We have all experienced the butterflies, the sweaty palms, and the racing heartbeat that accompany challenges such as public speaking or performance, interviews, tests, and presentations. Nerves are a normal part of life and often accompany occasions in which we are doing something risky or outside of our comfort zone. Nervousness is normal response to certain activities, particularly those which may involve a level of judgment, such as giving a speech or going on a date; a level of danger, such a bungee jumping, or learning to drive; or something potentially painful, such as the dentist or receiving an injection. However, for some people, nerves, and mild discomfort tips over into anxiety. When there is a level of judgment involved, this is usually called performance anxiety, known colloquially as ‘stage fright’.

Performance anxiety has been classed by the Diagnostic and Statistical Manual of Mental Disorders −5 (DSM-5) as a form of social anxiety and it can present as negative thoughts and feelings, including catastrophising, worrying about mistakes, fear of being judged, a sense of shame, and feelings of worthlessness. In addition, sufferers can be affected by an array of physiological signs, including fidgeting, nail biting, talking faster and/or louder, as well as more serious signs such as increased heart rate, shaking, dry mouth, sweating and high blood pressure.

Performance anxiety doesn’t just impact a person mentally, emotionally, and physiologically, but often the way they behave too. Notably, sufferers may choose to avoid activities which cause performance anxiety. This can have a huge effect on a person’s life, leading them to avoid activities which may be a fundamental part of their work or social life. Avoiding work or socially related activities can result in lack of promotion, loss of respect, loss of opportunity and even loss of the job itself. Performance anxiety itself can reduce wellbeing, but the result of suffering from it can be devastating.

Again, it is important to remember that anxiety is a natural and important part of being human as it serves to alert us to dangers. When we encounter a life threatening danger, anxiety kick starts the adrenaline which is necessary to act fast and run away. Adrenaline, also known as epinephrine, the stress hormone, is created in your adrenal glands. Adrenaline causes blood to rush into your major muscle groups making you feel stronger and more focused. Depending on the context, this can feel either exciting or nerve wracking, or even a combination of both. Unfortunately, the human brain perceives threats in the same way, whether they are life threatening or not. Whilst adrenaline can optimise performance, make us braver and can distract us from pain to a certain point, too much anxiety can also cause us to over respond to situations which are not life threatening in any way.

A willingness to experience nervousness can allow us to expand our horizons, engage in new, albeit nerve-wracking, experiences, and can help us to fulfil our potential, and reach goals. Avoidance of situations which make us feel nervous (experiential avoidance), can result in lowered self-esteem, self-doubt, less confidence and can prevent us from fulfilling our potential. The key is to focus on how great it will feel to accomplish goals, whilst recognising that mild discomfort can be a normal part of striving to achieve. Ask any person who has achieved a big goal, and they will likely tell you there were times on their journey when they were bored, nervous, tired, and lacking in skills and comprehension. Having the resilience to push through these times is what enables us to optimise our potential.

So, whilst nerves can be beneficial for performance, there is a tipping point at which they can become problematic. Performance anxiety has a detrimental effect on performance and some form of treatment or coaching strategy may be necessary to help overcome the effects. There is a plethora of treatments for performance anxiety. The gold standard of treatment is Cognitive-Behavioural Therapy (CBT) which research has shown to be an effective treatment for performance anxiety. CBT operates on the principle that our thoughts, feelings, and behaviours are interconnected and that uncomfortable feelings are a result of a sufferer’s perspective of an event. By changing thoughts and reframing perspective the sufferer can eliminate uncomfortable feelings.

Pharmacological treatments, such as Beta-Blockers, have been shown to work well in reducing the symptoms of performance anxiety. Beta Blockers can provide almost instantaneous relief; however, they can impair performance due to the potential for dry mouth, dizziness, and the reduction of circulation to hands and feet. This is less than ideal when treating performance anxiety in singers and musicians, as well as anyone else who needs to use their hands or voices. In addition, lowered ability can negatively impact the performance, increasing a sense of shame and self-doubt and increasing performance anxiety.

Acceptance Commitment Therapy (ACT, said as one word), has also been shown by research to be successful as a treatment for performance anxiety. The core theory of ACT is that trying to avoid uncomfortable feelings is the issue, not the thoughts and feelings themselves. ACT aims to reduce anxiety by helping people to accept challenging thoughts and feelings, and understand that they are transitory, rather than trying to avoid or fight them. This is because when we try too hard to avoid feeling bad, it actually makes things worse. Instead, ACT seeks to enhance psychological flexibility: the ability to be present, whilst accepting experiences and acting in accordance with values (Harris, 2009).

In addition to the above strategies, there is an abundance of alternative therapies which can help you with performance anxiety: including hypnotherapy, yoga, meditation, music therapy, progressive muscle relaxation, and guided imagery.

In the meantime, here are some techniques for you to try:

Being Present: Learning to focus on the here and now, rather than getting caught up in worries about the past or future can help with anxious thoughts.

• Exercise: Find a quiet, comfortable place to sit or lie down, close your eyes, and focus on your breath, body sensations, and surroundings to cultivate present moment awareness. Practice bringing your attention back to the present whenever your mind wanders and carry this mindfulness with you throughout your day to manage worries about the past or future.

Defusion: Finding ways to gain distance from troublesome thoughts, can prevent anxiety inducing thoughts from wielding their power.

• Exercise: Practice labelling troubling thoughts as “just thoughts” without engaging with their content. Then, shift your focus to engaging in a meaningful activity aligned with your values, regardless of the presence of those thoughts.

Acceptance: Be okay with whatever thoughts and feelings come up, without judging them as good or bad.

• Exercise: Take a few moments to simply observe your thoughts and feelings as they arise, without attaching any labels of “good” or “bad” to them. Remind yourself that thoughts and feelings are natural and transient experiences, and practice allowing them to come and go without judgment.

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Please note that the information in this blog is intended for informational purposes only. It should not be used as a substitute for psychological or medical care.