Athletes may first seek counsel from mental health professionals with concerns of performance anxiety. The mental health professional must carefully explore the context and origins of the athlete’s anxiety in order to identify and address the root cause. A detailed history and physical examination will help avoid missing comorbid conditions presenting with anxiety symptoms. This chapter highlights the importance of recognizing the circumstances in which anxiety symptoms may arise in athletes; identifying stressors that are exclusive to the athlete experience; determining how those symptoms can affect their performance and general livelihood; and developing a treatment strategy that maximizes the athlete’s performance.