By Dr Bradley Powell, Clinical Psychologist and Co-founder of Regal Private Therapy Practice, Harley Street, LondonFrom Formula 1 to Olympic swimming, rituals are part of elite sport. Most are harmless, and some measurably help performance. But when a routine stops feeling helpful and starts feeling necessary, it can tell us a great deal about anxiety, uncertainty and obsessive-compulsive disorder (OCD).
Key points
Pre-performance routines are an established sport psychology technique, and a 2024 meta-analysis found they improve performance, including under pressure.
Superstitions are different: they attribute influence to behaviours with no established causal link to the outcome.
A sporting superstition is not, on its own, a sign of OCD.
What matters clinically is why the athlete feels they must perform the ritual, and how they respond when they cannot.
Where OCD is identified, CBT with exposure and response prevention (ERP) is the treatment recommended by NICE.
Why are athletes superstitious?
Athletes develop rituals because sport is uncertain, and a familiar sequence can create a sense of predictability. Competitors, equipment, conditions and unexpected events all lie outside an athlete's control. Feeling more in control, however, is not the same as having more control.
Formula 1 offers a vivid example. In a 2023 episode of Red Bull's Mind Set Win podcast, former Red Bull Racing team principal Christian Horner described having a toilet he considered lucky in his early years in motorsport. He also discussed how drivers develop individual preparation sequences, such as the order in which they put on equipment or enter the car.
Using a familiar sequence to focus attention may serve a practical psychological function. Believing a particular toilet influences a Grand Prix does not. Both, though, may contribute to a subjective sense of readiness.
A 2025 qualitative study by Morris and colleagues interviewed 30 sportspeople about their superstitious rituals. Participants described links to confidence and anxiety, although the study did not show that superstitions improve performance. It does suggest rituals acquire real personal significance in competitive settings.
How do ordinary behaviours become rituals?
One explanation is associative learning: an athlete performs well after a particular action, then repeats it. A swimmer who happens to place their right foot on the block first before a personal best may keep doing so, and each further success can strengthen the association.
In my clinical work with athletes, one competitive swimmer attached significance to whether they had seen certain birds, such as magpies, before a race, as well as to which foot went on the starting block first.
Associative learning is only one route, however. Rituals also develop through observation, team culture, personal preference or attempts to manage anxiety. Clinically, what matters is the meaning the athlete attaches to the behaviour. Does it simply feel familiar? Does it aid concentration? Or does the athlete believe that skipping it could compromise their performance?
What is the difference between a pre-performance routine and a superstition?
A pre-performance routine is designed to support a task-relevant process, such as attention, breathing or visualisation. A superstition attributes influence to something with no established causal connection to the outcome.
A golfer's visualisation before a shot, or a basketball player's breathing sequence before a free throw, are routines. A 2024 meta-analysis by Rupprecht, Tran and Gröpel, covering 112 effect sizes, found that pre-performance routines improved sporting performance, including under pressure. Effect sizes varied, and there was substantial heterogeneity in some analyses. Crucially, the research examined task-relevant routines, not lucky socks or numbers.
| Feature | Preference | Pre-performance routine | Superstition | Possible compulsion |
|---|---|---|---|---|
| Purpose | Feels comfortable or familiar | Focuses attention on the task | Believed to influence the outcome | Reduces distress or prevents a feared outcome |
| If interrupted | Noticed, then forgotten | Adapted to circumstances | Mild unease | Significant distress; may feel compelled to restart |
| Flexibility | High | High | Variable | Low |
Athletes often combine routines and superstitions, and a superstition is not inherently a problem. Its significance depends on how strongly the athlete believes it is necessary.
Is a sporting superstition a sign of OCD?
Not on its own. Consider two swimmers who both place their right foot on the block first. The first does it because it feels familiar; if they get it wrong, they notice and carry on. The second believes the wrong foot could harm the race, becomes distressed when the sequence is interrupted and feels compelled to start again.
The outward behaviour is identical, but the psychological function differs. The first swimmer has a preference. The second may be performing a ritual to reduce distress, but an isolated superstition, even with anxiety attached, is not enough for a diagnosis.
OCD involves obsessions, compulsions or both. Obsessions are recurrent, intrusive and unwanted thoughts, images or urges that cause distress. Compulsions are repetitive behaviours or mental acts a person feels driven to perform, often to reduce distress or prevent a feared event. For a diagnosis, symptoms must be time-consuming or cause clinically significant distress or impairment.
How common is OCD in elite athletes?
The International Olympic Committee's 2026 consensus statement on mental health in elite athletes reports that OCD prevalence estimates vary widely, from about 1.7% to 5–8%. A higher figure of 18.9% relates to OCD and related disorders as a broader category, not OCD alone.
The statement acknowledges that unusual rituals and magical thinking can occur in elite athletes without being pathological. It recommends comprehensive assessment to distinguish sporting superstitions from clinically significant obsessive-compulsive symptoms. The evidence does not show that superstitions cause OCD, or that routines progress into it.
Why do some rituals become hard to give up?
Rituals can be maintained by negative reinforcement: when a behaviour relieves anxiety, that relief makes it more likely to be repeated. An athlete thinks, "What if I lose because I haven't done my routine properly?", completes the ritual and feels better, for now.
Cognitive models of OCD, notably Salkovskis's 1985 account, emphasise that the problem lies less in the thought itself than in the meaning attached to it. Negative reinforcement is not unique to OCD, though. Many ordinary habits persist because they reduce discomfort. Some people also repeat actions until they feel "just right", without any specific feared consequence. In a sport that prizes precision, that can look like good technique. Observation alone cannot tell these possibilities apart.
When should a sporting ritual raise concern?
From a clinical perspective, five features warrant closer exploration:
Distress. How does the athlete respond when the ritual cannot be completed? Mild frustration is understandable; significant anxiety or persistent intrusive concerns are not.
Perceived necessity. Is the routine seen as helpful, or as essential to prevent something unacceptable?
Flexibility. Can the athlete adapt when a competition schedule changes, or do they feel driven to repeat the sequence regardless?
Interference. Does the behaviour consume time, disrupt preparation or affect everyday life?
The wider pattern. Are there intrusive thoughts, mental rituals, checking or reassurance-seeking outside sport?
These are not diagnostic criteria, and one feature alone does not indicate a disorder. They help identify when a fuller psychological assessment may be appropriate. Inflexibility, for instance, can also stem from anxiety, habit or perfectionism.
How is OCD treated in athletes?
The aim is never to strip away helpful routines. Where a routine is flexible and task-relevant, there may be little reason to change it. Where an athlete depends on an arbitrary ritual, it can help to explore the beliefs that maintain it, guided by an individual formulation rather than an assumption that every superstition needs treatment.
Where clinically significant OCD is identified, CBT incorporating exposure and response prevention (ERP) is the evidence-based treatment recommended by NICE. ERP helps people face feared situations, thoughts or uncertainty while reducing the compulsions that maintain the problem. For an athlete, that might mean carefully planned opportunities to tolerate uncertainty without completing a non-essential ritual, while leaving legitimate technical preparation and safety procedures untouched.
The objective is not to make athletes less disciplined. It is to ensure their preparation stays functional rather than governed by compulsion.
Frequently asked questions
-
Yes. Rituals and superstitions are common in sport, and the IOC recognises they can occur without being pathological.
-
Yes. A 2024 meta-analysis found task-relevant pre-performance routines improved performance, including under pressure. This does not extend to arbitrary superstitions.
-
There is no evidence that sporting superstitions cause OCD. The two can involve similar psychological processes, which is why careful assessment matters.
Preparation, not dependence
Routines give athletes structure and focus, and superstitions are a familiar part of competitive life. Neither is inherently a problem. The key question is whether the routine helps the athlete prepare, or whether the athlete has become dependent on completing it.
Uncertainty is an unavoidable part of sport. Effective psychological preparation is not about eliminating it, but about performing well in its presence.
If you are an athlete, or anyone else, finding that rituals or intrusive thoughts are taking up more of your life than you would like, our Clinical Psychologists offer specialist assessment and treatment for OCD in London and online.
References:
International Olympic Committee. (2026). Mental health in elite athletes: International Olympic Committee consensus statement (2026). British Journal of Sports Medicine, 60(15), e111514.
Morris, B., Thornton, C., Neave, N., & Allen, G. (2025). Understanding the use of superstitious rituals in sports people. Journal of Sports Sciences, 43(18), 2046–2057.
Rupprecht, A. G. O., Tran, U. S., & Gröpel, P. (2024). The effectiveness of pre-performance routines in sports: A meta-analysis. International Review of Sport and Exercise Psychology, 17(1), 39–64.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583.
National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: Treatment (CG31).
Red Bull. (2023). What Christian Horner's pre-race rituals can teach us about focus. Mind Set Win.
