When is it time to try medication vs exposure, experience, and practice?
Recurring performance anxiety sucks
Heart beating. Face flushing. Palms sweating.
What do all of these things have in common?
For many people, performance anxiety is a secret struggle — hiding nerves from coworkers, colleagues, clients, and even sometimes family and friends.
One common treatment or method for overcoming nerves is exposure therapy — the more you do something, the easier it becomes.
This is why Toastmasters International is a globally successful organization. There are people all over the world who want to overcome performance anxiety and are willing to sign up, show up, and challenge their nerves.
But what do you do when Toastmasters is not enough?
When is it time to try medication instead of exposure, experience, and practice to beat the nerves?
For me, exposure therapy went well beyond attending a few Toastmasters meetings to beat performance anxiety.
My track record of public speaking practice grew long over more than 20 years of fighting to overcome nerves. This culminated in becoming a professional public speaker and writing an award-winning book on how to Flip the Fear of Public Speaking.
Over and over again, I would use exposure therapy to try and “overcome my nerves” before a large presentation.
My strategy included the following:
Ongoing informal Toastmasters practice at weekly meetings
Formal speech delivery at Toastmasters the week before any work presentation to “get into shape” and beat the nerves down
Hours of practice for any speech starting as early as possible (months, or at least weeks if possible)
A pre-speech “beat the nerves” routine, including acting warm-up exercises and power posing.
If this sounds extreme, it’s because it is.
I was terrified of showing nerves or performance anxiety in my formal work environment and went
to drastic lengths to prevent it from happening.
Did all of this work?
But it was also exhausting.
Especially when my career sometimes demanded multiple presentations per week.
And then there were the presentations that I couldn’t prepare for.
These were the worst — and because I wasn’t in control of when they would happen, I couldn’t prepare in the way that I wanted, and I lived in fear of them.
So, I tried propranolol for the first time
Propranolol is a beta-blocking drug. This means that it blocks certain chemicals in the body that are involved in the sympathetic nervous response, including:
controlling heart rhythm and preventing a “racing heart.”
preventing nervous sweating (palms, armpits, etc.)
preventing facial flushing (my biggest concern)
blocking feelings of performance anxiety resulting in a feeling of calm
Essentially, the effects are miraculous if you suffer from performance anxiety or nerves.
For me, I literally couldn’t believe how amazing it was to feel calm and under control of my body in a situation where I normally would feel panic and experience all of the symptoms above (racing heart, sweating, facial flushing, panic).
I couldn’t believe I had gone so many years without propranolol to help me fight my nerves.
And for a while, it was great.
Until it wasn't.
No miracle drug comes without a cost
In my case, the side effects I began experiencing started negatively affecting my life and led to depression.
I wrote about my experience in detail here:
Basically, what I learned was that I was using propranolol inappropriately.
It had become a professional and social crutch for me, and I increased my dose and usage to where I was taking it for any potential scenario where I thought I might experience anxiety.
As a result, I had many unpleasant physical and emotional side effects.
This kind of usage is inappropriate and likely why the FDA does not approve propranolol to treat performance anxiety.
Why I knew propranolol was wrong for me
After working with a clinical psychologist regarding anxiety, I learned that I needed an overall anxiety treatment, such as Zoloft, and not occasional support, such as propranolol.
Once I started taking a general anti-anxiety medication, things got a lot better — fast.
When I started taking something to treat the actual problem, it was incredible how the anxiety leveled out throughout my life — including a drastic decrease in performance anxiety.
And after literally 20 years of practicing the art of public speaking, suddenly, I was a professional speaker with tons of experience and less anxiety — amazing.
So, would I use propranolol again, or would I recommend it to someone who is currently struggling with performance anxiety?
First and foremost, I would recommend working with a clinical specialist to make a medically informed decision appropriate to your unique situation and medical history.
I can only offer general reasoning based on my own experience, which is limited to a case study of one.
However, here it is:
When propranolol might be helpful:
in cases of occasional performance anxiety — such as a wedding speech that will happen once and not again
for those who do not suffer from more generalized anxiety (another medication is likely more appropriate)
if there is no contraindication to taking a beta-blocking medication (discuss with a medical professional)
When anxiety might need a different approach:
If you feel anxious in many situations, including social situations, and not just the occasional presentation
if you have tried exposure therapy through Toastmasters or other practices and still experience a similar level of anxiety prior to public speaking or performing
if you are starting to experience negative self-talk, feelings of “failure,” or symptoms of depression related to performance anxiety
The bottom line
For me, years of excruciating work facing my nerves to overcome performance anxiety was both an exceptional gift to myself, as well as absolutely exhausting.
This is why propranolol came as such a miracle when I found it.
However, because I was not an appropriate candidate for long-term use, it ended up leading to depression and other negative physical side effects.
Do I regret it?
The learning I have from both going to the extreme to practice public speaking as well as from taking propranolol is absolutely invaluable.
As someone who knows the absolute panic that can come with performance anxiety and the relief from treatment with medication, I want to share now my experience with others who might be feeling the same.
If this article speaks to you, I encourage you to further work with a medical professional to explore the option of medication for generalized anxiety or performance anxiety.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
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