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Stage Fright—Causes, Symptoms, and Practical Solutions

Stage Fright—Causes, Symptoms, and Practical Solutions

Stage fright, sometimes called performance anxiety, is a common phenomenon that affects beginner performers and seasoned professionals alike. It’s typically accompanied by feelings of nervousness, fear, or anxiety before or during a performance in front of an audience. Whether you’re giving a speech at a public event, making a presentation at work, or participating in a sports competition, stage fright can affect your ability to deliver your best performance.

The excellent news is that with the appropriate strategies, you can cope with stage fright effectively. From gentle medications like beta-blockers to more engaging treatments like cognitive behavioral therapy (CBT), there are many ways to regain control and confidence while performing.

This article explains the causes, symptoms, and ways to overcome stage fright. 

Understanding Stage Fright—Basic Facts

Learning what stage fright entails can help you understand what its causes are and how to recognize it while helping you find the best way to manage it.

The issues to tackle are:

  1. What is stage fright?
  2. Why does your body react intensely to public performance?

What Is Stage Fright?

Stage fright is a complex mix of physiological and psychological responses that occur when an individual is required to perform in front of an audience. It’s characterized by nervousness and heightened anxiety. This state is typically triggered by the fear of negative evaluation rather than the physical presence of an audience.

Why Does Your Body React Intensely to Public Performance?

When we find ourselves in stressful situations, such as performing in front of an audience, our body’s natural response is “fight or run.” The reaction involves a series of physiological changes, primarily triggered by the release of adrenaline (also called epinephrine)—a hormone produced by our adrenal glands.

Adrenaline prepares our body for action. It increases our heart rate and blood pressure, dilates our pupils, and enhances our body’s ability to break down fats and sugars for energy. These changes are beneficial when we need to respond to a physical threat, but when the danger is merely perceived, such as in the case of stage fright, these changes can become overwhelming and cause the symptoms we associate with anxiety.

Source: cottonbro studio

What Causes Stage Fright?

The causes of stage fright are complex and vary among individuals. Five factors contributing to this condition are:

  1. Inadequate preparation
  2. Past negative experiences
  3. Perfectionism 
  4. Genetic factors
  5. Brain structure

Inadequate Preparation

If you don’t adequately prepare for a stage presentation, it can cause a heightened sense of fear and anxiety, resulting in the following:

  • Feeling lost on stage
  • Struggling to recall your material
  • Losing your train of thought

These may contribute to stage fright, making the experience more intimidating than it should be. 

Past Negative Experiences

Negative experiences from past performances can have a lasting impact on your perception of your abilities. They can create a fear of recurrence, intensifying the feelings of stage fright. For instance, if you previously forgot their lines during a performance, you may worry about repeating the same mistake, leading to anxiety and stage fright.


Perfectionism entails striving for flawlessness and setting extremely high standards for yourself. In the context of stage fright, perfectionism can be a double-edged sword. It can prompt you to prepare thoroughly for your performances but also induce the fear of not living up to these high standards, triggering anxiety and stage fright.

Perfectionists also fear making mistakes or being negatively evaluated by others, which may boost stage fright.

Genetic Factors

Research suggests that our genes may play a role in our susceptibility to anxiety disorders, including performance anxiety or stage fright. Certain genetic variations may make some people more sensitive to stress and cause them to have a heightened ‘fight or flight’ response when performing in front of others. 

Brain Structure

The structure and function of our brain also play a significant role in stage fright. The amygdala, the part of the brain that processes emotions, has been linked to anxiety disorders, including stage fright. When we’re in a stressful situation, the amygdala triggers the release of stress hormones and increases the heart rate, contributing to the symptoms of stage fright.

What Are the Symptoms of Stage Fright?

The symptoms of stage fright vary depending on several factors, but they typically fall into two categories:

  1. Physical symptoms
  2. Psychological symptoms

Physical Symptoms of Stage Fright

The physical symptoms of stage fright can be intense, typically mimicking the body’s ‘fight or flight’ response. You may experience the following:

  • Nausea
  • Dry mouth 
  • Sweating
  • Rapid heartbeat
  • Quivering voice
  • Shaking hands or knees

Psychological Symptoms of Stage Fright

The psychological stage fright symptoms can be more complex and challenging to recognize in the beginning, but they commonly entail:

  • Feelings of dread
  • Intense worry or panic
  • Negative self-talk
  • Fear of embarrassment or humiliation
  • Overthinking possible failure

These symptoms can significantly impact an individual’s ability to focus and perform effectively, sometimes causing panic attacks.

How To Overcome Stage Fright—Short-Term Strategies

Source: cottonbro studio

Depending on the specific factors contributing to stage fright, you can use short- or long-term strategies to address the issue. If you experience occasional situational anxiety, you can use these four non-pharmaceutical methods to cope with it:

  1. Deep breathing exercises
  2. Visualization techniques
  3. Progressive muscle relaxation
  4. Positive affirmations

Deep Breathing Exercises

Deep breathing, also called “box breathing” or “four-square breathing,” can help slow your heart rate and reduce feelings of anxiety. Concentrating on your breath can take your mind off the performance, improving your focus.

To use deep breathing to alleviate the symptoms of stage fright, follow these steps:

  1. Choose a comfortable position, sitting or lying down
  2. Inhale slowly and deeply through your nose for four seconds
  3. Hold your breath for four seconds
  4. Breathe the air out through your mouth for four seconds, releasing any tension in your body
  5. Wait for four seconds to lapse before taking another breath
  6. Continue this cycle for a few minutes or until you start to feel calmer

The more you practice this technique, the more effective it will be when you need it.

Visualization Techniques

Visualization involves mentally rehearsing your performance. It can be effective in reducing anxiety and building your confidence. To use this technique to overcome stage fright, follow these steps:

  1. Find a quiet place where you can focus without interruptions
  2. Visualize yourself on the stage, delivering your presentation successfully
  3. Try to include as many details as possible in your visualization, such as the venue, the audience, your speech, and your movements
  4. See yourself receiving applause from the audience
  5. Practice this visualization regularly to make the most out of it

Progressive Muscle Relaxation

Progressive muscle relaxation can help manage the physical symptoms of stage fright, like shaking hands or knees. To use this technique for combating performance anxiety, follow these steps:

  1. Sit or lie down in a comfortable and quiet place
  2. Close your hands into fists
  3. Tense the muscles in your hands as tightly as you can 
  4. Hold the tension and count to five
  5. Quickly release the tension in your hands and focus on the sensation of relaxation
  6. Allow your muscles to relax for about 15 seconds
  7. Repeat the process of tensing and relaxing other muscle groups in your body, including your arms, face, chest, stomach, back, thighs, legs, and feet

The goal isn’t to cause pain or discomfort but to become more aware of physical sensations and achieve a state of deep relaxation. With practice, you’ll become more skilled at noticing the difference between tension and relaxation and using this technique to reduce physical symptoms of stage fright.

Positive Affirmations

Positive affirmations can help you challenge and overcome self-sabotaging and negative thoughts that contribute to anxiety. Here are some guidelines for using this strategy:

  • Identify the negative thoughts or self-talk contributing to your stage fright
  • Create positive affirmations to counter these negative thoughts
  • Repeat these affirmations to yourself regularly, especially before and during the performance
  • Cultivate a positive mindset and trust your ability to deliver a successful performance

Positive affirmations are usually most effective when combined with other strategies for managing stage fright, such as rehearsing and deep breathing.

Source: Igreja Dimensao

Using Beta-Blockers To Overcome Stage Fright

You can use specific medications to cope with performance anxiety. If you don’t have generalized or social anxiety disorder, you can benefit from gentler drugs like beta-blockers to eliminate occasional stage fright.

These drugs suppress the release of adrenaline, reducing its impact on your body and alleviating the physical symptoms of situational anxiety.

Two beta-blockers commonly used for stage fright are: 

  1. Propranolol
  2. Atenolol 

Both medications are generally safe, but atenolol is typically recommended to individuals with asthma or respiratory issues since it has a minimal risk of affecting the airways when taken in small doses.

Learn more about these drugs from the table below:




Primarily indicated for

  • High blood pressure

  • Heart rhythm disorders

  • Heart or circulatory conditions

  • High blood pressure

  • Angina

  • Acute heart attack

Class of drug

Non-selective beta-blocker

Selective beta-blocker

Available doses

  1. 10 mg

  2. 20 mg

  3. 40 mg

  4. 60 mg

  5. 80 mg 

  6. 120 mg

  7. 160 mg

  1. 25 mg

  2. 50 mg

  3. 100 mg


  • Tablet

  • Extended-release capsule


Controlled substance



Brand name

  • Inderal

  • InnoPran XL

  • Hemangeol

  • Propranolol HCl Intensol


Suitable for children

Yes (only for FDA-approved conditions; don’t give it to children for performance anxiety)

Yes (only for approved conditions; don’t use it for performance anxiety)

Pregnancy category

C (risks can’t be disregarded)

D (consult your healthcare provider)

These medications were initially designed to treat heart conditions and high blood pressure, but studies suggest that they can be effective for performance anxiety, especially when administered in lower doses. For this reason, doctors typically prescribe them to individuals on specific occasions.

Beta-blockers are only available with your doctor’s prescription. Your healthcare provider will assess your health status and prescribe them only if the risks outweigh the benefits. 

While these medications can help, the use of beta-blockers for performance is still rather stigmatized, so most people may find it challenging to tell their doctors the specific reasons they need these drugs. The good news is that telemedicine platforms let you consult healthcare professionals discreetly and without additional stress. For example, Kick provides a secure and private environment where you can consult a doctor and get treatment tailored to your needs.

Kick—Convenient Solution for Stage Fright

Source: Brett Sayles

Kick offers a convenient solution for individuals dealing with stage fright or performance anxiety. Here’s how our performance anxiety program works:

  • You have a 10-minute online consultation where you brief us on your health status and anxiety issues
  • Our doctor prescribes the appropriate beta-blocker for you
  • If you have questions, you can reach out to your designated doctor anytime
  • If our team decides Kick isn’t the best solution for your specific issue, you don’t pay for the initial consultation, according to our Doctor Guarantee

Getting Started With Kick

To benefit from Kick’s program, follow these easy steps:

  1. Visit the signup page to start a brief consultation
  2. Complete the questionnaire to help us learn more about your specific issue
  3. Add your delivery and payment information

Your medication will be delivered to your home or local pharmacy in discreet packaging, making the procedure private and convenient.

Kick’s performance anxiety program has earned numerous positive reviews on Trustpilot, demonstrating its positive impact on the lives of our patients.

Source: Genie Music

Potential Side Effects of Beta-Blockers for Stage Fright

While beta-blockers can be effective for coping with stage fright, they carry the risk of side effects. Check out the table below for more information on the potential unwanted reactions:

Common Side Effects

Rare but Concerning Side Effects

  • Cold hands or feet

  • Dizziness or lightheadedness

  • Weight gain

  • Depression

  • Trouble sleeping

  • Shortness of breath

These lists aren’t exhaustive—inform your doctor if you experience unexplained body changes while on beta-blockers.

Long-Term Strategies for Overcoming Stage Fright

Even though beta-blockers can help with occasional stage fright, individuals with performance anxiety stemming from chronic generalized or social anxiety disorders may need stronger medications and therapy to manage these conditions.

Effective strategies for dealing with stage fright caused by chronic anxiety disorders include:

  1. Cognitive behavioral therapy
  2. Stronger medications
  3. Meaningful lifestyle changes
  4. Support groups

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) can be effective in managing anxiety disorders, including performance anxiety. CBT helps you identify and challenge negative thought patterns and behaviors that contribute to your anxiety.

Although this type of psychotherapy isn’t an instant solution, it typically brings excellent results. Over time, you can reduce your anxiety levels and improve your performance significantly.

Stronger Medications

In some cases, doctors may prescribe more potent medications—such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines—to individuals with severe anxiety disorders. 

These medications alter the balance of certain chemicals in your brain, alleviating the symptoms of anxiety.

You should use them under the supervision of a healthcare provider due to potential side effects and the risk of psychological dependence. They also give the best results when combined with psychotherapy.

Meaningful Lifestyle Changes

Lifestyle changes can play a crucial role in managing chronic performance anxiety. Some healthy habits to adopt include:

  • Exercising regularly
  • Maintaining a healthy diet
  • Getting adequate sleep

Stress management techniques, such as yoga or meditation, can also help reduce anxiety levels and improve your overall mental health.

Support Groups

Joining a support group can be helpful in managing performance anxiety. Sharing your experiences with others going through the same problem can provide comfort and reduce feelings of isolation. You can also get practical tips on effective ways to release performance-related stress.

Consult your doctor to determine the most appropriate treatment strategy for you. While these strategies can help manage the symptoms of stage fright, they may not eliminate it. But with the right approach, such as blending different methods, you can reduce its impact on your life and performance.

Emerging Trends—Using Technology To Overcome Stage Fright

Technology can be a valuable addition to a comprehensive approach to managing stage fright caused by chronic anxiety. You can consider the following options:

  • Virtual reality (VR)—VR technology can simulate environments where you can practice your presentations in various settings. It can help desensitize you to the fear of public speaking and improve your skills in a safe and controlled manner
  • Mobile apps—Some apps offer resources like guided meditation, breathing exercises, and cognitive behavioral therapy techniques
  • Telemedicine platforms—Telemedicine platforms like Kick provide a secure environment where you can consult healthcare professionals about sensitive issues like stage fright 

Before using any technology, conduct due diligence, including reading previous users’ testimonials, to determine if the resource is viable and effective.

Featured image source: ANTONI SHKRABA production