Performance Anxiety and How to Deal With It

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 10/05/2020

In one month you’re going to present at a staff meeting, but you’re already losing sleep over it. You know that day (and long before) will be filled with fear, nausea, and extreme self consciousness. Your heart races just thinking about it.

Whether it’s a meeting, a job interview, or a speech before a large crowd — if the feelings above sound familiar, you may be suffering from performance anxiety, also referred to as stage fright.

Consciously you know you’re not a screw up, but your shortcomings are all you can think about when you experience this type of anxiety. It isn’t just “in your head”, the symptoms of performance anxiety are very real and very disruptive. But you’re not alone, and you don’t have to continue to suffer.

What You Need to Know

  • Performance anxiety is a diagnosable type of social phobia.

  • However, it is only reserved for people who do not suffer from general anxiety — the fears are only associated with performing, public speaking, or being in front of people.

  • The symptoms of stage fright or performance anxiety are physical and mental, but most often include an increased heart rate, tremors, and sweating.

  • When you’re in the throes of this anxiety, your fears and thoughts worsen your physical symptoms, creating a cycle.

  • Many people of all ages and experience levels suffer from performance anxiety.

  • Potential solutions include pharmaceutical (beta-blockers), psychological (therapy), and self-administered (meditation).

What is Performance Anxiety?

For folks suffering from performance anxiety, the thought of an upcoming interview or presentation at work can cause panic, sometimes weeks before the actual engagement. It is a disruptive and excessive fear that you’ll do or say something humiliating, that you’ll make a fool of yourself or appear incompetent.

For many with stage fright, the overwhelming fear is that people will see you panicking — that your anxiety is visible and those who see you are judging you for your racing heart and sweaty palms.

This isn’t mere butterflies the night before a performance, but a diagnosable mental disorder.

According to the DSM-5 — the giant book used by mental health professionals to diagnose mental disorders — you may suffer from diagnosable performance anxiety if:

  • You have great anxiety in situations where you are exposed to “possible scrutiny by others”

  • This fear is restricted to speaking or performing in public

  • These situations consistently cause anxiety and have for 6 months or more

  • The anxiety you experience is out of proportion, or the fears unrealistic  given the circumstances

  • It causes you to avoid the situations that trigger it, or suffer through them with intense fear

  • The anxiety causes significant distress or impairment

  • The anxiety can’t be attributed to other causes like medication, medical conditions or other mental health disorders like generalized anxiety

While performance anxiety is a subset of social anxiety disorder, it is unique. If performing or public speaking isn’t the only time you experience this anxiety, you may suffer from a broader, social anxiety disorder.

Performance Anxiety Symptoms

The most common physical symptoms of performance anxiety are: high heart rate (tachycardia), tremors, nausea, and sweating. 

One study that compared people suffering from performance anxiety and those from a more generalized anxiety and found those with stage fright to have a greater increase in heart rate, an overestimation of the visibility of their symptoms, and an underestimation of the quality of their performance.

The initial symptoms of performance anxiety are often the physical ones  — the increased heart rate and sweating, for example. But, these symptoms cause psychological symptoms — “people are going to notice me panicking,” “I’m going to bomb this,” “I look like a fool.” These thoughts create a vicious cycle, as they’re likely to worsen the physical symptoms which (to the anxious mind) confirms the negative self-talk.

When your mind is in this loop, you may recognize that you’re being ridiculous but feel powerless to stop the cycle.

The full list of symptoms you may experience with performance anxiety is lengthy:

  • Tremors

  • Fear

  • Restlessness

  • Increased talking

  • Decreased concentration

  • Muscle tension

  • Tingling

  • High blood pressure

  • High heart rate

  • Shortness of breath

  • Sensation of throat restriction

  • Nausea

  • Diarrhea

  • Sweating

  • Flushed skin

  • Dry mouth

  • Voice changes

You’re Far From Alone

Performance anxiety doesn’t mean you’re incompetent — remember, it’s based in irrational fears. People of all ages and experience levels experience stage fright, according to research and anecdotes.

Marilyn Monroe, for instance, was said to have been long-plagued by stage fright. It’s been partially blamed for her insomnia and self-medicating drug problems. 

The famous composer and pianist Frederic Chopin is quoted as saying about his own performance anxiety: “An audience intimidates me, I feel asphyxiated by its eager breath, paralyzed by its inquisitive stare, silenced by its alien faces.”

You also don’t have to be a performer, actor or musician to suffer from stage fright or performance anxiety. A mere job interview or leading a meeting at work can trigger this type of anxiety. That being said, most research has been conducted on performers, as the experience is a well known job risk. 

A 1988 study of more than 2000 professional musicians found that 24 percent suffered from stage fright, 17 percent reported symptoms of depressions and 13 percent reported acute anxiety. The exact prevalence among non-performers is unknown, but it’s safe to say there are others silently suffering like you.

Coping With Performance Anxiety

Because performance anxiety is different from generalized anxiety, the approaches to remedy it may differ somewhat. A healthcare provider  may be reluctant to prescribe anti-anxiety medications (used to treat general anxiety), if you’re only experiencing anxiety prior to a triggering event. However, there are other solutions:

Relaxation techniques and meditation. Perhaps the simplest and beginner approach to treating performance anxiety is meditation or relaxation. For some, this can mean regular exercise. For others, meditations focused specifically on the anxiety are helpful.

A small 2003 study among music performers found an 8-week meditation program to reduce performance anxiety and increase pleasure experienced through performing. Another, in 2007, focused specifically on Zen meditation and had similar findings — that performers who regularly meditated not only saw a decrease in anxiety, but improvement in performance quality.

Beginning a meditation practice takes dedication, like any new habit. Scheduling a 10 minute session when you wake up in the morning, every day, is a good place to start. Once you’ve created the habit and are an experienced meditator, using meditation to calm your mind prior to a triggering event may lessen your symptoms.

Cognitive behavioral techniques. Cognitive behavioral therapy and solutions seek to explore the connection between thoughts and behaviors or outcomes. They attempt to break that cycle of negative self-talk and physical anxiety symptoms. These skills can sometimes be self-taught, but are most often developed with the help of a psychotherapist.

A therapist (or really good book on the topic) can teach you how to: recognize the triggers that cause your performance anxiety, anticipate and prepare for the thoughts that worsen your symptoms, and restructure those flawed thoughts to lessen the anxiety overall.

One popular cognitive approach to performance anxiety is the Alexander Technique, popular among professionals in performing arts.

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Beta Blockers for Performance Anxiety

Beta blockers, such as propranolol, are most commonly used to treat high blood pressure. But they’ve been used off-label for the treatment of performance anxiety, too. Several studies have looked at these prescription drugs for their ability to provide relief of stage fright symptoms. It’s believed they work by primarily reducing heart rate, which lessens that cycle of anxious self-talk and physical anxiety symptoms.

Otherwise anxious subjects in a 1980s study, for example, experienced lower heart rate, less stuttering and stammering, and tremors after taking 40mg of propranolol when compared to non-anxious individuals.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

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