Performance anxiety: How to ease stage fright

Many performers forgo normal childhood social experiences to hone their talents, at times sacrificing sound coping skills.¹⁷ CBT’s goal is to help them reduce negative biases and restructure cognitive processes to function better at whatever task is at hand. This involves teaching them to:

• recognize pessimistic thoughts that occur before, during, and after performances
• challenge the accuracy of these thoughts
• replace them with rational, helpful thoughts based on the assimilated information.¹¹

Exposure therapy can help individuals face feared activities so that counter-conditioning through habituation and extinction can safely occur. Useful strategies include imagination, role play, confrontation, videotaping, and homework assignments.¹¹

Experiencing anxiety is a component of exposure therapy. Thus, some clinicians avoid using concomitant medication that might decrease anxiety’s physical symptoms and interfere with the exposure process.²¹

Relaxation training can help the patient recognize and respond to autonomic and physical arousal during a performance.¹¹ For example, progressive muscle relaxation can be practiced first in session and then as homework.

Social skills training can help patients identify and change anxiety behaviors that cause negative audience reactions. Tools to help direct the patient towards more appropriate behaviors include modeling, behavior rehearsal, corrective feedback, social reinforcement, and homework assignments such as videotaping performances.¹¹ For public speaking anxiety, vocal and physical skills training¹⁰ and computerized virtual reality courses can help.⁴

Interpersonal therapy may be useful, based on the premise that performance anxiety occurs within a social and interpersonal context.²²

Related resources

• Toastmasters for public speaking. https://www.toastmasters.com
• Anxiety Disorders Association of America. https://www.adaa.org
• Social Anxiety Association. https://www.socialphobia.org

Drug brand names

• Atenolol • Tenormin
• Clonazepam • Klonopin
• Lorazepam • Ativan
• Nadolol • Corgard
• Propranolol • Inderal

Disclosure

Dr. Kelly reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Dr. Saveanu receives research support from Pfizer Inc. and is a consultant and speaker for Pfizer Inc. and GlaxoSmithKline.