By Michael Lardon, M.D.

“Choking” is a colloquial term that is used to convey the phenomena of acute performance failure under perceived stress.

However, acute performance failure is not a homogenous phenomenon. In the sport of golf there appears to be at least three entities that produce acute performance failure – panicking, choking and the yips.

All three of these phenomena are precipitated by perceived stress. In order to understand the differences of these three causes of acute performance failure, it is instructive to review the basic neuroscience concept of two general forms of memory. Explicit (declarative) memory governs the recollection of facts, events and associations. In contrast, implicit memory deals with procedural memory that does not require conscious awareness; for example, how one recalls riding a bicycle or playing a piano after many years of not performing the function.

Explicit (declarative) memory appears to be centered in the part of the brain called the hippocampus. When an individual incurs severe stress there is a secretion of epinephrine and glucocorticoids. It is well known that severe stress response can harm the hippocampus, preventing consolidation of conscious explicit memory. This is often experienced by the individual as feeling as if “their mind has gone blank.” This stress response with concomitant impairment in explicit memory also leads to the inability of the individual to think appropriately during a time of stress. Psychologists often report that these individuals experience what is called “perceptual narrowing.” Because of the inability of the individual to access explicit learning and memory, the individual then relies on instinct and this is the phenomenon that is present when the athlete has a panic attack.

An excellent example of this phenomenon in golf occurred in the 1999 British Open when Jean Van de Velde had a three shot lead going into the final hole. Thousands of fans watching the event, including the commentators, acknowledged that all Jean needed to do on the dangerous 18th hole at Turnberry was to hit three conservative iron shots, two-putt for bogey and receive his first Claret jug as British Open Champion. However, Jean made a critical strategic error, relied on instinct and chose his driver to tee off on the final hole. This serious strategic error eventually resulted in an untenable position where his ball was actually in the water and the famous image of Jean going into the water to hit the ball haunts golf fans to this day. As Jean set up to hit this shot, fortunately he was able to access his learned experience and make the proper decision of not hitting this shot and taking a penalty stroke and a drop. Jean was able to make a miraculous putt and force a playoff but subsequently lost in the playoff, and his strategic choices remain infamous to this day in golf lore. This is an excellent example of an athlete panicking and making poor choices yet still being able to execute shots. Essentially, Jean’s mind went blank and he relied on instinctive behaviors, i.e., being aggressive by taking a driver off the tee unnecessarily and almost choosing to hit an extraordinarily low-percentage shot out of the water.

In contrast, choking is something else all together. In panic, we have the loss of an individual’s cognitive abilities, thus resulting in the reversion to instinct. However, choking is about the loss of instinct. Motor programs that are normally implicit (are not in conscious awareness) partially reside in the deep brain structure, the basal ganglia. However, in conditions of severe stress when an individual chokes, the explicit system takes over and an individual who has had mastery of certain motor execution programs (golf swing) starts to consciously think about their swing, thus resulting in the loss of fluidity and kinesthetic touch. In a sense, the athlete becomes a beginner again because they start relying on a learning system that is no longer implicit and subconscious.

Crews, Debra J. and Landers, Dan; “Electroencephalographic Measures of Attentional Patterns Prior to the Golf Putt,” Med. & Sci. in Sports & Exercise, Vol. 25, #1, Jan 1993, pgs. 116-126). Dr. Crews found that the best putters had a distinctive brain wave pattern in the seconds leading up to the putt. The left side of their brain (which controls logical and analytical processing) was active. Then, just before the subject putted, the left side quieted and the right side (which controls spacial orientation, timing and balance) became more active. Dr. Crews hypothesized that chokers exhibited a different pattern where their left brain never shut down and raised the question if this led to a possible obstruction of the right brain hemisphere taking over (please see Mayo Clinic study).

Dr. Sian Beilock in the Department of Psychology at Miami University in Ohio hypothesized that limiting putting time would actually help execution by preventing skilled golfers from allocating too much attention to task control and guidance (Beilock, S.L., Bertenthal, B.I., McCoy, A.M., and Carr, T.H.; “Haste Does Not Always Make Waste; Expertise, Direction of Attention and Speed Versus Accuracy in Performing Sensory Motor Skills,” Psychonomic Bulletin and Review, 2004). In her experiment, Dr. Beilock’s results demonstrated that golfers were more accurate under speed instructions. She anecdotally reports that several golfers said that speed instructions aided their performance by keeping them from thinking too much about execution. Her research has shown that expert swing execution does not require constant monitoring, and limiting the time experts have to overthink prevents interference with performance and execution of various shots. In choking, the opposite goes on. The individual loses the capacity to access their implicit learning, starts to overthink and relies on explicit learning models, resulting in acute performance failure.

An excellent example of this choking phenomenon what evident in the final round of the 1996 Masters, when Greg Norman had a six-shot lead going into the final hole against Nick Faldo. Greg Norman, who was the number one golfer in the world at that time, poorly executed a number of shots that were markedly uncharacteristic for him. He did not panic and make a variety of poor choices like our Jean Van de Velde example, but rather was unable to properly execute shots of which he had previous mastery. In essence, Greg Norman lost his instinct and was probably thinking too much, resulting in acute performance failure. In contrast, Jean Van de Velde lost the ability to think, relied on instinct and made a variety of poor choices that led to his demise.

A third type of acute performance failure is often known as the “yips.” A great example of the yips is on the final hole of the 1992 Masters when Scott Hoke had a 12-inch putt to win. Scott not only missed the putt but he missed the hole entirely. On television replay examination of Scott’s stroke, he demonstrated a twitching motion which somehow appeared on this critical putt instead of his smooth patented stroke. Announcers gasped while commenting how could he yip that short putt to lose the Masters. The yips is often referred to as a focal dystonia. Dystonias are characterized as a movement disorder where an unwanted muscle contraction, or twitching, leads to an involuntary movement. In golf, it is seen most commonly in putting but also seen on other shots. Symptoms of the yips, like jerks during execution of shots, often result in mis-hits. This phenomenon is not circumscribed to the average golfer but is often cited with the world’s elite golfers and has derailed the careers of Johnny Miller, Ian Baker-Finch and Mark O’Meara. The neurophysiology of focal dystonias has been best elucidated by Dr. Jonathan Mink (Mink, J.W., M.D., Ph.D.; “The Basal Ganglia and Involuntary Movements,” Archives of Neurology, Vol. 60, Oct 2003, pgs. 1365-1368). Essentially Dr. Mink postulates that the basal ganglia (the area of the brain where implicit learning lives) is organized to facilitate voluntary movements and to inhibit competing movements that interfere with the desired movement. The idea is that in the basal ganglia there are various motor programs that operate on the subconscious level. When an athlete experiences the yips, or a focal dystonia, the pathways that govern the inhibition of competing motor programs break down thus resulting in the contamination of the original motor program.

Therefore, instead of the individual making one smooth stroke engaging the appropriate motor program, the individual’s smooth stroke is interrupted with a twitch, suggesting that two motor programs are operating simultaneously leading to mis-hit shots. The neuroanatomy of the basal ganglia and concomitant neurophysiology is currently of great research interest in the neuroscience community. It appears clear that stress causes release of the neurotransmitter glutamate which in turn causes release of dopamine in basal ganglia pathways that result in the disinhibition of competing motor programs. This is the reason why yips become more pronounced under stressful circumstances.

The renowned golf teacher, Hank Haney, has recently written a series of articles about overcoming the yips with both drivers and putters in December 2004’s Golf Digest. Hank describes his own personal problems with the yips over his twenty-year golf career and describes how he has had success in helping Mark O’Meara regain his putting abilities and his elite world golf ranking. Hank’s premise is that one has to understand doing the same stroke over and over again does not work. Essentially, Hank’s philosophy is to make a small change in the individual’s grip, thus engaging a slightly varied stroke and subsequent new motor program. The idea is that by engaging a new motor program, one is able to avoid the phenomenon of a competing motor program contaminating the stroke. A strategy that Hank has taught Mark O’Meara and a variety of other elite players seems to at least be successful in the short term. However, long-term results and longitudinal studies are still needed to confirm the efficacy of this intervention.

Dr. Ross of the Cleveland Clinic used functional MRI and asked individuals of varying golf levels to use mental imagery, imagining their golf swing. Correlation was noted that individuals with high handicaps showed greater activation of cortical areas of the brain, thus reinforcing the idea that as skill level advances conscious awareness of activity lessens and implicit learning becomes the predominant mode. (Ross, J.S., Tkach, J., Ruggieri, P.M., Lieber, M., and LaPresto, E.; “American Journal of Neuroradiology,” June-July 2003; Vol. 24 #6, pgs. 1036-1044).

In summary, we have discussed three important causes of acute performance failure.

Choking, which has been used as a ubiquitous term for all acute performance failures, in fact is a specific type of acute performance failure where the individual no longer relies on instinct and starts to consciously think about what was previously a learned behavior. In many ways, this phenomenon is antithetical to flow experience (Csikszentmihalyi, M.; “Flow: The Psychology of Optimal Experience,” Harper Collins, 1990), or what is commonly known at the athletic zone.

Panicking is another frequent cause of acute performance failure and is characterized when an individual has autonomic hyperarousal and sympathetic overload, experiences their mind going blank and reverts to instinct, much the opposite of the choking phenomenon. However, the end result is often the same.

Lastly, the “yips” is best characterized using the focal dystonia model where stress induces a cascade of biochemical events that lead to the disinhibition of competing motor programs resulting in a loss of fluidity of shot execution and also resulting in acute performance failure. It is essential for the clinician to understand these three varied forms of acute performance failure. Each etiology is treated differently and inappropriate recognition will not lead to improved performance. Although the detailed treatment is beyond the scope of this article, briefly the panic phenomenon is best treated with relaxation techniques, breathing techniques, centering techniques and learning to use process cues. In contrast, the choking phenomenon described is best addressed by using desensitization techniques coupled with attentional shift techniques, promoting instinctive execution of shots. Lastly, the “yips” or focal dystonia phenomenon described may be most effectively treated through slight modification in the golfer’s swing, thus engaging a different motor program that has not yet been contaminated by the disinhibition of competing motor programs.