’t have the data up there at all.
Every other condition on the planet—from how much you eat to how much you sleep, how strong the sun is—is a U-shaped curve. Everything we interact with is: Zero is terrible and a whole lot is awful, somewhere in the middle is good. But we just don’t accept that with physical activity. And the reason why we don’t accept it, it’s not logical, it’s cultural. We’re not interested in that as a limitation, we’re like, ‘Oh no, that doesn’t work for me.’ Well, it works for everything else in the world.
I actually thought we all knew there was a point at which too much exercise is not a good idea?
I think human beings have an instinct for when maybe something may become too much. However, we’ve been gaslit into believing that’s not really our limitation, we can really go farther. Because we have lots of people screaming in our ears about ‘no limits,’ and ‘there’s an obesity epidemic, so you better keep moving.’ Couple that with the fact that CDC guidelines for physical fitness literally say on their website: ‘the more, the better.’ The message becomes muddy because you’re viewing fitness influencers and, let’s face it, even those of us who wouldn’t call ourselves that are fitness influencers at this point. If you’re an average triathlete and posting about your workouts, you’re an influencer in some way, and the people you surround yourself with are influencing you and you’re being influenced by them. You’re all kind of speaking the same language, which after awhile, particularly in endurance sports, starts to become an echo chamber. What you think of as a lot vs. a little bit of training becomes skewed. In this community, we think ‘I’m going to go out in the rain, no matter what.’ There’s this kind of concept of what’s normal and what’s not that gets skewed, big time.
And so where we have those instincts for ‘oh no, this is too much,’ they become overridden.
What are these overtraining signs and symptoms you look for when you talk to athletes? Because, in your example here, if you have some goal, then you’re probably going to have to run in the rain sometimes—maybe not every time, but sometimes—and that’s not necessarily bad. But there’s a point at which, if you get hypothermia and you’re still out there, it’s a bad choice. So what are the signs that someone is taking it too far? What do you talk to athletes about, what should they look for?
When you start to make decisions that put training above everything—and I’m going to throw nutrition in there too because it’s the partner to the training in a way that can have a positive or negative effect on our mental health, and training does not operate in a vacuum—when we start to make decisions that have a negative effect on the rest of our lives. That is where we have to start wondering if we’re headed down the right path.
For example, when we are consistently prioritizing training over things like personal safety, physical safety, I’m even going to throw mental injury in there, because there are some times when the thought of going out again and doing another training session is crippling. There are things like: you’re isolating yourself from other people and events, not just ‘I had to miss whatever thing this one time,’ but it’s chronic. It can be very easy to make those decisions that prioritize training in a way that really starts to have a detrimental effect on everything else. Leaving work early, getting to work late, not paying attention to family, letting work slip or academic life slip, letting nutrition slip, not sleeping, not taking rest days, not having an off-season. All these things start to come into play.
It’s when your life is curving around your training; it’s not that your training is curving around your life.
What are the most common mental health issues you see with ultrarunners and triathletes? I saw the studies recently where it was 20-40% of are addicted to exercise. Obviously, there’s overtraining syndrome and underfueling, which are the same thing basically. What are the things you see most frequently?
First of all, I want to say that in the U.S. we use the DSM-5 and in Europe we use the ICD-11. In either of those diagnostic bibles there is no place for exercise addiction, it does not exist. It is only listed secondary to eating disorder, and that’s not what we’re talking about here. So we can talk about it somewhat—I did a narrative review paper and I mentioned exercise addiction or exercise dependence—but because it’s not a diagnosable condition, we can’t really talk about prevalence.
The rest of the stuff is going to be depression, anxiety, substance abuse, eating disorder. The numbers on eating disorder are dramatically incorrect, because they’re not catching a lot of sort of exercise bulimia—and those kind of behaviors are happening, particularly in ultra endurance sports. We do know, from some earlier research, that the most undiagnosed category is men. They’re not the most prevalence, but they’re the most undiagnosed group.
There’s also a significant contingent who are neuro diverse in one way or another. We’ve got more autism in ultra endurance sports that we think, more ADHD. We’re just not sure about what the numbers are, but there’s a significant portion.
When I talk to athletes, I see a lot of depression, a lot of anxiety. A lot of it is related to training, but a lot is related to nutrition as well. People are not fueling properly, they are not eating enough. The new REDS guidelines put a heavy emphasis on low energy availability and I would argue that, although it’s not a mental health condition, there are two reasons you get to that point: 1. Either ignorance, because you don’t know about sports nutrition and that’s fine, let’s get you the information you need to get better (but that’s a small portion of the athletes), and then 2. There’s the rest of everybody else, who are trying to do something else there—and that *is* a mental health issue. Low energy availability is not a mental health condition, but you don’t get there because you’re making smart decisions.
So is it possible to do an Ironman or a 100K or something, you know, longer—not a half-marathon—and be mentally healthy?
I think you definitely can, and it starts with solid nutrition and training plans, which operate on a ‘less is more’ kind of motto. Which is in contrast to the higher mileage training that was sort of in vogue awhile back. I think what elites can handle tends to skew what we think we should be doing.
If people train on a different mindset, a rest day every week, an off-season, and they’re stingy with their races every year. ie. ‘I’m going to do one big race a year and maybe a couple of little ones.’
For sure I don’t think training for an Ironman means you’re mentally ill, not at all. But I think it really requires work on the back end. Your first questions should be: Why am I doing this? And if it’s like, you know, ‘I wanna get through my divorce.’ Which, by the way, I’m calling myself out from when I was a newly divorced 20-something-year-old. Think about what you’re doing and why are you doing it, have resources and people you can talk to, can you get yourself a quality dietician, are you getting good advice.
I've said this in other places, but: Your relationship with ultra endurance sport is not a baseball bat that you use to wack at everything that’s wrong in your life. It’s like a crystal vase you take out when someone buys you roses for Valentine’s Day. You’re careful with it, you do what you need to do with it, and when it’s done you put it back on the shelf. It’s fragile. And if you use it like a baseball bat, you’re going to break everything in your life, including yourself.
I think the thing that’s always interesting to me is: I’m sure there are all kinds of mental health issues in pro sports and with the age-group athletes who are doing 25 hours/week every week, but at some point there’s nothing healthy about trying to win an Ironman World Championship. You’re not doing it to be healthy, you’re doing it for some other reason, to see if it’s possible?
I mean that’s the whole joke about ‘How many Olympians have overbearing fathers? All of them.’ Alternatively, me, I personally, get out there and it gets hard and I think, ‘You know what, I have other options in life,’ and then I’m not winning a world championship.
I could answer that as an athlete or I could answer it as a scientist. We see, time and again, that in order to do what you have to do in these ultra endurance sports you have to be able to override certain things about your instincts and your human tolerance. Because you can’t just muscle through. And people often use, either purposefully or inadvertently, other issues to be the driving force for their discipline or determination.
Some of it’s healthy, some of it’s not. We’re all different.
Which is why we need more research in this area. Across the board, what people are willing to do to participate in sports on an elite level, particularly where there’s not much budget and there’s a lot of abuse going on, it’s pretty wild. What is this doing for people that they’re willing to mess themselves up? It’s a great question, and I don’t know the answer.
There are inextricable links between what we think about ourselves and what we need to see about ourselves when we participate in these sports. We need to be enthusiastic about our community and we love the sport, that’s great, but we also need to watch where your life starts to bend around it rather than it bending back to your life. It’s really important.
Thanks from someone is has become very much "less is more" these days 😃