Fear of Speaking in Public: After Imagining Everyone Naked


If you’re like 90% of the population, you will feel anxious when speaking in front of an audience. Knowing almost every one has some type of performance anxiety doesn’t make it better. Why is that? I don’t know. But I do know the things that do work from my 25 years of clinical practice as a psychologist. I’ll start with the common symptoms, then move to the two most effective approaches for this condition. First, let’s see if you really have it.

Physical Symptoms of Performance Anxiety: Heart palpitations, sweating, shaking, blushing, It may also take other forms of nervousness; such as upset stomach, nausea, chills/hot flashes, but I’ll stick to the major players here. The symptoms happen as soon as you hear you’re going to have to hit the stage,

“Hi. We need you to give a _________ (speech, service, talk, briefing) on ___________(topic) in an ________ (hour/day/week/month). It really doesn’t matter when or what the topic, the important thing is that, just the idea of an audience watching you is terrifying. And people think Stephen King is scary. Try telling someone with performance anxiety you want them to, “Stand up and tell us about your reason for attending today.” Now them’s some frightening words.

So what to do?

Beta-blockers: I don’t like to push medicines for most anxiety disorders, but if you are looking for something that is immediately effective and not addictive, these are the best for targeting this type of performance anxiety. These drugs are used for various heart conditions, most commonly, hypertension so they have to be prescribed by a physician. It doesn’t have to be a psychiatrist or prescribing psychologist, any Primary Care Provider can do it.

These drugs slow your heart rate, and turn down the volume on the shaky hands you might notice when you’re in full view of your audience.  They don’t necessarily cause relaxation though.  You’ll still have that, “Oh my God, I can’t do this!” thought racing through your mind just before you get up, but your heart won’t take off out of control. For many people, that’s enough to help them break through those first few death-defying moments of getting on stage and speaking.

The medicine helps to break the cycle of feeling scared ☞ your heart starts racing, your hands trembling ☞ feeling more scared ☞  your heart keeps racing, your hands trembling.

Which beta blockers are prescribed for Fear of Public Speaking? The ones most commonly used for this form of anxiety are:
1. Propranolol: Inderal (10-80 mg)
2. Atenolol: Tenormin (50-150 mg)
They are usually prescribed 1-2 hours before you have to speak.There is a down side to taking these medicines. They can make you feel light-headed, sleepy or nauseous, so your doctor will probably suggest you take them at least a time or two before you face the audience. Otherwise, you might find yourself falling asleep instead of giving your speech. Hmmm, now that’s a way to get out it!
Keep in mind though that Beta Blockers don’t work as well if you suffer from Social Anxiety Disorder or Generalized Anxiety Disorder.Now to fix that “Oh My God” reaction I described earlier. Here’s what you can do:

Toastmasters: This is every man’s/woman’s no-frills type of behavioral therapy that “works if you work it,” as they say in AA. I could also suggest you visit a psychologist for cognitive behavioral therapy, and there would be nothing wrong with that. There are studies to support it.  But why spend extra money if you don’t have to, especially if you can get equivalent or better results. Toast Masters International has chapters all over the world. It’s  is a non-profit, education-based organization that teaches public speaking and leadership skills through a worldwide network. It  has more than 280,000 memberships in 13,500 clubs in 116 countries. The membership is $36 for 6 months. That’s less than a co-payment for two sessions of therapy under most insurances. Here is the link for Toast Masters if you want to know more:

The good news about Fear of Public Speaking is that practice makes perfect. So push past the fear and work it. I’d like to hear from you if you have any experiences with either medications for fear of public speaking or with Toast Masters or any other useful approach you’d like us to hear about.
I hope this gives you some better ideas beyond the old, “Imagine the people in your audience naked.” Unless of course, you’re speaking to a convention of models, then just forget everything I just said and stick with your imagination.


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