How to overcome performance anxiety from either stage fright or a poster presentation
Stage fright and the fear of public speaking are incredibly similar. Whether you are a dancer, painter, author, pharmacist, physician, or nurse you will more than likely be asked to get on stage and give a performance or presentation at some point. It is common to have performance anxiety.
For healthcare workers, most public speaking will be at conferences when presenting a research poster or lecture. (Although why limit yourself to just that!) This environment, while traditionally low key, can still be anxiety inducing. As a dancer, the expectation of getting on stage is much higher, and so are the number of people watching you. This can make the situation equally as terrifying. So what are some healthy ways we can overcome this fear of public speaking?
Deep breathing may make you roll your eyes as one of those “wholistic” voodoo techniques that doesn’t really work, but trust me, it does. More importantly, trust the research behind it. A recent study out of australia evaluated Heart Rate Variability or HRV (one of the more negative and measurable side effects of performance anxiety) as well as self-reported anxiety. They had three groups of trained musicians. One control group, one group instructed to take 30 minutes of slow breathing before their performance, and another group using slow breathing and HRV target biofeedback. The slow breathing groups showed improvements in HF (High Frequency) heart rates, meaning their heart rates were lower. They also showed less variability if LF/HF (low frequency/high frequency) ratio measures, meaning they did not have as much heart rate variability when compared to controls. The addition of the biofeedback did not provide any statistical benefits than just the slow breathing alone.
So why does deep breathing work?
Deep breathing works because when you use your diaphragm to breathe, you are activating your parasympathetic nervous system. The sympathetic nervous system is responsible for your flight or fight response. Your parasympathetic nervous system, is responsible for you rest and digest response, and directly contradicts your sympathetic nervous system. So when you activate your parasympathetic nervous system right before a big performance, you have already activated all the rest and digest pathways. So the fight or flight pathways have a much harder time overcoming this and you don’t have the heart rate increases typical of the nerves associated with performance anxiety.
The trick with tea is looking past the fancy labels and what they claim to do on the box, and read the actual ingredients. There are many natural herbs that have proven medicinal benefits, and a lot of teas designed to take your money and may even cause you harm. To learn more about herbs in general, check out this article written by Rose all about cooking with herbs!
When it comes to tea and performance anxiety however, the real trick is avoiding caffeine. It pains me slightly to say this as I absolutely love my caffeine in any form, but the research is undeniable. Caffeine may give you a slight energy boost, though more than likely that energy boost is from the sugar in the caffeinated drink. That small energy burst will be short lived, and lead to a crash in the end. Caffeine can more than double the amount of stress hormones such as cortisol and epinephrine your body is producing. It also decreases your GABA neurotransmitter which acts as your bodies natural ‘brake’, and slows down and relaxes your body. I hate to be the one to tell you all of this. But it is true. Caffeine really should be avoided before a larger performance.
What you can find in tea however that will help, is camomile. Camomile is a common ingredient in ‘sleepy time’ tea, however it does more than just help with sleep. It contains many antioxidants including flavones. Flavones have been shown to lower blood pressure, something which is incredibly beneficial when you are about to get on a stage!
Practice Practice Practice:
Another simple technique is to make sure you are as prepared as possible, so nothing can cause you additional stress on your big day. Nothing is worse than getting ready to get on stage and realizing there is a large tear in your skirt. The number of times I have had to frantically search for push pins to mount my poster is higher than I care to admit.
By making sure to pack your performance bag the night before, you have the opportunity to check your costume for any last minute tears you may need to fix, or find some safety pins to make sure you have them on hand. Read your emails carefully to know what will be provided to set up your poster. Map out the location of where you are going and know how long it will take you so you won’t get stuck in traffic. Memorize your speech so it comes off as seamlessly as possible. Practice your choreography with and without music, with and without mirrors, and make sure you practice at least once in your full costume so you know if you can wear bangles without having them fly off your wrist and into the audience. (Nothing will ruin a performance faster than hitting an audience member in the head… trust me I’ve been there and you don’t want that to happen to you.)
When to talk to your doctor about medication?
Before I start talking about medication, please remember that while I am a pharmacist I am not YOUR pharmacist. This article is not intended to be taken as medical advice. Please consult your physician and your pharmacist before starting any medications.
If none of the above techniques work for you, it may be time to talk to your doctor about medication. Medication can be used in addition to any of the above techniques, but it should not e the sole technique used to overcome anxiety. Try different combination of both pharmacological, and non-pharmacological techniques. Deep breathing by itself may not be as helpful as you need, but deep breathing, tea, and lots of practice may work in combination. If there is one type of medication that should be added though, it should be a beta blocker.
Beta blockers act on the Beta 1 and Beta 2 receptors and block adrenergic stimulation. This means they can decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand. Nonselective beta-adrenergic blockers (propranolol, nadolol) reduce portal pressure by producing splanchnic vasoconstriction (beta2 effect) thereby reducing portal blood flow.
No medication is FDA approved for performance anxiety, however propranolol has been the most studied. It comes in an immediate release formulation that will work quickly when used. This medication will not stop you from being nervous, but it will block the physiological response to nervousness. By not having the rapid increase in heart rate and blood pressure it is easier to focus on the performance itself, rather than your nerves.
Clonazepam (Klonopin), alprazolam (Xanax) and lorazepam (Ativan) all fall into a category of medications called benzodiazepines. These drugs can be used to reduce anxiety. However, they carry a high addiction potential, and are only recommended for short term use. Long term use of these agents has not been studied. If the beta blockers and other techniques do not work this could be considered, however this is an absolute last line agent and must be used in close collaboration with a physician and pharmacist. This drug class is one of the most abused controlled substances we have. That being said though, they may help with anxiety under the right conditions.
I hope this information has been helpful! Let us know how you overcome your nerves before a big presentation or performance! We would love to hear from you! You can contact us anytime here.