Therapy as maintenance: why men and high performers are dropping the stigma

The Short Version

A longevity physician, a megachurch pastor, an actor-filmmaker and a retired NFL star all talk about therapy the way most people talk about the gym: as regular upkeep, not an emergency room. Peter Attia does four hours of therapy a week and expects he may always need it [1]. Pastor Michael Todd says "Everyone should be in therapy—forever." [4] Ravi Patel calls therapy a "personal advisory board" and has talked dozens of male friends into going [2]. Antonio Brown says of life after football, "For sure you got to get therapy." [5] Several of them say men especially need this, because men are expected to stay stoic and isolated and often lack the support networks women have [2][5]. The comedians on Joe Rogan's show don't talk about therapy directly. They come at it from the side, through anxiety, loneliness and the value of friends you can be open with [3]. Taken together, these stories show a shift that makes asking for help easier before a crisis, not only after one.

Table of contents

What They Said

Peter Attia: "I may always need therapy—and that's okay"

Attia is best known for his work on metabolic health, aging and performance. In this conversation he turns to his own emotional life and describes mental health patterns that nearly cost him everything [1]. His starting point is that the longevity project fails without emotional healing: "There could be no greater torture than to figure out how to live longer… but without peace of mind." [1] For years, he says, he chased longevity through sleep, diet and exercise while staying joyless, angry and disconnected [1].

The high performer's playbook. In therapy with Esther Perel, Attia was told he ran his life with just three tools: obsession, detachment and rage [1]. Obsession showed up as workaholism, perfectionism and an addiction to output. Detachment meant emotional withdrawal and a lack of vulnerability. Rage became a funnel for every negative emotion, including fear, anxiety, shame and defensiveness [1]. Those traits helped him succeed, but they left him relationally bankrupt, isolated and in pain [1]. The episode summary describes this as the armored mindset many high achievers adopt [1]. Replacing those habits took years of therapy, worksheets and deliberate daily practice [1].

Why he frames it as maintenance. Despite his success, Attia still does four hours of therapy a week, including psychotherapy, behavioral therapy and medication when needed [1]. He compares it to exercise: essential, ongoing and transformative [1]. "I may always need therapy—and that's okay. Because I never want to go back to where I was." [1] Weekly behavioral therapy expanded his emotional vocabulary, replacing rage with more precise labels, such as saying "That made me feel unseen," instead of erupting in anger [1].

Dismantling the "others had it worse" excuse. One of the biggest barriers to healing, Attia says, is shame: the belief that "others had it worse, so I don't deserve to hurt." [1] He calls this toxic. Trauma is valid regardless of scale, and healing starts when we stop minimizing and start feeling [1]. He stresses that trauma is subjective: the same event can affect people very differently depending on their resilience, support and emotional tools [1]. "There are 100 internal truths for every one external truth." [1] He lists five forms of trauma that shape adult behavior: abuse, neglect, abandonment, enmeshment and witnessing tragedy [1].

The body connection. Attia describes a patient who followed all the physical health advice without improvement until she dealt with long-buried trauma from her father's death. With therapy, her body began to heal [1]. The summary links this to The Body Keeps the Score and to growing evidence connecting chronic emotional stress with fatty liver disease, metabolic dysfunction and autoimmune disorders [1]. For Attia, this is why therapy may be the missing piece in most longevity strategies [1].

Tools alongside therapy. He calls mindfulness meditation his number one tool for dissolving reactive rage and fear loops, because it creates a gap between stimulus and response [1]. He journals, both freeform and with prompts like "What upset me today?", and uses what he writes as material for therapy [1]. He also schedules mandatory playtime with his kids, including goofy things like scootering through Beverly Hills, to reclaim joy, because isolation is a slow death [1].

Pastor Michael Todd: "Everyone should be in therapy—forever"

Todd, the lead pastor of Transformation Church and author of Relationship Goals, is the bluntest of the group. "Everyone should be in therapy—forever." [4] He rejects the myth that therapy is for crisis or weakness. Instead he argues for preventive emotional care, professional help unpacking childhood wounds and relationship patterns, and combining faith and therapy as one strategy [4]. He puts that into practice: his church pays for therapy for its staff [4].

His own story explains the conviction. He describes his younger self as a liar and manipulator, addicted to pornography and emotionally unavailable, and he credits his healing to deep spiritual work, therapy and years of rebuilding trust with his wife, whom he's been with since age 14 [4]. "Trust is lost in buckets, but gained in drops." [4]

The clearest example of therapy as a deliberate investment comes from a family crisis. When he and his wife learned their son had autism, she needed emotional presence, not problem-solving, and he had to learn to stop avoiding discomfort and sit with pain [4]. Together they did intensive therapy, three hours a day for a week, and it changed how they communicate [4]. "I had to stop sprinting across the finish line without her. Better to finish together slowly than win alone." [4] The summary says the experience deepened their bond and built new trust and shared leadership in the marriage [4].

Todd's broader framework supports the same idea. He values transparency (offering the truth freely even when it's uncomfortable) over mere honesty (telling the truth when asked), and warns that the moment you start hiding what you feel, you start rotting from the inside out [4]. He's open that desire doesn't disappear in marriage, and he frames the answer as self-awareness and deliberate discipline, not suppression [4].

Ravi Patel: therapy as a trainer for your emotional life

Actor and filmmaker Ravi Patel, known for Meet the Patels and his HBO Max series The Pursuit of Happiness, is an outspoken advocate for therapy [2]. He calls it a "personal advisory board" for your emotional life [2]. He compares it to having a trainer at the gym: you go not because you're broken but because you want to get stronger [2]. He has convinced dozens of male friends to go by reframing it as emotional strength training [2].

Patel explains why men need it most. Men face a cultural expectation of isolation and stoicism. Women often have strong emotional support networks, and many men don't, so therapy becomes an essential way for them to reconnect with themselves and others [2].

His own life shows why regular work matters. After years of chasing a "big break through pilots and short-lived shows, he turned 40 and realized none of it had brought lasting joy. He was exhausted and disconnected [2]. Fatherhood, he says, exposed every crack in his life, from his marriage to his emotional triggers, and forced him to face parts of himself he'd rather ignore [2]. He and his wife have opposite parenting philosophies, which often leads to conflict [2]. In an argument he repeats a mantra: Create a safe space. Be on her side. Love her. [2] Even if he doesn't feel it at first, acting with love eventually brings his emotions in line, because love is a commitment more than a feeling [2]. He also talks about the humility of saying sorry" even when you don't feel it, as a bridge back to peace [2].

Antonio Brown: therapy for life after the game

Former NFL star receiver Antonio Brown brings the athlete's version. When Rogan asks whether he got therapy after football, Brown says: "Yeah. Yeah. For sure you got to get therapy." [5] He recommends it outright: "That's why I say I recommend people who get therapy and, you know, in your career, have good people in your corner" [5].

He describes what he actually worked on: "Just how you feel. You know, mental clarity, you know, emotional feelings." [5] That meant dealing with relationships that changed once he wasn't a football player anymore, and with people trying to use him for what he has [5]. He explains the loss of daily purpose: as a player, "you wake up with so much energy ready to put it out" [5]. The lesson he took from it was that "life's not about just being right" [5]. He says the same about sessions with Tony Robbins: "It's not even about me being right in the situation. It's about just being happy." [5]

Brown's "CTESPN joke brand has a serious side too. He says it's meant to raise awareness of head trauma, which gets written off as craziness, and he describes it as encouraging therapy, encouraging, how do you get through tough situation and then making it funny [5]. He wants to show them the cause of the crazy [5]. He mentions a close friend, a receiver who died and was found to have CTE, and a Tampa Bay teammate, Vincent Jackson, who was also later found to have CTE [5]. Rogan adds that society only started taking football head trauma seriously in the last 10 to 20 years [5]. As the conversation puts it, we're ignoring it as society because we love football." [5]

Both men describe the identity crisis retirement brings. Rogan cites a statistic that a large share of NFL players go broke within a few years of retiring, and notes that some players lose their identity entirely once they're no longer football players [5]. "Football is a chapter, life is a long game." [5] In that light, Brown's therapy wasn't a response to a breakdown. It was planned support for a predictable transition.

Joe Rogan and the History Hyenas: anxiety, friendship, and knowing when your way won't work

The Rogan episode with comedians Yannis Pappas and Chris DiStefano doesn't talk about therapy directly, so it adds to this picture from a different angle [3]. When DiStefano admits he cries when he gets really angry, Rogan says he wasn't born tough. He was a scared kid who got picked on and decided the only way out was to become formidable [3]. His advice on anxiety is to recognize thought patterns and separate your consciousness from them. Fighting, hunting and performing in front of thousands taught him how to stop a "what if spiral before it takes over [3]. Crucially, he stresses that some anxiety is chemical and that his approach won't work for everyone [3]. Anxiety is a liar," one of the guests adds [3].

Rogan also stresses how much it matters to have people you can talk to. Comics, he says, "are the best friends. They're the best friends to have because you could be open with them." [3] Without friends like that, "there's a lot of fucking sad, sad people out there." [3] He admits that "Some comics are sad," and a guest adds, "Tears of a clown." [3] He argues that people who claim to prefer isolation are often unwell, because humans are wired for community [3]. He also supports regulated psychedelic therapy centers with screening, proper doses and counselors, while warning "there's no biological free lunch" [3]. The comedians' contribution is less go to therapy than a clear case for openness and connection, the same gap Patel says therapy fills for many men [2][3].

Where They Agree, and Where They Don't

Agreement: therapy is upkeep, not a verdict of weakness. Attia compares it to exercise [1]. Patel compares it to a gym trainer [2]. Todd calls it preventive care that everyone should get [4]. Brown treats it as a normal part of changing careers [5].

Agreement: it's ongoing. Attia expects he may always need it [1]. Todd says "forever" [4]. Patel describes an advisory board, something you keep, not a one-time fix [2].

Agreement: men face particular barriers. Patel names the cultural expectation of stoicism and isolation and the lack of support networks [2]. Attia's own playbook of obsession, detachment and rage is a portrait of the armored high achiever [1]. Brown's account of athletes losing their identity, and Rogan's point about lonely men without friends to open up to, point the same way [3][5]. Todd's story of emotional unavailability, and of learning to sit with pain instead of fixing it, fits the pattern too [4].

Agreement: therapy is one tool among several. Attia pairs it with meditation, journaling, play and diet [1]. Todd combines it with faith [4]. Patel links it to commitment and deliberate acts of love [2]. Brown pairs it with "good people in your corner" [5]. Rogan emphasizes friendship and community [3].

Difference: how much, and for whom. Attia does four hours a week, including medication when needed [1]. Todd and his wife did an intensive three hours a day for a week during a crisis [4]. Brown describes therapy tied to a specific transition [5]. Todd's "everyone, forever" is the most universal claim. Rogan is more cautious. He describes his own non-clinical path through anxiety but explicitly says it won't work for everyone and that some anxiety is chemical [3].

Difference: therapy plus faith, or therapy alone. Todd presents faith and therapy as a single strategy [4]. Attia frames his work in clinical and scientific terms, citing trauma research and metabolic links [1]. Patel frames it as growth and happiness [2]. They don't contradict each other, but they give different reasons for the same habit.

Difference: self-directed toughness versus professional help. Rogan's story of becoming formidable and learning to stop anxiety spirals through fighting and performing [3] is a self-built route, and it contrasts with Attia's years of guided work to unlearn his armor [1]. Rogan's caveat that his way isn't for everyone [3] makes room for both.

Why It Works

The sources offer several explanations for why ongoing therapy helps, especially for high performers and men.

It replaces old survival habits. Attia's obsession, detachment and rage once helped him succeed but later hurt him [1]. The summary describes these as childhood adaptations that once protected us and now cause harm [1]. Therapy, worksheets and daily practice gradually swap them for better tools [1].

It builds emotional vocabulary. Naming a feeling precisely ("That made me feel unseen") instead of funneling everything into anger gives you options [1]. Meditation's gap between stimulus and response makes room to do that [1].

It makes up for missing support networks. Patel's argument is that many men lack the emotional support networks women often have, so a therapist fills that role [2]. Rogan's point that open friendships matter, and that isolation is a sign something's wrong, supports the same idea [3].

It supports hard transitions. Retirement from sports brings money pressure, changed relationships and a loss of identity [5]. Parenting exposes every crack [2]. A child's diagnosis can overwhelm a couple's usual ways of coping [4]. Planned therapy prepares people for these predictable pressures.

The mind affects the body. Attia's patient improved physically only after addressing her trauma, and he links chronic emotional stress to metabolic and autoimmune problems [1].

Openness keeps problems from festering. Todd warns that hiding what you feel makes you rot from the inside out, and that trust is rebuilt drop by drop [4]. Regular sessions make openness routine.

Where It Applies, and Where It Doesn't

It applies to people who look fine from the outside. Attia was already successful and physically optimized [1]. Todd leads one of the most prominent churches in the US [4]. Brown won a Super Bowl [5]. Their point is that success doesn't mean you're well, and that you don't need to hit bottom to benefit.

It applies to predictable life transitions. Retirement from a career, becoming a parent, a child's diagnosis and reaching midlife are all points where these sources sought or recommend help [2][4][5].

It doesn't mean one method fits everyone. Rogan is explicit that his self-taught approach to anxiety won't work for everyone and that some anxiety is chemical [3]. Attia's regimen includes medication when needed [1]. Todd combines therapy with faith, which not everyone shares [4]. Four hours a week is Attia's choice, not a prescription [1].

Other supports matter too. Brown's good people in your corner [5], Rogan's friendships [3], and Attia's play and relationships [1] all count as support. Therapy doesn't replace them.

Head trauma is a medical issue, not just an emotional one. Brown's CTE awareness points to a physical cause behind behavior that gets written off as craziness [5]. Anyone with a history of head impacts, or with serious anxiety, depression or trauma symptoms, should see a qualified medical or mental health professional instead of relying on self-help alone.

What To Do With It

1. Book therapy before you need it. Treat it like Attia treats exercise, as ongoing upkeep [1], or like Todd's preventive emotional care [4].
2. Think of it as an advisory board or a trainer. Patel's framing can help if the word "therapy" still feels like admitting weakness [2].
3. Retire the "others had it worse" excuse. Attia calls this shame toxic. Your pain counts regardless of scale [1].
4. Name your playbook. Ask whether you rely on something like Attia's obsession, detachment and rage, and bring that pattern to a professional [1].
5. Build your emotional vocabulary. When anger comes up, try to name the feeling underneath, as in "That made me feel unseen" [1].
6. Journal and bring it to your sessions. Use a prompt like "What upset me today?" and treat your notes as material for therapy [1].
7. Consider intensive therapy in a crisis. Todd and his wife did three hours a day for a week after their son's diagnosis, and it changed how they communicate [4].
8. Plan support for big transitions. Brown went to therapy when football ended, to deal with changed relationships, loss of routine and people trying to use him [5].
9. Encourage the men around you. Patel talked dozens of friends into going by calling it strength training [2]. Rogan's point about open friendships applies too [3].
10. Keep good people in your corner. Therapy works alongside the friends and family who genuinely have your back, as Brown recommends, and alongside the play and connection Attia now schedules [1][5].

Sources

1. How to Heal Stress, Trauma & Mental Health Issues with Peter Attia · The School of Greatness
2. Pursuing Happiness with Ravi Patel · The School of Greatness
3. 2249 - Yannis Pappas and Chris Distefano · The Joe Rogan Experience
4. Mastering Relationships, Marriage & Sex (The SPIRITUAL Keys) with Pastor Michael Todd · The School of Greatness
5. 2286 – Antonio Brown · The Joe Rogan Experience