Run Farther and Faster
Lager
Dr. Lager was one of the speakers at the 10-year "Runiversary" of Run Farther and Faster, a running organization in northern Virginia. The event, which was held in February 2020, provided education, resources, and support to distance runners. Dr. Lager spoke on mental strategies for runners to implement to get the most out of their race.
Select Publications
Train Your Brain to Beat Chronic Pain (book)
Hunt, 2025
The Guilford Press
Many athletes and retired athletes struggle with persistent pain. MAC-SAPP member Dr. Carly Hunt translates state-of the-art neuroscientific research reveals surprising new insights into pain as the brain's alarm system, designed to warn us of danger. When that alarm gets stuck in a high-alert mode, this concise, practical guide presents a range of proven interventions that can help you not only cope with pain, but actively reduce it. This book shares crucial information about brain training techniques, lifestyle changes that target inflammation and other pain triggers, resources for self-care and support, and conventional and complementary medicine approaches to weave into your own integrative care plan. It truly is possible to beat chronic pain--this book points the way. Book Link
Perspectives on performance anxiety in young athletes and dancers
McDuff, garvin, & Marsalis, 2025
Sports Psychiatry
Introduction: Competitive Performance Anxiety (CPA) is commonly seen in sports psychiatry and performance psychology practices that provide services to young athletes and dancers. Rates in this population have risen over the past decade due to rapid progression to the highest competitive levels, early specialization, and year-round training. CPA presents during competition with overthinking, anxious arousal, somatic distress, and behavioral responses that interfere with the execution of critical motor skills and routines and that eventually erode confidence and reduce performance consistency. Methods: This paper reviews the literature on CPA in youth athletes and dancers and presents a clinical model that breaks down the common presentations of CPA into cognitive, emotional, somatic, and behavioral domains. Anonymized cases from the practices of a sports psychiatrist and performance psychologist are presented to illustrate the variability in manifestations, common co-morbid conditions, treatment approaches, and outcomes. The integrated use of brief psychotherapies and adjunctive use of psychiatric medications is discussed. Results: Six CPA cases from individual and team sports and dance are presented and discussed. The use of mental skills training and cognitive behavioral and acceptance and commitment therapies are detailed. The short-term use of beta blockers and selective serotonin reuptake inhibitors and other antianxiety medications is described. The outcomes of each case resulted in reduced anxiety and improved performance consistency. Conclusions: CPA is a common problem in youth athletes and dancers but responds well to brief psychotherapy and medication management. Slow to respond cases often have other co-morbid psychiatric disorders and these must be identified and treated as well. Article Link
Working with sports organizations and teams
McDuff & garvin, 2016
International Review of Psychiatry
Athletes and coaches at all competitive levels will utilize sports performance and psychiatric services at very high rates if the services are offered on-site and free of charge and are broad in scope and culturally sensitive. Services should be available throughout the team year and cover areas such as team building, mental preparation, stress control, substance prevention, sleep and energy regulation, injury recovery, crisis intervention, and mental disorder treatment. The staff offering these services should be diverse by gender, profession, and culture, and the fees should be paid by the organization. When these services are endorsed by the team’s leaders and inte grated with the athletic training/medical/player development staff, their utilization will grow quickly and lead to positive outcomes individually and collectively. Article Link
Mental Health Treatment During the COVID-19 Pandemic
McDuff and members of the IOC
Submitted to the British Journal of Sports Medicine
Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. The novel coronavirus disease 2019 (COVID-19) has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a review of the impact of the pandemic on management of those symptoms in athletes. It specifically addresses psychotherapy, pharmacotherapy, and higher levels of care. Within the realm of psychotherapy, crisis counseling might be indicated. Individual, couple/family, and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants, and medications for substance use disorders. Providers must consider when in-person management (e.g., for physical examination, laboratory testing) or higher levels of care (e.g., for crisis stabilization) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.