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Author: Dr Muffazal RawalaConsultant Adult Psychiatrist

Feeling apprehensive before a performance, be it sporting, acting or public speaking is perfectly normal and something most, if not all of us, can relate to.

The anxiety becomes a problem when your career rests on those performances or when it begins to seriously impact on your quality of life.


What is performance anxiety?

Performance anxiety, to a degree, is a very useful set of emotions - triggering a ‘fight or flight’ response that prepares the body for the danger it perceives, making us more alert and ready to respond.

For many, these feelings naturally subside once the event is underway or shortly after and the feelings aren’t severe enough to stop the person from performing.

However, for some people, performance anxiety can be hugely limiting, preventing them from carrying out their job or engaging in activities that they love.

That is when performance anxiety becomes a problem and help should be sought.

Nothing is more devastating to a performing artist than not having the chance to be on stage and as the pervasiveness of performance anxiety attests – nothing is more threatening than having that chance


Symptoms of performance anxiety

Amazingly, 84% of American actors confessed to suffering from performance anxiety1 and when you look at the pressures many performers are under it is no wonder.

Professional performers dedicate their lives to their passion, spending long days rehearsing and honing their skills. They may feel under extreme pressure to excel by the public, their sponsors or themselves.

The common performance anxiety symptoms are:

  • Dreading the performance, worrying endlessly about it
  • Becoming numbed, distant and withdrawn
  • Trembling hands and voice
  • Sweating
  • Feeling sick or having stomach cramps
  • A racing pulse and pounding heart
  • Tightness in the throat which can hinder talking
  • A dry mouth

Perhaps because it is so normal to feel anxious before a performance, people with performance anxiety often do not seek help. They may feel embarrassed and that they should be able to cope. If their career is based around performing they may not want to make others aware of their condition for fear of public scrutiny or appearing ‘weak’ in front of others.

It’s often common for those with performance anxiety to resort to using drugs or alcohol to help them manage their symptoms and allow them to go on stage or perform. There are regular media stories about celebrities who have developed addictions to substances and one reason for this use, may be as a way of them dealing with the continued and extreme stress of knowing they have to perform night after night.

1Solovitch, J (2011)


Causes of performance anxiety

  1. A part of the brain called the amygdala is responsible for our fear function.
  2. The amygdala triggers a set of chemical reactions that results in adrenaline being released.
  3. The adrenaline is responsible for our heart rate soaring and gives us the dry mouth so common with performance anxiety and stage fright.

What is interesting is that performers can suffer with no symptoms and then seemingly, for no reason, begin to feel extremely nervous before a performance, which can have a serious impact on their ability to perform.
Often performance anxiety is started by one, relatively small, bad experience which the brain then ‘learns’ to be fearful of. A pattern of negative associations is formed which is incredibly hard to conquer.

When I met with the doctor they immediately put me at easy and made me feel sane. I have struggled with feelings that my fears are all in my head, I haven’t been able to talk to anyone else before meeting with the doctor. I now have a way forward and things are much better – I can finally enjoy what I love doing.

Louis, London


Treating Performance anxiety – talking therapies

For some people techniques such as pre-performance rituals, deep breathing and imagining their performance in a positive light can all be really helpful in overcoming nerves. For other people with severe performance anxiety, talking therapies and medication might be needed.

CBT (cognitive behavioural therapy), psychotherapy and counselling can all be really useful in understanding the root causes for the anxiety and fear. This can help give long term relief from the performance anxiety symptoms. Talking therapies can also help teach coping mechanisms as a way of handling the emotions when they arise. Click here to read more about talking therapies for anxiety.


Treating Performance anxiety – medication

Some people benefit from medications that help inhibit the impact of the adrenaline that is triggered, although others report that the medications affect the quality of their performance, turning them into ‘zombies’.

For some professionals taking medications could contravene rules and therefore is not an option they are willing to take. As medication only really controls the physical symptoms of performance anxiety, the sufferer is still left with the emotions of fear and dread.

It is really important to get a full and thorough assessment from a qualified clinician before taking any medications as there can be severe health implications for certain medications used. Click here to read more about medications used for anxiety.

Having worked with many people who have strong, overwhelming feelings of fear and anxiety, it is always rewarding when you see the daily impact finding the right treatment can have.
MBBS, MSc, MRCPsych

Consultant Adult Psychiatrist
London

Dr Muffazal Rawala is an experienced NHS Consultant Psychiatrist, currently working for East London NHS Foundation Trust. He has a Medical Degree, a Masters in Transcultural Mental Health, has a postgraduate certificate in Psychopharmacology and is a...

 

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