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Performance Anxiety & Public Speaking

Performance anxiety, also known as stage fright, is a type of social anxiety disorder characterized by an intense fear of being scrutinized, judged, or negatively evaluated during public or performance-oriented situations.

What is Performance Anxiety & Public Speaking?

Performance Anxiety, also known as stage fright, is a type of social anxiety disorder characterized by an intense fear of being scrutinized, judged, or negatively evaluated during public or performance-oriented situations. Public speaking, a common scenario triggering performance anxiety, involves addressing an audience, whether large or small and delivering a speech or presentation.

Individuals experiencing performance anxiety often feel a heightened sense of self-consciousness and fear that they will make mistakes or be perceived negatively by others. This anxiety can manifest both physically and psychologically, impacting the individual’s ability to perform optimally in a given situation. While some level of nervousness is normal before a performance, performance anxiety goes beyond typical pre-event jitters, leading to significant distress and impairment.

Public speaking, in particular, can evoke fear due to the perceived pressure to present oneself eloquently and persuasively. The fear of forgetting lines, stumbling over words, or facing an unresponsive audience can contribute to heightened anxiety. Performance anxiety can affect individuals across various domains, including public speaking engagements, musical performances, athletic competitions, or even everyday activities where one feels subject to evaluation.

Treatment for Performance Anxiety & Public Speaking

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a highly effective approach for addressing performance anxiety and fear of public speaking, helping individuals develop confidence, manage stress, and perform at their best in high-pressure situations. At Light On Anxiety, our specialized therapists offer compassionate and evidence-based care tailored to the unique needs of individuals struggling with performance anxiety.

In CBT sessions, clients learn to identify and challenge maladaptive thought patterns and beliefs related to performance, such as catastrophic thinking and negative self-talk. They also develop skills to manage physical symptoms of anxiety, such as rapid heartbeat and sweating, through relaxation techniques and controlled breathing exercises. By learning to reframe their thoughts, build resilience, and practice exposure to feared situations, individuals can gradually overcome their performance anxiety and improve their performance outcomes.

Through personalized therapy sessions and supportive guidance, we empower clients to thrive in their professional and personal pursuits.


Medication may be considered in the treatment of performance anxiety, public speaking anxiety, and generalized anxiety symptoms, particularly for individuals experiencing moderate to severe distress or impairment in functioning. At Light On Anxiety, our team of psychiatric providers collaborates closely with clients to assess their unique needs and develop personalized medication regimens.

Beta-blockers such as propranolol are commonly prescribed to target physical symptoms of anxiety, such as trembling and rapid heartbeat, that often accompany performance anxiety and public speaking anxiety. Additionally, medications such as selective serotonin reuptake inhibitors (SSRIs) may be used to reduce overall anxiety symptoms and promote relaxation.

Our approach to medication management prioritizes safety, efficacy, and collaboration with clients to ensure they receive the most appropriate treatment for their symptoms while minimizing potential side effects.

Integrating CBT + Medication

A combined approach of therapy, including CBT, and medication management may provide the most comprehensive treatment for performance anxiety, public speaking anxiety, and generalized anxiety symptoms. At Light On Anxiety, we offer integrated treatment plans that address both the psychological and physiological aspects of anxiety.

Our therapists and psychiatric providers work closely together with clients to tailor treatment plans to their individual needs and preferences.

  • CBT helps individuals develop coping skills, challenge negative thoughts, and build confidence in performance situations.
  • Medication management targets symptoms of anxiety, providing additional support and relief.

Through this combined approach, we empower clients to overcome their anxiety, enhance their performance outcomes, and cultivate greater resilience and well-being in their professional and personal lives.

Your Unique Path to Freedom From Performance Anxiety 

Our goal is to create a treatment plan that aligns with your needs and preferences, recognizing that each individual’s journey is unique.

What are the symptoms of Performance Anxiety & Public Speaking?

Performance anxiety, particularly in the context of public speaking, can manifest through various symptoms. While specific symptoms can vary among individuals, common manifestations include:

  • Rapid heartbeat
  • Trembling or shaky hands
  • Sweating
  • Dry mouth
  • Nausea or stomach discomfort
  • Muscle tension
  • Shortness of breath
  • Racing thoughts
  • Difficulty concentrating
  • Negative self-talk
  • Fear of embarrassment or humiliation
  • Catastrophic thinking (imagining the worst-case scenarios)
  • Memory lapses or difficulty recalling information
  • Avoidance of public speaking opportunities
  • Frequent requests to speak later in a presentation or meeting
  • Fidgeting or pacing
  • Excessive use of filler words (e.g., “um,” “uh”)
  • Seeking reassurance from others
  • Difficulty maintaining eye contact with the audience
  • Intense nervousness or anxiety
  • Feelings of dread or panic
  • Preoccupation with the upcoming performance
  • Irritability or mood swings
  • Fear of being judged or evaluated negatively

FAQs about Performance Anxiety & Public Speaking

To manage an elevated heart rate during public speaking and reduce performance anxiety, consider the following strategies:

  1. Deep Breathing.
  2. Before speaking, visualize yourself delivering a successful presentation.
  3. Practice progressive muscle relaxation by gradually tensing and then releasing each muscle group, starting from your toes and working your way up to your head.
  4. Replace negative thoughts with positive affirmations. Remind yourself of your preparation and expertise on the topic. Focus on the message you want to convey rather than worrying about potential mistakes.
  5. Stay present in the moment by practicing mindfulness techniques. Pay attention to your breath, the sensations in your body, and the details of your surroundings. Mindfulness can help ground you and reduce anxiety.
  6. Reframe Anxiety as Excitement.
  7. Moderate Caffeine Intake Limit.
  8. Warm Up Your Body.

Yes, people with anxiety can do public speaking. It might be challenging, but with practice, support, and coping strategies, many individuals successfully manage and overcome their anxiety to speak in public.

Performance anxiety can manifest as an overwhelming sense of nervousness and fear before or during a performance, such as public speaking. Physically, individuals may experience trembling, sweating, a racing heart, and tension. Mentally, there’s often a fear of being judged or making mistakes, leading to self-doubt and heightened self-awareness. The mind may go blank, making it challenging to concentrate.

While performance anxiety and ADHD are distinct conditions, individuals with ADHD may be more susceptible to experiencing anxiety, including performance anxiety. The challenges associated with ADHD, such as difficulty focusing, impulsivity, and hyperactivity, can contribute to heightened stress in performance situations. However, it’s essential to recognize that not everyone with ADHD experiences performance anxiety, and anxiety can occur independently of ADHD.

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Learn more about how we can create a custom individual treatment plan to fit your goals.

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