Performance Anxiety: How to ease exam anxiety and stage fright?

“I hear the thud of my foot tapping. I’m aware of my chest pounding, a lump in my throat, and heat rising from my face. Everyone is watching me, waiting for me to make a mistake.”

“Why can’t I stop my hand from trembling?”

“Why my palms are sweating profusely?”

“My mind goes blank, and I don’t know how to answer my exam questions!”

Many patients come to pharmacy to ask about medication for performance anxiety especially students who encounter exam anxiety and some working adults who are facing stage fright.

What is performance anxiety?

Stage fright or exam anxiety or performance anxiety is the anxiety, fear, or persistent phobia which may be aroused in an individual by the requirement to perform in front of the audiences or during exam. 85% of the population experiences discomfort about public speaking and exam, however, this anxiety does not impair most people’s ability to function.

What are the symptoms of performance anxiety?

Typical symptoms of performance anxiety.

What is the medication usually prescribed?

Medicine is the fastest way to treat performance anxiety. Propranolol, 10 mg about 1 hour before the performance, is most often prescribed. Before prescribing a beta blocker, evaluate the patient’s medical history and cardiovascular status, including blood pressure and pulse have to be evaluated by doctor. This is essential to check for side effects and tolerability towards the medicine.

Many drugs can be prescribed to treat anxiety. However, proper patient's health evaluation tests have to be done before deciding the most suitable medicine. Please consult your doctor or pharmacist for more information.

What are the other treatment choices?

Drugs are actually not recommended for long term use. Hence, many PSYCHOTHERAPY OPTIONS are suggested to treat performance anxiety.

1. Exposure therapy can help individuals face feared activities so that counter-conditioning through habituation and extinction can safely occur. Useful strategies are imagination, role play, confrontation, videotaping, and homework assignments.

Experiencing anxiety is a component of exposure therapy. Thus, some clinicians avoid using concomitant medication that might decrease anxiety’s physical symptoms and interfere with the exposure process. 

2. Relaxation training can help the patient recognize and respond to autonomic and physical arousal during a performance. For example, progressive muscle relaxation can be practiced first in session and then as homework.

3. Social skills training can help patients identify and change anxiety behaviors that cause negative audience reactions. Tools to help direct the patient towards more appropriate behaviors include modeling, behavior rehearsal, corrective feedback, social reinforcement, and homework assignments such as videotaping performances. For public speaking anxiety, vocal and physical skills training and computerized virtual reality courses can help.

4. Other related resources

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