Beta blockers are a class of drugs for anxiety that block the action of adrenaline in the body. Therefore the physical symptoms of the stress response are reduced. I’m often asked if they should they used for public speaking fear?

Firstly, beta blockers are not officially drugs for anxiety, but cardiac medications. However, by reducing some of the symptoms associated with public speaking anxiety, like the ‘shakes’, the idea is that they can help you concentrate on the task at hand.

For example, since they can lower heart rate, beta blockers have been used by Olympic marksmen to provide more aiming time between heartbeats. Some musicians use beta blockers to reduce the adrenaline-driven shaking during auditions and performances. And it’s rumored that many politicians use them for important speeches.

The 3 questions are:

Do they really work?
Are they safe?
What’s the best way to manage public speaking anxiety?

1. Do they really work?

What can they do?

Nobel prize-winning scientist, James Black, invented beta-blocker drugs to block the effect of adrenaline on the heart. So beta-blockers can reduce the adrenaline-related physical symptoms associated with the stress response. Some scientific studies show that beta blockers significantly reduce symptoms like shaking hands that can hinder some musicians playing. Those in the studies said they felt better about their performance after taking beta blockers, and music critics consistently judged their performances to be better.

One of my clients – a senior manager in the entertainment industry – has used beta blockers for important presentations with no side effects. He said the physical symptoms he usually felt (heart racing and shaking of hands) made him spend too much time thinking about the nerves and how to control them. So he was more formal and stuck closer to ‘script’.

With the beta blockers reducing those symptoms, he felt free to be more conversational and expansive. So, he found the experience positive, however…

What can’t they do?

… he pointed out that they are useless if you’re not prepared. Public speaking fear is built on uncertainty – and if you feel uncertain about your preparation, your anxiety will increase. Some of the work we did together focused on message and structure which provides a foundation of clarity – as well as providing a ‘roadmap’ for the delivery of a speech or presentation. If you’re standing there thinking ‘I’m not sure what my point is here’, they won’t improve things.

Beta blockers can’t help anxiety of a purely psychological nature. If your public speaking anxiety shows itself mainly in psychological ways (e.g. general uncertainty or negative inner voices), beta blockers will not help you.

Reduced energy levels

Another thing to consider is that many people feel adrenalin helps them focus, giving them an edge that adds intensity to the performance. Australian actress Cate Blanchett has said, ‘a little bit of fear keeps one on one’s toes’.

When I was 19 and playing football semi-professionally, I saw a specialist about the migraine headaches I would get after each match.‘Post exertional headaches are a documented condition’, he said. I remember feeling a wave of relief that modern medicine understood my pain and would have a cure. He placed a vial of pills on the table.

‘These are drugs to reduce heart rate and blood pressure, which should therefore reduce your headaches.’
‘But won’t that reduce my energy and physical performance on the field – the same effect as me not exerting myself as much?’

‘Well, yes.’

I didn’t use them.

2. Are they safe?

Beta blockers are prescription medications for good reason. There’s a fairly long list of side effects, including:

Rash, anaphylactic shock (sudden unconsciousness or death), cold extremities, fainting, dizziness, fatigue, headache, depression, sleep disturbances, nightmares, hallucinations, short term memory loss, high or low blood sugar, stomach ache, flatulence, constipation, nausea, diarrhea, dry mouth, vomiting, heartburn, bloating, impotence or decreased libido, difficulty urinating, bronchospasm, cough, wheezes, naal stuffiness, joint pain, and muscle cramps.

Although this is an exhaustive list, many performers who take beta blockers in small doses and or special occasions have found no side effects at all from their use.

The positive view…

According to a 2004 New York Times article, the editor of the Harvard Medical Letter, Michael Craig Miller, thinks there is little risk in taking them because they only affect physical, not cognitive anxiety. “Stage fright is a very specific and time-limited type of problem. There’s very little downside except whatever number you do on yourself about taking the drugs” he said.

The cautionary view…

An opposing view can be found in the comments left by musicians at www.hornplayer.net:

“A common side effect is loss of concentration, and my playing rapidly went downhill because of this… I ended up sounding as if I were sight reading. As soon as I figured out the connection, I quit the pills for good; I never really needed them, anyway.”
“…in performance, I had 3 quite severe panic attacks, something I never had experienced prior to that year or since. If you ever read any of the books on prescription drugs, a caution often added is that certain drugs may produce the opposite effect from that intended, so – be careful and check it out, as it’s a very individual thing.”

3. What’s the best way to manage public speaking anxiety?

The real objective when speaking in public is to think clearly – and speak clearly. So a better question than ‘are drugs good’ is ‘what’s the best way to mange stage fright?’

Many people believe they can’t think clearly because the physical symptoms are overloading your system. The irony is that the intensity of your physical symptoms is a result of not thinking clearly.

Half of the physical symptoms are due to the initial stress response, while the other half are the result of the way you think about the situation.

The physical symptoms are real, but their intensity is directly related to the way you process them. For example, if you believe that your shaking hand (a minor symptom of the adrenaline released to give you energy for your speaking event) means that you are ‘losing control of your body!’, all your physical symptoms will increase with the drama of that thought. In other words, the stress response increases when we perceive a threat to our safety.

So symptoms can be reduced if we come to the conclusion that there is no real threat. So, when you know WHAT to do and HOW to do it (tip: natural style), your mind is efficiently directed and speaking anxiety is manageable.

Now, it’s possible that one drug-induced positive experience will help you come to that conclusion. But there are some risks associated with that path.

You could also learn the Vivid Method which demystifies public speaking anxiety and shows you how to redirect your attention to stay in control.

You see, nerves are okay. They’re manageable. They’re a useful signal. If you rely on medication you are saying your nerves are out of your control, treating your body as the enemy and the signals as a demon to be exorcized.

This fight or flight response (and your public speaking fear) can be minimised when we understand what’s going on and realise it’s something we can influence – something we can manage.
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If you’d like to develop your presentation skills, consider:

Drugs for public speaking fear: Should I take Beta Blockers?