"Seeing my therapist every Thursday, it's kind of religious for me," Biles said shortly after she officially punched her ticket to the Paris Games with an all-around victory at the US trials. "That's why I'm here today."
Mental well-being has become as much a focus as strength and conditioning for elite athletes, who long battled the weight of expectations, anxiety and fear of failure in silence for fear of seeming weak.
When Biles, a four-time gold medallist at the 2016 Rio Olympics, pulled out of most of her events at the Tokyo Games three years ago as she struggled with her mental health and the disorienting spatial disorder gymnasts call the "twisties," some were sympathetic, but plenty of critics branded her a quitter who cost the US team gold.
Biles's French coach Cecile Landi said the decision by such a high-profile athlete helped lift the stigma -- a boon for competitors in all sports.
"I think it used to be almost shameful to talk to (a therapist)," Landi said. "You have a problem, she has issues."
Instead, she said, "It helps all the athletes.
"It's not about (having) a problem. It's actually getting proactive and making sure you become the best athlete and person you can be by doing that work."
From something "kind of embarrassing to talk about," Landi said, mental health has become recognized as a key component in athletic achievement.
Sports federations and governing bodies have responded, offering resources and adding mental health professionals to their staffs.
In Paris, some 90 national team staffs will include credentialled mental health officers, and organizers have provided an array of amenities aimed at promoting mental well-being.
Swimming superstar Michael Phelps has spoken candidly of struggling in the wake of his glittering Olympic campaigns, saying in 2018 that after every Olympics he fell into a "major state of depression."
But doubts and demons can strike even when an athlete appears poised to dominate on the biggest stage.
Just a year after winning five gold medals at the Tokyo Olympics US swimmer Caeleb Dressel abruptly withdrew from the 2022 swimming World Championships for unspecified medical reasons.
He has since described the mental toll his pursuit of perfection took.
Dressel, who stepped away from the sport for almost a year, is now headed to Paris with a chance to defend two of the three individual gold medals he won in Tokyo.
Teammate Regan Smith credits work with sports psychologist Emily Klueh -- a former elite swimmer now working for USA Swimming -- with helping revitalize her career.
Scared at first
Smith was just 17 when she set world records in both the 100m and 200m backstrokes in 2019.
But a crisis in confidence and drop in form saw her settle for two silver medals and a bronze at the pandemic-delayed Tokyo Olympics.
The 22-year-old, now training with Phelps's former coach Bob Bowman, said the coaching change and her decision to consult a mental health professional had helped her return to peak form.
She regained the 100m backstroke world record at the US Olympic trials.
"I felt scared at first," Smith said of her decision to seek therapy. "I was afraid to ask for help and then I finally did and realized what I had been missing out on for so long."
Freestyle sprinter Jack Alexy, who is headed to his first Olympics, has not sought the help of a therapist, although he thinks mental fitness is "a huge part of success" in a sport where months or even years of preparation can come down to a race lasting less than a minute.
"I kind of took it in my own hands and started journalling a year and a half ago to get my thoughts out on paper and kind of just analyze my preparation process and what I'm doing in and out of the pool," he said.
"That kind of set me up for success for the past two years. I think it's important to check on the mental side, just as important as the physical side."
