Table 1. Selection of studies for inclusion in review.
Author Title Design / Sample Type of Intervention Pressure manipulation Control Condition Measures Outcome
Abbott et al. (2009) The impact of online resilience training for sales managers on wellbeing and performance. A-B-A
behavioral workshop
Natural experiment- number of sales by managers. The control group consisted of a randomly allocated sample of (occupational) sales managers from an Australian industrial organization based in home-offices. Control group participants continued their usual sales job with no intervention. Depression Anxiety and Stress Scales (DASS21; Lovibond and Lovibond, 1995)
Pre-intervention (prior to starting the program), post-intervention and at follow-up (10-weeks after the end of the program).
Work performance statistics (meeting sales targets).
Both groups (experimental and control) met more of their target gross margin after the intervention than at baseline, but there were no differences in work performance between groups. No significant difference between intervention and control groups on depression, anxiety, stress or quality of life measures.
Balk et al. (2013) Coping under pressure: Employing emotion regulation strategies to enhance performance under pressure. A-B
Emotional regulation strategy during pressurized task Laboratory study- Golf putting task with additional pressure variables (videotaping participants and financial incentive). Self-selecting participants from a golf club and then randomly assigned to the control group. Control participants were given no emotional regulation strategy, only to feel their emotions freely. Pressure/ tension subscale from the Intrinsic Motivation Inventory (Deci and Ryan, 1994). The number of successfully holed putts (range 0–10). Heart Rate (HR). Arousal and anxiety scale (Fisk and Warr, 1996) The number of successfully holed putts (range 0–10). The use of distraction, had improved performance under pressure. Reappraisal maintained performance under pressure
Distraction condition reported higher levels of arousal.
Beauchamp et al. (2012) An integrated biofeedback and psychological skills training program for Canada’s Olympic short-track speed skating team. A-B
Simulation Field experiment- simulation training of short-track speed skating performance with additional pressure variables (crowd noise, picture of the performance venue). No control condition Heart rate, respiration, muscle activity, skin temperature, Ottawa Mental Skills Assessment Test (OMSAT-3) (Durand-Bush et al., 2001), Cognitive-State-Anxiety- Inventory- 2 (CSAI-2) (Martens et al., 1990), Recovery-Stress Questionnaire (RESTQ-Sport) (Kellmann and Kallus, 2001). Test of Attentional and Interpersonal Style (TAIS) (included a performance under pressure element and confidence) (Nideffer, 1976). Interviews. The short-track speed skating team achieved their medal target of two gold medals, two silver medals, and one bronze medal.
Bell et al.(2013) Enhancing mental toughness and performance under pressure in elite young cricketers: A 2-year longitudinal intervention. A-B
Simulation Field experiment- cricket training drills with additional pressure variables (punishments for not meeting performance standards). Players that were not selected as a future potential for the England program were asked to join a comparison control group. Continued usual training program. Mental Toughness Inventory, Performance, (Woodman and Hardy, 2001)
Cricket performance on batting, bowling and fitness tests.
Punishments, and more specifically the threat of punishment enhanced performance under pressure. Importance of transformational leadership and coping support in facilitating this intervention.
et al. (2013)
Evaluation of an imagery intervention to improve penalty taking ability in soccer: A study of two junior girls teams. A-B
behavioral workshop
Laboratory experiment- Penalty soccer kick with additional pressure variables (competitive comparison, publishing data, psychologists observing performance). Two soccer teams took part. Both teams were randomly assigned into a control or intervention group. Control group were ‘Active’ and given a stretching routine rather than a psychological intervention. The Finnish Athletic Coping Skills Inventory-28 (Peaking under pressure) (Smith et al., 1995)
Bespoke self-efficacy and situational anxiety scale.
Number of goals scored.
No significant difference in performance between intervention and the control group
Players who scored high on a scale measuring ability to peak under pressure showed significant improvement in penalty taking ability.
Breso et al. (2009) Can a self-efficacy-based intervention decrease burnout, increase engagement, and enhance performance? A quasi-experimental study. A-B-A
Psychological consultancy session Natural experiment- the number of exams passed over the school year. Control group were volunteers that participated in the academic stress and anxiety workshop but chose to not receive the one-on-one intervention program. Academic self-efficacy (Midgley et al., 2000), Academic assessment and academic burnout (Schaufeli et al., 2002).
Exams passed
The intervened group presented higher levels of performance.
The intervened group presented higher levels of self-efficacy and task engagement.
Crocker et al. (1988) Cognitive-affective stress management training with high performance youth volleyball players: Effects on affect, cognition, and performance. A-B
behavioral workshop
Field experiment- volleyball serving drill (delivered to North region of Canada volleyball team) during a training session. Those from the southern region of Canada comprised of the control group, which received no intervention. Performance scores.
SCAT (Sport Competition Anxiety Test) (Martens, 1977), CSAI-2 (Martens et al., 1990) and thought listing procedure
Volleyball serving drill performance.
Improved performance compared to the control group.
No significant difference in trait or state anxiety.
Griffiths et al. (1985) The effects of relaxation and cognitive rehearsal on the anxiety levels and performance of scuba students. A-B
behavioral workshop
Natural experiment- Scuba diving performance Control group consisted of enrolled novice SCUBA divers receiving basic SCUBA diving training with no relaxation/cognitive rehearsal intervention. Respiration rate, state-trait anxiety inventory general trait (Spielberger et al., 1983). Bespoke measures of anxiety. Pre-dive anxiety reduced before the task, however lack of transference when performing the actual pressurized task.
Significant improved performance for the experimental group in comparison to the control group perform the underwater task.
Hunziker et al. (2013) Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial. A-B
behavioural workshop
Laboratory experiment- simulated medical emergency (cardiac arrest) Students were randomly allocated into the control group and took part in a video training session and a baseline test. Bespoke measures of stress (post intervention). A significant benefit in terms of reducing perceived levels of stress/overload.
No statistically significant improvement in performance was observed.
McClernon et al. (2011) Stress training improves performance during a stressful flight. A-B
Simulation Laboratory experiment-
Simulation of piloting an aircraft.
Control participants were recruited from the Naval Postgraduate School and randomly allocated to received identical flight skill acquisition training but without ‘psychological’ training. Bespoke measures of stress. Performance of flight. (post intervention) Flight simulation training enhanced performance (telemetry data, certified flight instructor evaluations) than control participants. Significant reduction in perceived stress.
Meyers & Schleser (1980) A cognitive behaviour intervention for improving basketball performance. A-B
Psychological consultancy session Natural experiment- basketball match performance for each game of the athlete’s 28-game basketball season. No control condition Performance statistics (minutes played, field goals attempted, field goals made, foul shots attempted, foul shots made, and total points scored) (pre and post intervention) Measured effectiveness from global performance scores only.
Points per game increased significantly after intervention.
Moore et al. (2015) Reappraising Threat- How to Optimize Performance Under Threat A-B
Emotion regulation strategy Laboratory study- Reward. Performance comparison. Video. ‘non-contingent’ feedback. Negative Participants were randomly assigned to a reappraisal or control group. Control group received neutral instructions that informed the participants about a nondemanding cognitive task in which they had to think about capital cities for one minute. Challenge and threat states after the pressure and reappraisal/control instructions (computed by converting each participant’s cardiac output and total peripheral resistance residualized change scores into z-scores).
Performance statistics (the distance the ball finished from the hole in centimetres).
Despite performing similarly at baseline, the reappraisal group outperformed the control group during the pressurized task.
Olusoga et al. (2014) Coaching under pressure: Mental skills training for sports coaches. A-B
Psychological consultancy session Natural experiment- Intervention delivered to sports coaches to cope with competition demands during the competitive season. No control condition Mental Skills Questionnaire (MSQ; Bull et al., 1996) Social Validation Questionnaire (SVQ) (Thelwell & Greenlees, 2001 (Did the coping under pressure intervention help?)
MCOPE (Crocker et al., 1995) CSAI-2 (Martens et al., 1990) Qualitative interviews.
Subjective coaching performance.
Coaches rated their ability to perform under pressure; positive changes in perceived ability to cope.
Reduced perceived intensity of somatic anxiety. Sharing experiences building self- confidence, and developing the ability to physically relax.
Page et al. (2015) Brief mental skills training improves memory and performance in high stress police cadet training. A-B
Cognitive-behavioral workshop Laboratory experiment- police officers replicating a defensive spray incident. The control group comprised of police cadets undergoing OC (oleoresin capsicum) spray training. Control participants were randomly selected and then moved to a different classroom and attended a 75-minute lecture on cardiovascular physiology. Bespoke confidence, level of stress, and pain.
Heart rate (HR) and hemoglobin-oxygen saturation (SpO2)
Recall of information (memory) from the defensive spray incident.
No difference in heart rate or Sp02 values post intervention. Cadets that reported being more confident had better memories.
Significant difference in performance- police officer’s ability to recall more salient aspects of the scenario.
Prapavessis et al. (1992) Self-regulation training, state anxiety, and sport performance: A psychophysiological case study. A-B
Psychological consultancy session Natural experiment- shooting performance for a competitive rifle shooter No control condition CSAI-2 (Martens et al., 1990). Electromyogram. Heart Rate. Urine testing for catecholamine (i.e., noradrenaline and adrenaline). behavioral state anxiety (movement of gun) was measured using accelerometer.
Performance scores (3 rounds of 20 shots).
Intervention was effective in improving shooting performance.
Effective in reducing state anxiety and enhancing confidence which was perceived to be beneficial for the performer.
Kimura et al. (2015) Effect of a brief training program based on cognitive behavioral therapy in improving work performance: A randomized controlled trial. A-B-A
Cognitive-behavioral workshop Natural experiment- number of sales from employees. Control participants were randomly allocated to receive no intervention and continued work performance tasks. Researcher designed cognitive flexibility scale and self-evaluation of stress. Subjective performance scores indicated an improved performance.
No significant difference in dysfunctional thinking patterns in comparison to baseline.
Lorains et al. (2013) An above real time training intervention for sport decision making. A-B-A
Simulation Laboratory experiment- video simulation of Australian rules football with additional time pressure. Participants were randomly allocated into the control group where they received no training or practice for the pressure task. Global performance scores of reaction times and decision-making.
Decision-making accuracy was increased by training in above real-time simulations, on the computer-based task, compared to normal speed training or no training at all
Wetzel et al. (2011) Stress management training for surgeons-a randomized, controlled, intervention study. A-B-A
Simulation Laboratory experiment- simulation of a surgical operation. Surgeons were randomly assigned into a control group and completed the pressurized task at baseline, but then received no treatment before re-test. Heart rate/ Heart rate variability, salivary cortisol. State-Trait-Anxiety-Inventory (STAI; Marteau and Becker, 1992). Bespoke stress and confidence scale.
Surgical decision making (DM)-–observer rating of the surgeon’s decision process.
The experience of a simulated surgical crisis was regarded as beneficial for enhancing performance. In addition, surgeons reported an increase in practicing technical skills decision making under pressure and confidence.
Enhanced observational teamwork. Reduced heart rate variability during simulated surgery.
Wood & Wilson (2012) Quiet-eye (QE) training, perceived control and performing under pressure. A-B-A
Cognitive-behavioural workshop Lab Experiment-
Soccer penalty kick task with additional pressure variables (Only one kick, financial incentive, random order, different goalkeeper was used in contrast to the training conditions.
Participants were randomly allocated to a control group which practiced taking penalties and received basic information on taking penalties. They were instructed to score as many goals as possible. Gaze control, Control beliefs (Jordet et al., 2006) Mental Readiness Form-3 (MRF-3; Krane, 1994)
Shooting accuracy
QE training was successful in optimizing aiming behavior; encouraging participants to aim for the optimal area of the target facilitating optimum performance under pressure.
Positive impact upon the control beliefs of the performer. Control beliefs appeared to be related to intensity of state anxiety and the way in which the penalty taker approached the shot.
Mesagno at al. (2008) A pre-performance routine to alleviate choking in “choking-susceptible” athletes. A-B-A-B
Cognitive-behavioural workshop Field experiment- tenpin bowling performance with pressure variables (videotaping all shots, audience presence, money). No control condition Self-Consciousness (Fenigstein et al., 1975). Sport Anxiety Scale (Smith et al., 1990) Coping Style Inventory (Anshel and Kaissidis, 1997). CSAI-2 (Martens et al., 1990)
Performance error, from center of the target to center of the ball.
Qualitative interviews
In a sample of ‘choking susceptible participants’ performance of ten pin bowling significantly improved.
Reduction in self-awareness and provided a method of maintaining task-relevant cues, especially after an unsuccessful shot. Pre-performance routine useful in reducing negative self-talk and help maintain task-related focus.
Mesagno et al. (2009) Alleviating choking: The sounds of distraction. A-B-A-B
Emotion regulation strategy Field experiment- performing a basketball task with pressure variables (videotaping all shots, audience presence and money). No control condition Self-Consciousness (Fenigstein et al., 1975). Sport Anxiety Scale (Smith et al., 1990) Coping Style Inventory (Anshel and Kaissidis, 1997). CSAI-2 (Martens, 1990)
Free-throw shooting percentage (total successful free throws in each trial block)
Qualitative interviews
Reduction in the intensity of somatic anxiety. Audience/ fear of underperforming was biggest perceived pressure.