Performance Anxiety: Symptoms, Causes & Treatments

You’ve got a sales presentation, a wedding speech or an interview coming up. But all you can think about is that knot in your stomach. While some nerves are natural, performance anxiety, or stage fright, can make events like these feel impossible.

Your anxiety around these situations can start to take over your life. You may even try to avoid them altogether and end up getting stuck in an anxiety cycle. 

Performance anxiety doesn’t just affect you once, either. When one nerve-wracking event is over, your brain fixates on the next one. And, of course, there’s always a next one. 

We’ll go over the symptoms, causes and treatments for performance anxiety to help you navigate the issue and potentially find a solution.

Performance anxiety is exactly what it sounds like: anxiety about a performance. 

Also known as stage fright or stage anxiety, you might experience it before a meeting, presentation, speech, interview or any situation where you have to “perform” in front of an audience. 

And it’s more than simple butterflies. Performance anxiety is a diagnosable mental disorder. You might experience out-of-proportion anxiety compared to the event, have an intense fear of being judged or feel deeply worried you’ll embarrass yourself. 

Those with performance anxiety may suffer through events with extreme anxiety or avoid events that trigger it altogether. 

Think that’s you? What you’re feeling may be performance anxiety if it can’t be attributed to medication, a medical condition or another mental health issue like panic disorder.

Performance anxiety is a part of social anxiety disorder or social phobia. But instead of feeling anxiety in any social situation, it only manifests when you’re talking or performing in front of people.

Fear of public speaking — known as glossophobia — is arguably the most common type of performance anxiety. We don’t know exactly what the prevalence of this type of performance anxiety is, but some research suggests a whopping 75 percent of people experience glossophobia.

It’s not just talking in front of people that triggers performance anxiety, though. You might get it leading up to a sports game, an open mic night or even before getting it on with a new partner.

What causes performance anxiety, exactly? A lack of self-confidence can be to blame, and the symptoms of the condition can make it worse. More on those next. 

Performance anxiety symptoms include:

• Blushing

• Sweating

• Trembling

• High heart rate 

• Your mind going blank 

• Nausea 

• Rigid body posture 

• Feeling self-conscious 

• Fear people will judge you negatively 

• Finding it hard to make eye contact

• Speaking in an overly soft voice 

• Dry mouth 

• Anxiety chills 

If you get sexual performance anxiety, you might experience lowered arousal or lubrication. And guys can experience erectile dysfunction or premature ejaculation. 

You may experience a mix of both mental and physical symptoms of anxiety. And some physical symptoms can make your anxiety worse, creating a vicious circle. Anyone who’s ever worried about anxiety-induced sweat patches while leading a staff meeting can attest to that.

There are many ways to deal with performance anxiety. They range from at-home exercises like meditation and self-soothing techniques to professional help and medication.

Let’s dive into them. 

Meditation 

Meditation can help lower stress and ease anxiety symptoms, and research shows it can help with stage anxiety, in particular.

A small 2006 study looked at how Zen meditation could help musicians. One group did eight weeks of meditation while a control group did nothing. At the end of the experiment, participants performed in a concert. 

The group who had been meditating had less performance anxiety and gave better musical performances — a win-win. 

Try scheduling a short meditation session every day where you relax and focus on your breathing. You can also try meditating before a triggering event to help reduce anxiety in the moment.

Coping Skills 

There are some key coping skills you can focus on to help fix performance anxiety — or at least stop it from controlling your life so much. 

These healthy coping mechanisms include: 

• Reframing your emotions. Your emotions are most likely out of proportion to the event. For example, even if a presentation goes badly, your boss (probably) won’t hate you, you’ll keep your job and you’ll have a chance to redeem yourself. Remind yourself of this to calm those negative thoughts. 

• Practicing self-care. Don’t forget to look after your health and well-being. Get enough shut-eye, eat your veggies and make time for fun and friends. A happy and healthy you will perform better, whether you have anxiety or not. 

• Prioritizing exercise. Research shows regular exercise is linked to better emotional resilience in stressful situations. But you don’t need to sign up for a marathon just yet. Even a daily 30-minute walk is enough to boost your mood.

Relaxation Techniques 

Relaxation techniques can help you relax — hence the name — and keep your anxiety in check when you experience performance anxiety. 

Relaxation techniques include:

• Progressive muscle relaxation

• 4-7-8 breathing

• Box breathing 

• Guided imagery 

Like meditation, you can practice relaxation techniques in your day-to-day life, as well as before a panic-inducing performance, to reduce your symptoms.

Sound a bit out-there for you? Science backs us up. 

A 2015 study looked at 62 teens who did three solo musical performances in front of judges. *Gulp.*

One group took part in an eight-week cognitive behavioral program that included relaxation techniques, goal-setting and visualization. Another group acted as the control group and did nothing — except stress over those performances, we’re sure.  

The study concluded the cognitive behavioral group program was effective at reducing performance anxiety.

Self-Soothing Techniques 

In high-stress moments — think the night before a presentation — you can turn to self-soothing techniques to keep your anxiety under control. 

Self-soothing techniques include: 

• Journaling 

• Deep breathing 

• Positive affirmations 

• Mindfulness meditation

• Calming touch

You can learn more about how to self-soothe anxiety in our blog.

You can also turn to natural remedies for anxiety, such as chamomile, valerian root or lavender oil.

Cannabidiol (CBD) is another option. A 2011 study found that a single dose of CBD helped those with generalized social anxiety disorder (GAD) perform better on a simulated public speaking test.

Participants who took CBD experienced less anxiety, cognitive impairment and discomfort during their speeches compared to the control group, who didn’t take CBD.

Cognitive Behavioral Therapy 

Cognitive behavioral therapy (CBT) is a type of psychotherapy designed to change the way you think, behave and react in certain situations.  

One CBT method you might have heard of is exposure therapy. It involves exposing yourself to the thing you’re scared of and confronting your fears head-on. 

Ever had a friend who’s afraid of public speaking suddenly sign up to do stand-up comedy? They might be trying exposure therapy — and they might be onto something. 

A 2023 study found that repeated stage exposure helped lower heart rate, reduce restlessness and minimize playing errors in string players with music performance anxiety. A 2020 paper states it may help with sexual problems relating to performance anxiety too. 

CBT is available in group therapy, one-on-one sessions or through online therapy. 

Another similar option is acceptance and commitment therapy (ACT), which includes techniques like mindfulness and goal-setting.

Beta-Blockers for Performance Anxiety 

When it comes to medication, beta-blockers are a common treatment for performance anxiety. They can reduce the physical symptoms of the disorder, including rapid heart rate, sweating and tremors.  

Propranolol is a type of beta-blocker prescribed off-label for performance anxiety. And the research behind it is promising. 

A 2015 systematic review and meta-analysis highlighted studies showing propranolol can help those with exam nerves and performance anxiety — specifically musicians and surgeons.

Propranolol side effects do exist, though. They range from drowsiness and abdominal pain to nausea and gastrointestinal issues — not exactly what you want before a big client meeting.

Seek medical advice if you’re interested in beta-blockers. Beta-blockers should only be taken under the guidance of a healthcare professional and not self-prescribed.

Palms sweaty? Knees weak? Arms heavy? (Vomit on your sweater already, Mom’s spaghetti). Ahem. You might have performance anxiety.

Here’s what to keep in mind:

• Performance anxiety doesn’t just affect performers. It can strike whenever you have to talk in front of people — like during a meeting, presentation, interview or speech of any kind.

• Symptoms of performance anxiety can be mental and physical. They include sweating, nausea, a pounding heart and your mind going blank. 

• You don’t have to live with performance anxiety. Performance anxiety treatments include meditation, CBT and beta-blockers like propranolol.

Need help dealing with performance anxiety? Connect with one of our online psychiatry professionals who can prescribe propranolol, or check out our mental health services like online therapy.