Your heart hammers inside your throat. It feels like you have to think about every breath you take. No matter how many times you dry them, your palms are wet and cold.
If this experience sounds familiar to you, then you've probably experienced stage fright – and you're not alone.
Prue Leith, South African chef, restaurateur, and television personality, found herself face-to-face with stage fright for the first time in her career when she launched a live show.
“Nothing prepared me for the horror of stage fright,” she wrote for the Daily Mail, “My heart seems to ricochet from my chest to my throat; my mouth is dry; my hands are shaking; and my mind goes completely blank.”
She recalls feeling so frightened on stage that it was as if she couldn’t breathe. She wanted to quit, but knew she made a commitment. She wondered how she was going to get comfortable on stage for the next two months.
“Given I could barely speak for terror, I persuaded my doctor to give me propranolol pills, a type of beta blocker, to calm my heart,” she explained.
The calming effects of propranolol let Leith not only finish her tour, but let her “fly through the performance, and walk out on cloud nine.” She says she still feels some nervousness, but doesn’t feel nearly as terrified.
Leith is just one of many performers who have openly discussed their performance anxiety. Among musicians, performance anxiety impacts anywhere from 16.5% and 60%, depending on the study conducted. In the general population, some estimates say performance anxiety affects 40% of people.
Of those, an estimated 36.9% of adults in the US with anxiety disorders seek treatment. One particularly effective treatment for anxiety, as Prue learned, is beta blockers.
The calming effects of propranolol let Leith not only finish her tour, but let her “fly through the performance, and walk out on cloud nine.”
What are beta blockers?
Beta-blockers are a class of drugs used to treat conditions such as hypertension, arrhythmia, angina, and others including anxiety and migraines. They’re among the most widely prescribed drugs in the world.
Propranolol, which is the type of beta blocker Leith was prescribed, alleviates the physical symptoms of anxiety by blocking adrenaline to decrease heart activity and lower blood pressure. This includes those unsettling feelings like shakiness, rapid heart rate, and sweaty armpits.
Note, however, that beta blockers can only treat the physical manifestations of anxiety. To be effective for the long term, they should be combined with cognitive behavioral therapy (CBT) under the guidance of a licensed mental health care professional.
When used as needed for one-off performances, beta blockers can settle nerves for even the biggest stadium crowds. Katy Perry and Shawn Mendes are two other well-known celebrities that use beta blockers, and together with Prue, are just a few among the many in Hollywood who have benefited from them.
Of course, wanting to perform with less stress isn’t reserved just for musicians and celebrities. Beta blockers like propranolol have been prescribed to relieve public speaking anxiety and used alongside exposure or CBT to help social anxiety and certain phobias in day-to-day life.
How beta blockers help with anxiety
Beta blockers effectively alleviate the physical symptoms of anxiety by blocking adrenaline and similar fight-or-flight hormones from affecting your cardiovascular system. This helps you remain calm and maintain focus during your performance.
Our hearts have two clinically significant types of beta receptors that receive messages from stress-related hormones, such as norepinephrine and epinephrine (also known as adrenaline). Beta-blockers do as their name suggests— they block the adrenaline from binding to those receptors and slow the rate and intensity of the heartbeat.
Propranolol is a non-selective beta blocker, which means it blocks both beta 1 and beta 2 receptors. Beta 1 receptors are found primarily in the heart; beta 2 receptors are present in the lungs, smooth muscle, and GI tract. When taking propranolol or other non-selective beta blockers, blood pressure and heart rate decrease.
Beta blockers are prescribed “as needed” for anxiety and, regardless of type, are typically well tolerated. However, as with any medication, beta blockers may not be for everyone and some people may experience more noticeable side effects.
While beta blockers can be and are sometimes prescribed long term for managing anxiety, they’re best used as a short-term treatment for those big moments in life. For longer term results, medication should be combined with CBT to treat the underlying cause of the symptoms.
How Kick can help you treat performance anxiety
Anxiety affects over 40 million adults in the US, making it the most common mental illness. If you or someone you know struggles with anxiety, there are medications and therapies available and ready to provide relief.
At Kick, our doctors prescribe either propranolol or atenolol, depending on your personal circumstances. Learn more about your risk-free options with our doctors here.