As a sports psychiatrist specializing in high performance, working with athletes, their coaches and trainers, across individual and team sports, I am often consulted to help high performers better understand what contributes to underperformance under pressure and how to overcome it. Before we launch, I tend to use the word “underperformance,” but most of the performers I work with use a different term. They call it “choking” or “folding,” which typically happens in the big moments or when the game is on the line.

In this article I offer an evidence-based framework that I use in my practice to help high performers and their stakeholders understand why they choke, and I share some practical steps to reduce the chances that this behavior becomes a repeated pattern.

Concept 1: Two different neural systems handle performance skills, and depending on which one is running the show, the risk for choking increases.

To understand choking in high performance, we start with the brain and its processing relationship to two factors, movement and memory, at different stages of professional development, because these two factors are foundational to how the brain processes certain skills and are the same factors that are affected when choking occurs. When someone is a novice and just learning a skill, the conscious brain is using certain structures (the prefrontal cortex and medial temporal lobe), and they are very self-aware of the actual skill that is being learned and tend to pay attention to all the details and mechanics involved in performing the skill or action to make sure the movement or skill is correct. This system, the “Explicit/Declarative System,” tends to go step-by-step. It is slow, rigid, self-aware, and uses a lot of memory. This novice brain system makes a lot of sense for beginners or rookies who are still learning and perfecting tasks.

By the time a veteran performer comes to see me, they have moved past the novice’s explicit declarative system and transitioned to a more automatic neural network used by experts: the “Implicit/Procedural System.” Unlike the novice’s explicit declarative system, the expert’s implicit system (which includes the basal ganglia and cerebellum) doesn’t need a lot of cognitive loading and works at a subconscious level. It uses parallel processing, runs on automatic, and is lightning fast. This implicit system makes perfect sense if you think about how elite veterans operate in the big moment.

When a performer is at the top of their game and flowing, things tend to look effortless and automatic because the Implicit System is typically running the show, drawing from years of practice, rehearsals, and muscle memory to direct hundreds of micro-muscles to execute flawlessly under pressure. Clutch performance happens here.

But under intense pressure, unusual circumstances, or unanticipated stress, the brain might interpret or perceive that there is a threat. Once that perception hits, the prefrontal cortex (Explicit System/Novice Mode) picks up the panic or competitive stress anxiety and tries to run the show by making performers more self-conscious and less automatic. Performers become more outcome- than process-focused and begin to scrutinize every action, which can lead to second-guessing and hesitation, because their Implicit System/Expert Mode has been essentially hijacked. Choking can result as these two systems conflict while the performer tries to regain the freedom they enjoyed under the Implicit System/Expert Mode. The irony is that they are now trying to regain subconscious flow by relying on the Explicit System/Novice Mode, which forces them to consciously keep a step-by-step account of every movement to deal with the perceived threat.

Concept 2: When working memory is overwhelmed, the brain temporarily loses its ability to coordinate performance predictions and can no longer do what it was trained to do.

Once the conscious mind, the Explicit System/Novice Mode, which has limited working memory, starts running the show, the veteran performer temporarily loses access to the hundreds of automatic actions, subconscious patterns, and habitual muscle memories that come from the parallel processing abilities of the Implicit System/Expert Mode. The Explicit System/Novice Mode, with its limited working memory scope, simply cannot process the multiple millisecond coordination demands that the Implicit System/Expert Mode handles so automatically through parallel processing. An elite tennis player, for example, subconsciously coordinates dozens of muscle groups to complete a precision serve. This seems effortless and automatic when it is run through the Implicit System’s lightning-fast parallel processing. If that tennis player switches over to threat mode, the Explicit System/Novice Mode’s working memory simply doesn’t offer the bandwidth to perform with the same speed, and the player chokes. Not due to a lack of skill or ability, but because their brain is in threat detection mode and the prefrontal cortex, with its low working memory, starts stalling, freezing, and crashing under the load it’s not designed to handle.

Concept 3: Under threat, the brain’s stress response can narrow focus to just one body part or action. This can disturb the natural flow of movement and cause a performer to choke.

Movement, especially fluid athletic movement, is connected to a kinetic chain through which energy often travels in sequence from the ground up through the feet, ankles, legs, knees, thighs, hips, and torso, all the way to the hands. For a tennis player to successfully complete a serve, a baseball player to throw a pitch, or a basketball player to hit a free throw, this chain is usually operating in sequence. But under perceived threat, this typically automatic and sequential biomechanical process is interrupted as the prefrontal cortex and the Explicit System dominate to help the performer regain control. In this situation, the performer’s conscious mind takes over and hyper-focuses on one body part instead of relying on the natural kinetic chain. The tennis player forgets to rotate her hips, or the basketball player forgets to bend their knees. They inadvertently, and in many cases unknowingly, cut off the natural flow of energy from the rest of the kinetic chain as they fixate on a limb or wrist, or the racket or the bat, and rely on isolated movements disconnected from whole-body sequencing, which negatively affects fluid execution. This underscores that choking can also have a biomechanical, not just psychological, dimension. A broken kinetic chain signals a potentially distorted or disrupted attentional state that shows up as choking.

CONCEPT 4: The common denominator in choking is the triggered intrusion of the conscious mind, which breaks the performer’s kinetic chain, stiffens their mechanics, and overrides years of rehearsal or practice in a single moment of second-guessing or self-doubt.

A natural question I often get from coaches, trainers, and players is: why does choking happen if the high performer is elite and has veteran status? After all, they are performing tasks they have practiced, they have years of experience, and they generally are performing under pressure. Why does a system that was working 30 minutes ago suddenly fail? These are excellent questions that help us think more clearly about what exactly shifts players from Implicit System/Expert Mode to Explicit System/Novice Mode. Another way of saying this is that there are triggers that shift players from ordinary performance threat appraisal to hypervigilant perceived-threat behaviors. Once the brain’s threat detection center (the amygdala) is triggered by a player’s perception of the moment, they can become less automatic, less fluid, and less reliant on subconscious processing. Instead, they become more conscious and deliberate and rely more on explicit monitoring, and the focus shifts from performing to surviving. This sets the stage for choking behaviors.

In my practice, I have encountered a few common triggers that invite the conscious mind to take over the moment by overriding the Implicit System/Expert Mode brain structures (the cerebellum and basal ganglia) that make elite performers appear automatic, effortless, and instinctive when they perform. When the conscious mind gets triggered, players (usually in near-win or game-on-the-line situations) start playing “not to lose” instead of staying in their automatic flow state. The mind says, “don’t f- this up,” and starts paying more attention to survival than to the task at hand, and choking can occur.

An underrated trigger of choking is conscious awareness of accumulated fatigue. Typically, when veteran players are in a flow state, the Implicit System helps them adapt fairly automatically, but if the Explicit System (the conscious mind) registers the fatigue as an issue (i.e., “my legs are shot; I don’t have it anymore”), the performer becomes more self-aware of the fatigue and may attempt to fix the system by compensating with manual overrides (i.e., “I’ll just push harder”). This conscious approach can disrupt the kinetic chain and/or deplete the working memory that automatic performance quietly depends on, and increase the choke factor.

Another trigger centers on seemingly small, triggering distractions during “dead times,” where no skill is being executed but the empty time breaks the performer’s automated rhythm, things like game delays, medical timeouts, a fan running on the court, the ball getting stuck behind the backboard, or the performer prematurely envisioning the championship trophy in their mind during the game or performance. Once these micro-triggers take hold, the flow state can be interrupted, and performers can move from the unconscious flow state to explicit monitoring (self-awareness), and this awareness shift sets the table for choking when they return to play, because the conscious mind is now activated. It’s one reason why we see players continuing to warm up or do focus drills during delays or unexpected occurrences.

Unlike unexpected micro-triggers that can activate the conscious mind when the skill is not running, an unfamiliar cue or unexpected action by an opponent during competition can trigger mid-game conscious (prefrontal cortex) thinking, because the performer has never encountered or prepared for the novel action. Because the Implicit System’s automatic retrieval system doesn’t recognize it, or can’t match it to a stored pattern, the brain goes into threat mode, the Explicit Monitoring system kicks in, and the overthinking, analytical mind begins the self-talk: How do I move? What should I do? In the absence of trust for instinct, and the presence of self-doubt, cognitive load increases, decision making falters, the kinetic chain is disrupted, and reaction times are off. Not surprisingly, choking follows.

These are just a few of the reasons that I discuss with clients who want an evidence-based rationale for choking behaviors. The irony of choking is that the brain is not trying to harm the performer. It’s focusing on what it’s designed to activate when faced with a perceived threat: self-preservation and protection. The unfortunate downside is that the tools it uses to correct are the ones that contribute to the choking behaviors. In my next article, we will discuss evidence-based ways to address choking behaviors.

Derek H. Suite, M.D., M.S. is a sports psychiatrist and mental performance strategist working across professional basketball, football, hockey, and soccer. He is the founder of Full Circle Confidential, host of The SuiteSpot podcast, and author of the forthcoming Sleep as Performance Medicine.