CINCINNATI -- The physical toll from a 162-game Major League schedule is easy to see: A runner hobbles around the basepaths, a batter grimaces after being nailed in the ribs by a 96-mph fastball, a pitcher hangs his head in exhaustion from toiling under a hot August sun.

But few can see the mental grind and anguish that come from playing on a daily basis, or the shattered confidence resulting from a game that is as much about failure as success. One bad relief appearance becomes two ... how do you stop the slide? Two games without a hit is just a third 0-fer from becoming a slump. Combined with the constant worry about job security, the mental part of the game can be as much an obstacle to success as any physical one.

Throw in the pressure to perform and self-doubt -- not to mention countless barbs flung from the Internet, talk radio and the fans in the stands -- and who could fault a player who begins to hear his inner voice telling him that failure is just around the corner?

"It seems like it's a constant battle of inner dialogue in assessing a situation and dealing with the pressure," Reds rookie outfielder Chris Dickerson said. "Negative thinking can be your biggest enemy in this game."

Earlier this season, when Dickerson was struggling both at the plate and in the field, he met with sports psychologist Ken Revissa to stop "mentally paralyzing myself with negativity." He credits the meetings for his calmer mindset in the batter's box.

"You can continue to find ways to enhance the daily preparation from a mental standpoint," said Dickerson, who escaped his slump in May and had a solid June before landing on the disabled list with a separated shoulder in July.

The field of sports psychology has steadily taken on a larger supporting role in getting players ready to take the field. According to a 1994 study by Dr. Ronald Smith, a former psychologist for the Astros, psychological skills are as indicative of future performance as physical or technical skills in Minor League Baseball. It's even more so the case for pitchers.

One of the first players to turn to a sports psychologist was right-hander John Smoltz. After two strong years as a young starter for the Braves, he was 2-11 at the All-Star break in 1991 and turned to sports psychologist Jack Llewellyn.

"It's been a big key in my turnaround," Smoltz said at the time. "The main thing he taught me was to focus on the good and forget the bad."

And it worked. Smoltz rebounded to go 12-2 in the second half and was a big part in the Braves' run to the World Series, which they lost to the Twins in seven games in one of baseball's most memorable Fall Classics.

There were others who sought help after Smoltz's well-documented success, most notably Mets right-hander Pete Harnisch in 1997, but there was not an immediate change in the baseball culture. In recent years, as more players' struggles with personal issues have become public, treatment for those struggles has become more commonplace and organizations have become more supportive and proactive in treating them.

Into the public eye

In 2006, Royals right-hander Zack Greinke battled a social anxiety disorder and took a leave from the team. This season, Reds first baseman Joey Votto missed a month and admitted he was suffering from depression after the death of his father in 2008. Detroit left-hander Dontrelle Willis and St. Louis shortstop Khalil Greene both also have spent time on the DL this season to deal with anxiety issues.

"I've been lumped into the Khalil Greene, Dontrelle Willis, Zack Greinke category," said Votto. "I'm not saying one way or the other about those guys, because I don't know what they're dealing with. But I do know I've had a real struggle with my father's passing. It's really something I've had a real hard time with. It was my biggest hesitation coming out and letting people know, letting my teammates know. We're supposed to be known as mentally tough and able to withstand any type of adversity."

After being removed from a game against the Brewers on May 29, Votto spent over 40 minutes in a closed-door meeting with Reds manager Dusty Baker, general manager Walt Jocketty and head trainer Mark Mann, where it was decided it was best he get the help he needed to deal with his depression.

"I think it helps, yeah," Jocketty said of sports psychology. "We hope to do more of that in the future. At the previous three clubs I was with, St. Louis, Colorado and Oakland, we had sports psychologists -- they were more performance-enhancing guys. I think it's important. It's another aspect that helps players develop."

The Rockies have long practiced the policy of having their Major and Minor League players work with the team's sports psychologist, or "performance-enhancement coach," Ronn Svetich, as much as they would stress any form of physical preparation.

Players have become more and more open about their need for extra help on the mental side of the game. Rockies second baseman Clint Barmes is a proponent.

"It just gets you thinking on trying to stay positive and keeping the game as simple as possible and not trying to overthink it too much," Barmes said. "[Svetich] was a huge help for me."

Instant credibility

Who better to assist a player with the mental side of the game than someone who has lived it? Former Major League pitcher Bob Tewksbury, who played for six teams from 1986-98, has been the sports psychology coach for the Red Sox since 2004.

After retiring, Tewksbury finished his undergraduate work and went on to receive a Master's Degree in sports psychology and counseling from Boston University. His role takes him to all levels of the Red Sox organization -- from the lowest rung through the Majors -- to work with players both individually and in groups. The 48-year-old is a fixture at Fall Instructional League and Spring Training, ready to assist.

"I found my own little niche that's exciting and fun and rewarding," Tewksbury said. "It's been great."

If a player ever doubted his credibility, Tewksbury wouldn't need to do much more than produce his own baseball card. Likewise for former Phillies pitcher Don Carman, who also works as a sports psychologist.

"I have a PhD in pitching after playing for 18 years," Tewksbury said by phone from his home in New Hampshire. "The players that I'm in contact with, especially present-day Major League players, really identify with that. They know I've been in their shoes, really. Its gets you in the door. But after that, you still have to be able to work on the player's issues, whether they are on- or off-the-field issues, to help them play the best they can and up to their potential."

Tewksbury had a lifetime record of 110-102 with a 3.92 ERA over 302 games with the Yankees, Cubs, Cardinals, Rangers, Padres and Twins. He was a 1992 All-Star selection for St. Louis during a season in which he won 16 games. He had 17 victories the following year.

"I tell players, 'I've spent parts of seven years in the Minor Leagues,'" Tewksbury said. "'I was demoted five or six times. I had two surgeries. I've been traded and released. I've gotten knocked out in the first inning. I've made the All-Star team. I've rode the bus around the Southern League, the New York Penn League and International League.' There's nothing they've gone through that I haven't gone through."

Dealing with failure

In a game in which hitters are often statistically expected to make outs in seven to eight times per 10 at-bats, failure is an unavoidable option -- even for players that came into professional baseball as the best of the best from their town, city, high school or college.

Still, the fear of failure can be paralyzing for many players.

"You need a mental game plan when you're either unconfident or uncomfortable. That happens a lot in baseball," Tewksbury said. "You have to be comfortable with being uncomfortable, and that's hard to do. But it's necessary. You try to teach that early. The sooner they can learn with that, they increase their chances for success and getting to the next level -- and hopefully to the big leagues."

The key isn't to accept failure; it's to avoid becoming consumed by it. Some players can overanalyze every bad at-bat or pitch or outside comment. As they dwell on it, they might change their approach or mechanics when something isn't working. But others are able to simply go to the plate with confidence, knowing they are a good player.

"They don't worry about the results or consequences as much. They just play," Tewksbury said. "Those are the players that consistently do well at the Major League level."

"The biggest lesson I learned in the Minor Leagues was learning from the mistakes and not looking at it as such a bad negative, but more of a learning experience," Barmes said. "I was pretty hard on myself and my own worst enemy. Instead of blowing up or carrying it from one at-bat to the next or into the field defensively, I was able to let stuff go. I would try to realize what I did wrong and learn from that and move on, or just let it go if that's all I could do."

Preparing for success

Players can't control what happens after the ball leaves their hand or after it makes contact with the bat. They often can't dictate when trades, releases, promotions or demotions are coming.

One thing they can control is preparation. A ballplayer can spend hours upon hours readying himself to play with stretching, batting practice, running, throwing, watching video and reading scouting reports.

Some try to prepare for success by visualizing it -- over and over -- through mental rehearsal.

"It's good to visualize what you want to do and see yourself doing it," Barmes said. "It's trusting and letting it happen. I believe in that. Say I'm hitting and trying to shoot the ball to right-center field or up the middle. I try to get a good pitch to do it on. You focus on it and that's what you try to accomplish. There have been times you could see it happen in your head. It's a good feeling when you can actually repeat it."

When Dickerson worked with Revissa, he was told to take 20 minutes of meditation time before games. Dickerson would close his eyes, focus on breathing and visualize his best swings and everything he wants to see happen later that night.

"I think people underestimate the power of positive visualization," Dickerson said. "When you see something happen, it's almost like your body has already been through the motions in a sense. It can make a tremendous difference when used properly."

"Not a lot of players understand the maximum benefit of using it effectively," Tewksbury said. "It can be difficult. Some people are more visual than others. It's a lot easier for a confident athlete to picture success than an unconfident athlete. The unconfident just thinks of failure."

There are other ways to use visual examples to promote success -- sometimes by showing a player just how he reacts to his own failure. Working with Rockies pitcher Jorge De La Rosa, Svetich showed him video of his performances -- not during pitches, but between them.

The tape showed De La Rosa losing his poise after giving up hits or walks.

"So I could say, 'Wait a minute,'" Svetich said. "'This is all part of the game of baseball. So why would you de-power yourself because of a situation in baseball that has no power over you? It's your perception of the situation that causes you to be empowered or de-powered.'"

Honest self-examination after talking to Revissa also helped players like Dickerson escape bad habits that prevented success.

"What to you do before a game? What's your routine like?" Dickerson said. "What do you do in the box or think about when you step in? What do you think about when you take a bad swing? Then it's learning to reverse all of that thinking to a positive notion.

"An umpire makes a bad call -- OK, what are you thinking? Go on to the next pitch. I still have two pitches left. If I get my pitch here, smoke it. It's not being worried about the results but going from pitch-to-pitch and constantly focusing on making a positive swing or move on the ball."

Open with feelings

Once upon a time, a baseball clubhouse was one of the last places you'd expect a player to open up about his feelings. While it's become more acceptable to openly discuss topics like fears, pressure, anxiety and stress, there still are players that would rather swallow a bag of broken glass than admit they're having trouble.

"There's still a little bit of a barrier with players and their perception," Tewksbury said. "Anytime someone says 'psychology,' they say 'Oh my God. I can't talk to him because it's sign of weakness!' That's permeated our culture a little bit, particularly with males in our world."

Many players from around the league have either tried or embraced using sports psychology. The Rockies' Jason Marquis, currently tied for the National League lead in victories, started using it before the 2008 season with the Cubs. Future Hall of Fame slugger Frank Thomas worked with a psychologist during his career. The Dodgers and Royals hired sports psychologists in 2008.

"I wish I had that resource when I played," Tewksbury said. "I think it would have helped immensely for the transition to the Major Leagues and focusing on things that are within your control versus so many things that are out of your control that players worry about."