What the research says
This page summarizes my research efforts on psychological resilience and pain perceptions in ultrarunning. It is a narrative review of the peer-reviewed literature on how ultrarunners experience pain, build resilience, cope, find meaning in the sport, and sometimes pay for it. Each topic below gives the short version, and the full paper is available on request.
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Ultrarunners Feel Pain, and They Respond to It Differently
The research on athletes and pain points in the same direction again and again. Athletes tolerate more pain than non-athletes, yet the difference in how much pain they report feeling is much smaller. Across the studies I reviewed, the gap in sensation was small and inconsistent, while the gap in tolerance was large and consistent.1,2
The explanation sits in how the brain processes pain. Attention, expectations, the meaning an athlete attaches to a sensation, and descending pathways that adjust the signal before it reaches awareness all shape the experience. Experienced ultrarunners also seem to be more accurate at telling discomfort, fatigue, and real injury apart, which may be the most useful skill in the whole picture.3
Where this comes from. Two meta-analyses, one review of pain coping in elite ultra-endurance athletes, one set of interviews with experienced ultrarunners, and one scoping review of 17 studies. Numbers in the text point to the sources at the bottom of this section.
What this means in practice
Pain regulation looks like a skill that can be trained earlier than race experience alone would allow. Interoceptive awareness work, cognitive reappraisal, and progressively harder training sessions all fit that purpose. The ability to override discomfort also carries injury risk, so athletes need to respect how ambiguous pain can be during a race.
What We Don't Know Yet
Most of what is known about athletes and pain comes from lab tests such as cold water immersion, which are shorter and different from the pain of a long race. Many of the ultrarunning studies are small, single-event, and mostly male, and several are cross-sectional, so they show an association and cannot show what caused it. It is also unclear how much of the difference comes from the sport shaping people and how much from the kind of person who is drawn to it.
The practice suggestions above are a reasonable reading of this evidence, and they still need to be tested directly in ultrarunners.
Sources for Pain Processing
Numbered in the order they first appear above.
- Tesarz J, Schuster AK, Hartmann M, Gerhardt A, Eich W. Pain perception in athletes compared to normally active controls: a systematic review with meta-analysis. J Pain. 2012;153(6):1253-1262. doi:10.1016/j.pain.2012.03.005
- Thornton C, Baird A, Sheffield D. Athletes and experimental pain: a systematic review and meta-analysis. J Pain. 2024;25(6):104450. doi:10.1016/j.jpain.2023.12.007
- Paley CA, Johnson MI. Human resilience and pain coping strategies: a review of the literature giving insights from elite ultra-endurance athletes for sports science, medicine and society. Sports Med. 2025;55:2137-2146.
- Emeka L, Meijen C. Pushing through the pain cave: lived experiences of pain tolerance in male ultra-marathon runners. Sport Exerc Psychol Rev. 2024;18(2):40-54.
- Delalay M, Hotz Boendermaker S. Mental pain responses of ultramarathon runners: a scoping review. Sports. 2026;14(2):72.
Resilience Is Built Over Time
Popular culture treats resilience as a trait you either have or you don't. The research describes it as a process that shifts across phases of training, competition, and life. Motivation, emotional regulation, confidence, coping skills, and social support work together to determine how much a setback disrupts an athlete.1
In a survey of 750 runners, the ones who felt autonomous and competent in their training were more likely to return to baseline after stress and more likely to grow from it.2 Each time a runner restores balance after a hard stretch, the experience changes how the next stressor gets interpreted.
Where this comes from. A systematic review of 92 studies, a survey of 750 runners, a study of 56 elite runners at the HURT 100, and a systematic review of resilience and injury covering more than 4,400 athletes. Numbers in the text point to the sources at the bottom of this section.
What this means in practice
Resilience is trainable. Coaches can design training that exposes athletes to manageable challenge while protecting their choices and sense of mastery, then build in time to reflect on hard experiences. For athletes already competing at an elite level, further gains may come from nutrition, pacing, sleep, and crew support.
What We Don't Know Yet
Resilience and mental toughness are measured in different ways from study to study, which makes results hard to compare. The survey of 750 runners shows that autonomy and competence go along with resilience, and it cannot show that one causes the other. The HURT 100 sample is small, comes from a single event, and is made up of elite runners, so the threshold idea is an interpretation that still needs to be tested.
The recovery findings come from injured athletes across many sports, so how well they apply to ultrarunners is not yet clear.
Sources for Resilience
Numbered in the order they first appear above.
- Gupta S, McCarthy PJ. The sporting resilience model: a systematic review of resilience in sport performers. Front Psychol. 2022;13:1003053.
- Diotaiuti P, Corrado S, Mancone S, Falese L. Resilience in the endurance runner: the role of self-regulatory modes and basic psychological needs. Front Psychol. 2021;11:558287.
- Brace AW, George K, Lovell GP. Mental toughness and self-efficacy of elite ultra-marathon runners. PLoS One. 2020;15(11):e0241284.
- Mastroianni MA, Timoney BF, Abdelaziz A, et al. The impact of resilience on injury incidence, recovery, and performance in athletes: a systematic review. Orthop J Sports Med. 2025;13(10):23259671251376705.
Coping Works Best as a Toolkit
Two large meta-analyses show that psychological training improves performance in athletes. Mindfulness-based programs were linked to better performance, attentional control, psychological flexibility, and emotional regulation.1 Goal setting, imagery, self-talk, and cognitive-behavioral strategies also helped, and programs that combined several techniques outperformed programs built around one.2
Within ultrarunning, coping matures with experience. Athletes who handled events of extreme duration well leaned on patience, calm, self-regulation, and long-term commitment more than competitiveness or aggression.3 The mindset that suits a 5K and the one that suits a hundred-miler turn out to be different.
Where this comes from. Two meta-analyses of psychological training in athletes, a study of coping in ultra-trail events of extreme duration, and a review of the psychological predictors of success in ultrarunning. Numbers in the text point to the sources at the bottom of this section.
What this means in practice
Athletes do better building a varied toolkit than leaning on one favorite strategy. Mindfulness, imagery, self-talk, and cognitive reappraisal are all supported by the evidence, and using them together gave the strongest results.
What We Don't Know Yet
The meta-analyses cover athletes in general, not ultrarunners specifically, so how well their results carry over to very long events is still open. Few trials have tested these techniques in ultrarunners directly. The studies of what successful ultrarunners do describe patterns, and they cannot show that those strategies caused the success.
The suggestion to combine techniques is a reasonable reading of the evidence, and it still needs to be tested in this population.
Sources for Coping
Numbered in the order they first appear above.
- Wang Y, Lei SM, Fan J. Effects of mindfulness-based interventions on promoting athletic performance and related factors among athletes: a systematic review and meta-analysis of randomized controlled trial. Int J Environ Res Public Health. 2023;20(3):2038.
- Reinebo G, Alfonsson S, Jansson-Frojmark M, et al. Effects of psychological interventions to enhance athletic performance: a systematic review and meta-analysis. Sports Med. 2024;54:347-373.
- Trabucchi P, Pellegrini B, Savoldelli A, et al. It's not difficulty that matters, but strategy: perceived stressor, functional and dysfunctional coping strategies in ultra-trails of extreme duration. PLoS One. 2025;20(9):e0332058.
- Thornton OR, Ly S, Colon I, Cole H, Li W. The psychological indicators of success in ultrarunning: a review of the current psychological predictors in ultrarunning. Ann Med Health Sci Res. 2023;13(7):730-736.
Why People Keep Coming Back
As involvement deepens, ultrarunning often becomes tied to identity, purpose, and how a person understands themselves.1,2 Pain and effort get interpreted as part of growth, mastery, or even spiritual experience, which helps athletes stay engaged when conditions get harder.1,3,4
Ethnographic research found that ultrarunners use value-laden language to make sense of suffering. Finishing despite exhaustion, severe pain, and sleep deprivation becomes evidence of discipline, motivation, and perseverance. That connects a willingness to hurt on purpose to values that matter well beyond running.5
Where this comes from. Ethnographic and interview research with ultrarunners, a questionnaire study of mountain runners, and reviews and frameworks on psychological factors in ultrarunning. Numbers in the text point to the sources at the bottom of this section.
What this means in practice
Intrinsic motivation and personal meaning give runners something steadier than external validation, which tends to be fragile. Athletes benefit from building a sense of purpose in their running that holds up when a race or a season goes badly.
What We Don't Know Yet
Most of the research on meaning in ultrarunning is qualitative, which gives a rich picture of how athletes talk about suffering and cannot show how common any of it is. Interviews also come mostly from male, Western athletes at single events. Emotional intelligence as a foundation for other strengths is a proposed model and has not been tested directly, and the link between a fused identity and compulsive persistence comes from reviews and theory, not from studies that followed runners over time.
Sources for Meaning and Identity
Numbered in the order they first appear above.
- Bill T, Philippe RA. A new temporal framework for the passionate engagement journey of ultra-endurance athletes: a qualitative investigation. PLoS One. 2023;18(11):e0293864.
- Thornton OR. The motivational architecture of success in ultrarunning: a systematic review. University of North Carolina at Chapel Hill; September 19, 2025.
- Paley CA, Johnson MI. Human resilience and pain coping strategies: a review of the literature giving insights from elite ultra-endurance athletes for sports science, medicine and society. Sports Med. 2025;55:2137-2146.
- Emeka L, Meijen C. Pushing through the pain cave: lived experiences of pain tolerance in male ultra-marathon runners. Sport Exerc Psychol Rev. 2024;18(2):40-54.
- Gross T. Talking about and coping with pain and suffering in ultrarunning as moral language. Qual Res Sport Exerc Health. 2025;17(3):205-221.
- Mendez-Alonso D, Prieto-Saborit JA, Bahamonde JR, Jimenez-Arberas E. Influence of psychological factors on the success of the ultra-trail runner. Int J Environ Res Public Health. 2021;18(5):2704. doi:10.3390/ijerph18052704
- Thornton OR. Emotional intelligence as a cornerstone of success in ultrarunning: a synthesis of meta-analytic evidence and psychological theory. Unpublished manuscript. University of North Carolina at Chapel Hill; 2023.
- Nicolas M, Gaudino M, Bagneux V, Millet G, Laborde S, Martinent G. Emotional intelligence in ultra-marathon runners: implications for recovery strategy and stress responses during an ultra-endurance race. Int J Environ Res Public Health. 2022;19(15):9290.
- Thornton OR, Li W. The psychology and psychopathology of ultrarunning: mental health and psychiatric insights into extreme endurance athletes. Int Neuropsychiatry Dis J. 2025;22(1):1-5.
The Strengths and the Risks Come From the Same Traits
Discipline, perfectionism, and high conscientiousness help ultrarunners succeed. Taken too far, the same traits can turn into compulsive training, rigid eating habits, and an identity fused with running.1 The population that scores high on mental toughness and self-efficacy also shows elevated rates of depression, anxiety, obsessive-compulsive tendencies, disordered eating, exercise addiction, and sleep problems.1
Fueling is an underrecognized part of this. Many of the breakdowns seen late in ultras, including quitting, poor pacing, irritability, and confusion, are often predictable results of too little carbohydrate, dehydration, electrolyte imbalance, or gut trouble.2,3 What a crew reads as mental weakness is frequently a fueling problem with a fueling solution.
Where this comes from. A screening survey of ultramarathon participants, an EEG study of ultramarathon racing, a systematic review of grit and physical activity, and reviews of mental health, nutrition, and motivation in ultrarunners. Numbers in the text point to the sources at the bottom of this section.
What this means in practice
Mental toughness is not always a virtue. Regular screening, education about early warning signs, and psychological support belong in training plans. Crews, pacers, and aid station volunteers serve as outside thinking and emotional regulation for athletes whose own cognition is degrading, so they need to know the signs of cognitive decline, a nutritional crisis, and distress.
What We Don't Know Yet
Screening tools flag who may be at risk and do not diagnose anyone, and the screening data come from small samples at single events. How much higher the rates of depression, anxiety, and disordered eating run in ultrarunners than in comparable non-runners is not yet well established.
The brain recording study compared runners before and after racing, so the effect on decisions made during a race is an inference that still needs direct testing. Whether very high grit leads people to train through injury rests on reviews of grit and physical activity in general, and not on ultrarunners followed over time.
Sources for The Cost of Grit
Numbered in the order they first appear above.
- Thornton OR, Li W. The psychology and psychopathology of ultrarunning: mental health and psychiatric insights into extreme endurance athletes. Int Neuropsychiatry Dis J. 2025;22(1):1-5.
- Thornton OR. The nourished mind: a meta-analysis of nutritional-psychological synergies in ultrarunning performance. University of North Carolina at Chapel Hill; October 16, 2025.
- Knechtle B, Braschler L, Weiss K, et al. 24-hour ultra-marathon running: a narrative review of performance factors and physiological impacts. Sports Med Open. 2026;12:32.
- Buck K, Spittler J, Reed A, Khodaee M. Psychological attributes of ultramarathoners. Wilderness Environ Med. 2018;29(1):66-71. doi:10.1016/j.wem.2017.09.003
- Boere K, Young NP, Copithorne F, et al. Ultramarathon racing elicits changes in behavioral and electroencephalographic indices of executive function. J Appl Physiol. 2026;140(1):1-8.
- Martin J, Hromyak A, Sax van der Weyden M, Weinstein AA, Boolani A. The relationship between grit, resilience and physical activity: a systematic review. Front Sports Act Living. 2025;7:1563382.
- Thornton OR. The motivational architecture of success in ultrarunning: a systematic review. University of North Carolina at Chapel Hill; September 19, 2025.
Coming soon
Overtraining
Training through fatigue and pain without enough recovery affects a lot of ultrarunners, and it deserves a full breakdown of its own. That page is being written and will be added to this site soon.
Beyond the Sport
Many of the strategies ultrarunners use to cope with pain, including acceptance, cognitive reframing, mindfulness, interoceptive training, and a sense of internal control, apply to people living with persistent pain. Ultrarunners are a naturalistic example of how meaning, resilience, and well-regulated responses can change how threatening pain feels.
For physical therapists and other rehabilitation professionals, this offers a framework for patient engagement and pain management. Whether these skills transfer directly to clinical populations still needs to be tested.
Request the Full Paper
The full paper includes the complete discussion, the practical recommendations for athletes, coaches, and clinicians, and the reference list behind everything on this page. Tell me a little about how you'd use it and I'll send a copy.