Mental Health in Combat Sports: An Interview with an Expert

“I used to be the guy I hate now,” JC Santana joked. Santana, who founded the Florida-based Institute of Human Performance in 2001, was describing his earlier self as a young combat athlete. “I was that kid in his 20s and 30s who thought, ‘The more you hurt me, the more I like it,’” he said, in a recent interview with FHE Health.

This approach to combat preparation resulted in “a lot of [bodily] damage” when Santana was training with professional fighters. It also helps to explain why today he spends much of his time training other MMA fighters and other combat athletes at all levels to protect themselves from concussions and improve their functional performance.

What is the role of mental health in combat sports, particularly mixed martial arts? Mixed martial arts (MMA), is an extreme sport in which two combatants use a mixture of various martial arts to compete inside a caged area. For an expert’s insights, read on.

The Importance of Mental Health in MMA and Combat Sports

When asked to reflect on the importance of mental health in MMA and combat sports, Santana shared his conviction that mental wellness is “the most important aspect of wellness, regardless of occupation or sport.” He expressed “alarm” that mental health has “not become a front-and-center topic” in MMA competition, where “head trauma is a likely event” and “a natural byproduct of full-contact combat.”

Naturally, then, mental health isn’t just “important from a competition aspect—it’s also a huge consideration after the athletic career is over.” That is also why, Santana stated, “reducing head trauma and thereby improving mental health outcomes has become a center point of my practice.”

Key Elements of Mental Health Training

If mental health is critically important in combat sports, could Santana provide some examples of how it is incorporated into training routines? He mentioned several ways:

• A preventative approach and practice protocol that minimizes the risk of concussions – Examples include a focus on “hard metabolic training” in controlled environments, reduced live practices (sparring), protective headgear when sparring, and an emphasis on body positioning and movement when sparring, among other measures.
• “Psychological-spiritual” tools like “Relax Your Face” – Santana uses this cue to help fighters “not attach a value or meaning to the emotions and feelings associated with high-level exertion, such as when they are grunting or grimacing in their efforts.” The goal is to “develop a calm intensity with no emotions attached, very much like a cyborg,” so that fighters objectively perceive “what is in front of them or inside of them” with non-judgmental acceptance. This allows for calm technical execution of any technique or strategy.
• “An emphasis on the basics of recovery” – By that, Santana did not mean “the insane recovery techniques being popularized on Instagram,” but rather “time to relax, proper sleep, nutritious food, and basic supplements.” “Insane techniques are for those that are not willing to master the basics,” Santana said.
• Cutting-edge, neuroscience-based treatments – These “neuro therapies,” such as those FHE has developed and provides, work to safely and non-invasively restore the health and function of the brain, using the latest technologies.

Common Mental Health Challenges for MMA Fighters

“The biggest problem that fighters face, which negatively impacts their mental health, is the abusive fighting culture that they have been raised in,” Santana said. By that, he meant a “the more you hurt me, the more I like it” mindset and way of life.

“I understand this culture because I used to be part of it,” Santana added.

Often, this fighting culture comes with other common mantras from the world of sports that only “add insult to injury by reducing fighters’ recovery time.” These include messages like “the more is better,” “embrace the grind,” and “love the pain.”

One problem with this abusive culture is that it can contribute to insufficient recovery time between fights, and that can begin a destructive cascade of events. Here is how Santana explained it:

Insufficient recovery can not only lead to the breakdown of the body, but it can also lead to insomnia. Insomnia negatively impacts the restorative hormonal processes that occur at night. Once insomnia kicks in, it’s not long before the immune system is compromised and upper respiratory tract infections set in. Oftentimes, antibiotics are needed to deal with secondary infection, further degrading performance.

A reduction in performance often negatively impacts income, and that can lead to a further decline in a fighter’s mental outlook. In short, lack of proper recovery has far-reaching implications on a fighter’s mental health, and those effects can be nothing short of “demoralizing.”

What Helps Fighters Manage the Pressures of Competition?

Santana named a few ways that he helps fighters manage the mental health pressures of competition:

• Focusing on the “safe hard training” (that doesn’t involve head trauma) and “getting rid of the “unnecessary ‘junk volume’ of training”
• Learning to “leave the fighter and fighter persona in the ring and bring the athlete to IHP”
• Encouraging fighters to take a different approach to their careers, much different from the more “barbaric” model currently being used, and think of themselves as “professional athletes” who “must manage a very valuable set of resources (finances, physical energy, technical acquisition, professional services, etc.”)

Signs That a Fighter Is Struggling with Their Mental Health

What could be mental health cues that it may be time to get help? “There are many signs of deteriorating mental health that a coach may not see, such as behaviors in the home or social environments,” Santana said. “However, slurred speech, lack of attention/memory, slow cognitive processes, and uncharacteristic irritability can also be signs of mental health decline.”

What many people may not know is “that by the time these signs/symptoms show up, significant damage could already exist.” That is why Santana recommends “proactively” addressing these issues through smarter training and interventions like “brain mapping and neural rehabilitation at FHE,” which support earlier detection and prevention of brain injuries in these athletes.

An Example of How Mental Training Has Helped a Fighter

As one example of “what can go wrong if one does not seek help when [mental health] issues first present themselves” and of how recovery is possible with treatment, Santana shared the story of Irwin Rivera, one of Santana’s former fighters. Rivera, Santana said, is “a shining example of how important and effective proper treatment can be.”

“Many of our fighters have confided in us that they have struggled with many demons, from illicit drug use to physical and mental abuse,” Santana continued. “Tools that teach the importance of being in the moment and nonjudgment, such as our “Relax Your Face,” are valuable techniques grounded in powerful spiritual teachings.” Santana added that “some of our fighters claim that the unique coaching methods used by IHP have helped them grow not just as athletes but spiritually, into better people.”

Advice for Fighters Who Are Hesitant to Seek Help

Santana had this advice for fighters who may be struggling with a mental health issue and are hesitant to seek help: Think of “help” as any other performance enhancement strategy currently used. Mental help therapy is no different than massage, medication, acupuncture, or using a sauna. It is much easier to get help for a mental health challenge when it is “just like any other strategy or therapy used by elite athletes.”

The Future Role of Mental Health in Combat Sports

Looking ahead, what might be the role of mental health in combat sports? In some ways, we are ending where we started, with the paramount importance of mental health and lessons over the last decade from football and head trauma (i.e. concussions).

Santana was quick to point out that “in its current and commercial form, MMA is only 30 years old,” so “we are now observing the first generation of fighters and how head trauma has affected them.” (“In terms of numbers, they are just not that many to study.”)

Meanwhile, the promotion of the new “Power Slap” sport by Ultimate Fighting Championship CEO Dana White raised concerns for Santana that we “have learned nothing” from traumatic brain injuries in the NFL. He anticipated that “we are going to see a ton of CTE in the near future, both from MMA and Power Slap-type sports.”

Santana also saw the irony in the fact that leaders in the combat world are “super concerned about the use of steroids and performance-enhancing drugs—but the brain? Who cares about that?”

More combat athletes are starting to care, thanks to Santana and his lead.