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

Toastmasters for public speaking (Malaysia) Click Here

What is morning after pill?

Since I worked in the pharmacy, for the past 11 years, there are so many questions on morning after pills (emergency oral contraceptive pills). I believe it would be easier to simplify everything in questions and answers format as below. Hope it is clear enough to clear my patients’ and readers’ doubts ^_^!

Don't feel embarrassed to consult your pharmacist. Morning after pills is actually very common in Malaysia.

What is morning after pill?

Levonogestrel pills, in layman term emergency contraceptive pills, including the brands POSTINOR TABLET 2’s and ESCAPELLE TABLET 1’s. They are up to 89% effective when taken within 72 hours (three days) after unprotected sex. They continue to reduce the risk of pregnancy up to 120 hours (five days) after unprotected sex, but they are less effective as time passes.

How does Levonorgestrel Tablet work?

Levonorgestrel Tablet is one pill with Levonorgestrel, a hormone that has been used in many birth control pills for over 35 years. Levonorgestrel Tablet contains a higher dose of Levonorgestrel than birth control pills, but works in a similar way to prevent pregnancy. It works mainly by stopping the release of an egg from the ovary. It is possible that Levonorgestrel Tablet may also work by preventing fertilization of an egg (the uniting of sperm with the egg) or by preventing attachment (implantation) to the uterus (womb).

How effective is Levonorgestrel Tablet?

The sooner you take Levonorgestrel Tablet, the better it will work. Take Levonorgestrel Tablet as soon as possible after unprotected sex. If it is taken as soon as possible within 72 hours (3 days) after unprotected sex, it will significantly decrease the chance that you will get pregnant. 7 out of every 8 women who would have gotten pregnant will not become pregnant.

How will I know if Levonorgestrel Tablet worked?

Most women will have their next menstrual period at the expected time or within a week of the expected time. If your menstrual period is delayed beyond 1 week, you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional.

What if I am already pregnant and use Levonorgestrel Tablet?

There is no medical evidence that Levonorgestrel Tablet would harm a developing baby. If you take Levonorgestrel Tablet (accidentally) after you are already pregnant or it does not work and you become pregnant, it is not likely to cause any harm to you or your pregnancy. The pregnancy will continue. Levonorgestrel Tablet will not work if you are already pregnant.

What should I do if my menstrual period is delayed beyond 1 week and I have severe lower stomach (abdominal) pain?

If you have severe lower stomach (abdominal) pain about 3 to 5 weeks after taking Levonorgestrel Tablet, you may have a pregnancy outside the uterus, which is called a tubal pregnancy. A tubal pregnancy requires immediate medical treatment, so you should see a healthcare professional immediately!!

However, morning after pills cannot be taken more than 2 times in a month. It has been reported with many unwanted side-effects. Please consult your pharmacist for other safer and more effective alternative for long term use.

Chinese Fine Dining Experience @ The Mandarin Hotel, KLCC (NON-HALAL)

There is a Chinese restaurant named Han Li Heen 丽宝轩 inside the The Mandarin Hotel, KLCC. Sound a bit funny to say that this was our first fine-dining experience in a Chinese restaurant inside the 5* hotel. We would say it was indeed a memorable FINE-DINING experience ^_^..

External view of the Han Li Heen 丽宝轩 Chinese Restaurant. As expected, it looks elegance, luxury and high class; In short, exactly the 5-star hotel restaurant look.

Internal of the restaurant is very conducive with the luxury and elegance feel. The soft traditional Chinese music makes the environment even more comfortable. If you scrutinize, the kitchen is right in front (with full glass panel).There were about 20 chefs inside busy preparing the dishes.

Our first dish - Appetizer - Sweet and sour fried anchovies. RM0.

The condiments - Chili sauce, preserved green chilies, chili belacan and soy sauce (at generous amount) were found on each dining table for the clients to enhance the flavor of their dishes.

Chef's specialty - Imperial hot and sour szechuan soup with prawns. 宫庭虾球酸辣羹。 A few pieces of big prawns were found inside. This soup tasted really nice until we need to ask for extra rice. RM42 nett.

Vegetarian dish - Steamed bean curd with mushrooms and vegetables. 碧禄翡翠滑豆腐。 This dish seems like a mixed vegetable for us with the silky smooth tofu hidden beneath. RM38 nett.

Chef's specialty - Jasmine tea leaf smoked free range chicken (half chicken). 茶香烤鸡。 This is the best chicken we ever tried. The chicken meat is succulent, juicy inside with Jasmine fragrance and bouncy chicken skin outside. They were really good at controlling their flavorings, it tasted just nice, without over-dosing of salts and soy sauce. Thumbs up for this dish! RM90 nett.

Ginger and spring onion dip to go together with the chicken. We love this very much!!

Fragrance steamed white rice @ RM4.25 nett/bowl.

The bill...RM189.30 for the Chinese fine-dining experience in 5-Star Hotel.

Overall, it was a great experience. The dishes served were very fine (the chicken were served without the bones), the food ingredients used were at the highest grade and the taste was excellent. We will definitely come back again one day for their dim sum. It seems like a must order dish in this restaurant as every table would order at least 3 plates of the dim sum (according to my 1 hour of observation there ^_^).

KLCCP AGM

KLCCP AGM was held in The Mandarin Hotel, Kuala Lumpur on 13^th April 2016. The meeting started at 10.30am sharp. As usual, many senior citizens appeared as early as 8.30am, and the buffet breakfast was finished before 10am.

The board of directors.

Youngsters spotted in the AGM. Sort of surprising as KLCCP AGM had attracted quite a bunch of young people ^_^.

Free flow of hot coffee and tea.

Free flow of iced water as well.

Heard the director said that there were about 1900 shareholders and 700 proxies attended this AGM. But it seems like there was only about 200 people inside the hall.

It was quite worrying to know that The Mandarin Hotel occupancy rate was 48% for year 2015. And they are looking to for new tenants to set up office at Menara Exxonmobil after the main occupant i.e. US oil giant Exxonmobil decided that it won’t be taking up the whole building anymore under a new long-term lease agreement. However, I am still confident with this 1^st and only stapled REIT in Malaysia. Hopefully, it can perform even better and offer better yield this year!

** CLICK HERE to find out how we used the door-gift **