Are you a violinist or a singer who regularly experiences a sense of dread before a performance? Or maybe your heart starts racing, and you begin to sweat profusely, as you’re about to deliver a speech? If this sounds familiar, you could be suffering from performance anxiety.
Musicians, speakers, or anybody else that has to perform under pressure, can experience performance anxiety due to a variety of factors. The fear of an adverse reaction from the audience often impacts their ability to function at an optimal level.
Many performers turn to medications, especially beta-blockers, to combat performance anxiety. Beta-blockers are generally safe, but they might come with some unpleasant side-effects like nausea and dizziness .
Here, we’ll take a closer look at performance anxiety and some of its causes. We’ll also discuss how beta-blockers help with performance anxiety and explore some alternative remedies that might act as natural beta-blockers without the side-effects.
What is performance anxiety?
Performance anxiety, also known as stage fright, is the stress response that happens within someone when they are required to perform for an audience. It is a form of anxiety that is often experienced by people that have a social anxiety disorder (SAD). SAD is an irrational fear of being judged, humiliated, or embarrassed.
Performance anxiety is not a mental disorder. Its the body’s natural response to stressful situations, and most people experience some anxiety before they have to perform. It becomes problematic when the stress response is severe enough to interfere with someone’s ability to perform at a normal level.
What are some symptoms of performance anxiety?
The symptoms vary from person to person. For some people, stage fright is relatively mild. Others can experience panic attacks when its time to perform or speak in front of an audience.
Some common symptoms of performance anxiety are as follows .
- Elevated heart rate
- Increased blood pressure
- Excessive sweating
- An impulse to back out of the performance
- Trembling hands
- An increase in errors in the performance
What causes performance anxiety?
Performance anxiety can be a self-fulfilling prophecy. Negative thought patterns about one’s own ability to perform can lead to a fight-or-flight response on stage and impact the performance. The performer then thinks their anxiety was warranted, making them more likely to experience stage fright in the future.
Environmental factors, like being bullied as a child  or having overly critical parents are thought to increase the risk of developing social anxiety disorder (SAD), and performance anxiety.
Having a hyperactive amygdala (a part of the brain that regulates emotions and stress response) has also been linked with SAD . It might leave someone predisposed to an exaggerated fear response, which could potentially cause performance anxiety.
What are beta-blockers?
Beta-blockers are a class of pharmaceutical drugs that block the effects of adrenaline hormone (also known as epinephrine), which plays a vital role in triggering the fight-or-flight response when you’re in a stressful situation . Beta-blockers are also known as beta-adrenergic blocking agents, or beta-adrenergic antagonists (since adrenaline is a beta-adrenergic substance).
Doctors typically prescribe beta-blockers for a variety of conditions such as abnormal heart rhythm, high blood pressure, angina, glaucoma, among others.
How do beta-blockers work?
Adrenaline is a neurotransmitter that triggers the fight-or-flight response by attaching itself to beta receptors found in the heart, kidneys, eyes, and other parts of the body. Beta-blockers block adrenaline from binding with the beta receptors .
By blocking the effects of adrenaline, beta-blockers reduce the stress on the heart and lowers the force with which it has to pump blood. This has a relaxing impact on the blood vessels found in the heart, brain, and around the body .
Beta-blockers also relax blood vessels by preventing the kidneys from releasing a hormone called angiotensin II .
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How Do Beta Blockers Help With Performance Anxiety?
According to Dr. Robert Attaran, an assistant professor of cardiology at Yale University, beta-blockers are commonly used to treat physical symptoms of performance anxiety . He says that the use of beta-blockers to combat stage fright is accepted within the medical community, for the most part, assuming they are taken with appropriate caution.
When a performer or speaker takes a beta-blocker, it slows their heart rate, reduces the trembling and sweating, and it regulates their breathing and blood pressure. It helps the performer feel relaxed, essentially negating the stress response to help them get through the performance. However, beta-blockers can’t address the underlying causes of stage fright. Those require longer-term solutions, as we’ll discuss below.
According to a 2016 review of existing research, propranolol (the ingredient in Inderal) is similarly effective in reducing anxiety when compared to benzodiazepines, another class of drugs used for anxiety. However, it only worked in the short-term .
What are some common over-the-counter (OTC) beta-blockers?
There are various beta-blockers available on the market, but here are some of the most common ones (and their ingredients).
- Inderal (Propranolol)
- Sectral (acebutolol)
- Coreg (Carvedilol)
- Zebeta (Bisoprolol)
Inderal is the most common one when it comes to people using beta-blockers for performance anxiety.
It is critical to remember that everyone responds to medications and treatments differently. If you’re considering using beta-blockers for stage fright, or another condition, be sure to consult a medical professional before you begin.
Are there any alternative remedies that might act as natural beta-blockers?
Beta-blockers can temporarily address the symptoms of performance anxiety. For a longer-term solution, there are several natural remedies and lifestyle adjustment options available to address the underlying causes of your stage fright.
Relaxation techniques to reduce overall anxiety levels
When you start feeling anxious, your initial impulse might be to try and relax, but you can’t force relaxation. However, you can achieve a physiological state that allows relaxation to happen. Here are two relatively simple techniques can aid relaxation both in the short-term and in the long run.
Belly breathing is your built-in natural beta-blocker
Belly breathing, or diaphragmic breathing, is the process of taking long breaths in and out of your stomach, instead of your chest. This technique of breathing is taught as the foundation for most meditation or relaxation techniques. Belly breathing can benefit you in numerous ways, including lowering stress levels, regulating blood pressure, and controlling mind-chatter .
Belly breathing is one technique that you can use during a stressful situation for immediate relief. But, like most things, you’ll enjoy greater benefits if you make it a daily practice.
Mediation for reducing overall anxiety
Mediation is a practice where you focus your mind on a specific thought or activity (like breathing) to increase awareness of yourself and your environment. It is also called a mindfulness practice.
Meditation has several benefits when it is practiced consistently. For those suffering from performance anxiety, meditation can help by reducing overall stress and anxiety . One of the most convenient ways to develop a meditation practice is through the Headspace app. Otherwise, an internet search can also provide you with numerous methods to get started.
Progressive muscle relaxation
Progressive muscle relaxation (PMR) is another relaxation technique that might be considered a natural beta-blocker. It is designed to help you develop a habit of being in a relaxed state, which would then carry over to situations in your day-to-day life, such as when you’re performing.
There’s some scientific evidence to back up the efficacy of the progressive muscle relaxation technique. A 2018 study published in the Journal of Exercise Rehabilitation concluded PMR is a valid treatment option for minimizing anxiety and depression in people hospitalized with leprosy .
PMR is a simple practice of alternating between tensed and relaxed muscles. To get started, begin with a few deep belly breaths and by relaxing your body. Then start tightening and releasing one muscle group at a time. Most practitioners recommend starting with your lower extremities, and then gradually moving up till you reach the face.
For best results, try to create a daily practice of 10 to 20 minutes in a quiet place.
Systematic desensitization as a natural alternative to beta-blockers
Developed by Joseph Wolpe, a behavioral therapy pioneer, systematic desensitization is a technique designed to treat various anxiety-related disorders. It is based on the classical conditioning premise that anything that is learned can be unlearned. There’s evidence to suggest that systematic desensitization might help in reducing performance-based anxiety .
The technique works by you imagining yourself in various fearful situations, typically a progression from the least to most fearful. In those imaginary situations, you practice relaxation techniques to compete with your anxiety and fear.
To combat stage fright, you would imagine that you’re about to deliver a performance. As you get anxious, you would practice deep breathing or another relaxation technique. Once you can remain calm in your imagination, you might be better equipped to face the situation in real life.
Cognitive-behavioral therapy (CBT)
CBT is designed to shift your mindset around challenges that you find overwhelming. It seeks to replace negative thought patterns by breaking them down to smaller parts and replacing them with positive ones.
When dealing with social anxiety disorders (SAD), CBT will seek to identify irrational thoughts and beliefs and replace them with realistic ones. For performance anxiety, CBT might focus on the following problem areas:
- Limiting beliefs you have about your self-worth
- Embarrassment over a bad past performance
- Tendencies for excessive perfectionism
- Fear of judgment from the audience
Your therapist will work with you and create a treatment plan based on your specific needs. CBT seems to work best if you believe it will work and put in the effort to make it a success. As a part of your treatment, you might be given homework assignments to help you make progress.
There’s evidence to suggest that CBT is effective in reducing anxiety in social situations, and that its benefits are long-lasting .
If you’re in the US, get in touch with the National Association of Cognitive-Behavioral Therapists to find a qualified CBT practitioner near you. If possible, reach out to a therapist first and ask to hear more about their experience using CBT to assist people with stage fright and/or social anxiety.
Yoga for performance anxiety
Yoga is a practice that aims to integrate both your mind and body with physical poses (known as asanas), controlled breathing, and a period of intentional relaxation. Yoga originated from ancient India, but it has been growing in popularity worldwide over the last few decades. One survey found that around 7.5 percent of the U.S. population has tried yoga at least once.
According to the Harvard Mental Health Letter, a regular yoga practice can decrease the negative impacts of an exaggerated stress response . Since stress response plays a vital role in performance anxiety, yoga might be beneficial to those who experience stage fright.
Yoga also increases your heart rate variability (HRV), which is the measurement of change in the time between successive heartbeats. A higher HRV will help your body adapt better to stress, thereby blunting performance anxiety.
One 2009 study found that yoga, when combined with meditation, significantly reduced performance anxiety in young professional musicians .
To find a yoga studio close to you, search “your city+yoga studio” on Google. If there are no studios close by, there are plenty of free instructional videos on the internet. All you need is a mat, a glass of water, and you’re all set.
Final thoughts on Beta Blockers & natural alternatives
Having performance anxiety can be detrimental to your quality of life. It can keep you from doing the things you love, like performing in front of an audience. It can also affect your grades, or your career, if you suffer from excessive anxiety during a test or a presentation.
The good news is that you don’t need to live with performance anxiety. Ideally, you’re able to develop a relaxation or mindfulness practice to reduce your overall anxiety levels. If that’s not enough, you can seek out a therapist to help you with cognitive-behavioral therapy (CBT) or systematic desensitization to address any underlying causes of performance anxiety.
In the meantime, if you want to try beta-blockers as a temporary solution, be sure to speak with your doctor first.
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