Scared of Center Stage? Understanding Performance Anxiety

Whether it's the presentation you’re about to give to that packed boardroom or the fact that you’re on deck to sing karaoke at the neighborhood bar — we all have something that causes us to break into a cold sweat and sends our pulse skyrocketing.
 
So, how do you know if you’re dealing with a normal bout of nervous energy or if you’re experiencing a brush with performance anxiety? To start with, it helps to understand what performance anxiety is, what makes it tick and, of course, how to treat it.

How is performance anxiety different?

When it comes to the varieties of anxiety you can experience, there are many different flavors out there. One of the more comprehensive ones is social anxiety which can include intense fear about specific social situations where you believe you may be embarrassed or humiliated, avoidance of anxiety-producing social situations and feelings of anxiety that are out of proportion with the situation.

This is a good place to start when it comes to understanding performance anxiety, which affects millions of people around the world, of all ages and genders.

“Performance anxiety is anxiety that shows up in specific circumstances, and it’s under the umbrella of social anxiety,” explains Sarah Campbell, a clinical psychologist and affiliated assistant professor with the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine.

Though the Diagnostic and Statistical Manual of Mental Disorders, a publication of the American Psychiatric Association that classifies psychological conditions, generally considers performance anxiety to be mostly restricted to public performance settings, Campbell explains that in common conversation, other situations where your performance might be judged can also apply.

“Performance anxiety often shows up when an individual believes that other people are evaluating their behavior and that a particular outcome is expected of them,” she says. “For instance, someone could have performance anxiety at work, playing sports, during physical intimacy, parallel parking, playing an instrument, at a karaoke bar — the list goes on.”

And even seemingly benign acts like chatting up new people (special shout-out to those especially painful “networking events”) and eating and drinking in front of others can be triggering for some.

Signs you're experiencing performance anxiety

When it comes to performance anxiety, there are three areas where you may be affected.

Your thoughts: 
When it comes to thoughts, if you’re experiencing performance anxiety you are very preoccupied with what you believe others are thinking about you. You’re also excessively concerned about being negatively evaluated. “People may believe that the stakes of performing well or not are very high, and that the consequences of ‘not performing well’ are really serious, though they usually aren't," says Campbell.

Your emotions:
When it comes to emotions, your performance anxiety will make you feel anxious (duh), but you may also experience feelings of shame or low self-esteem.

Your behaviors:
Behaviorally, having performance anxiety can cause you to choose, over time, to engage less and less with the situations that cause anxiety. Which ironically, Campbell notes, means that your performance anxiety is likely to continue indefinitely if it’s not addressed.

Something else that’s important to know? Performance anxiety can cause physical symptoms which include:

• Sweating palms
• Increased heart rate
• Shortness of breath
• Dry mouth and tight throat
• Trembling hands, knees, lips and voice
• Nausea and upset stomach 

There’s hope for you still

Despite all that doom and gloom, there are ways to treat performance anxiety, with cognitive behavioral therapy (CBT) being one of the most tried and true methods.

"CBT has the strongest evidence base for overcoming performance anxiety,” says Campbell. “This often involves identifying what beliefs may be negatively impacting a person in a situation, learning relaxation techniques, and then approaching the challenging situations while over time gathering information about how rarely — if ever — the feared outcome happens.”

Basically, it’s all about confronting your worst fears about what could go wrong and training yourself to chill out and understand that people probably aren’t judging you, and if they are, it’s not the end of the world.

Campbell also emphasizes how helpful mindfulness and grounding strategies can be when it comes to dealing with performance anxiety. Some examples of CBT, mindfulness, and grounding strategies might be:

• If you’re presenting to a crowd of people, try redirecting your attention from the facial expression of the person in the front row and instead focus on the feeling of your hands on the podium.
• If you’re having sexual performance anxiety, it can be helpful to try to move your attention from the dialog in your head to the feelings of what’s actually happening in your body.
• Competing in a sport? Try some positive self-talk before the big game, focusing on how hard you’ve practiced and how well you know you’re going to do — you can also listen to some calming tunes in your earbuds to soothe your nerves before competing.

Trying your hand at other relaxation techniques like meditation, yoga and controlled breathing can also be helpful when you want to quiet your mind and redirect your negative thoughts and emotions. And, just think, if you practice every day, you’ll have the tools you need, when you need them most.

Are beta blockers helpful?

Curious about how beta blockers might help? Beta blockers are medicines that lower your blood pressure and help block the effects of adrenaline — which means your heart will beat more slowly. Plus, they help widen the veins to improve the flow of blood in your body.

Campbell notes that propranolol (the most common one) does lower blood pressure and can reduce some of the physiological sensations of anxiety — but it might not be helpful in situations when you want an elevated heart rate, like during sex or while you’re exercising.

The best course of action? Speak with your doctor if you’re concerned that you have performance anxiety and if you feel like it’s taking a toll on your life and happiness. They will help you figure out solutions and hopefully get you back to rockin’ out to “Sweet Child O’ Mine” in front of the crowd in no time.