Stage Fright/Speech/Presentation Anxiety
Stage Fright/Speech/Presentation Anxiety refers to experiencing intense anxiety when you are the focus of attention. It occurs most commonly when giving a presentation or a performance in front of a group, but might also happen one-on-one (for example, speaking in front of an authority figure, in an interview, or on a date). What counts as a “presentation" can be very brief: Introducing yourself, rotating introductions, raising your hand, or being called on in a meeting can count. The anxiety is usually most intense leading up to and at the beginning of a performance, and, for many people, it decreases rapidly a few minutes in (if things are going well).
Performance/Speech Anxiety is notable for its prominent physical symptoms. Heart racing, shortness of breath, sweatiness, blushing, tremulousness (in your arms or voice), and difficulty concentration or speaking are prominent signs. Patients often complain that their body is "betraying them" right when it is most important. Often, these physical symptoms are the main reason people start to avoid presentations and speeches altogether.
Many people can recall a particularly bad presentation or performance that triggered their anxiety, but some tell me it started at a certain age for no particular reason. Often, the issue (and the need for treatment) comes to head right after a new job, a promotion, or a change at work or school suddenly requires them to give more presentations.
How do I find out if I have Performance/Speech Anxiety?
The best way to find out whether or not you have Performance/Speech Anxiety is by meeting one-on-one with a mental health professional (i.e. a therapist or a psychiatrist). Short of that, you can still get a good idea about the diagnosis from the DSM-V and various online scales.
The DSM-V (short for Diagnostic and Statistical Manual, version 5) contains the criteria that psychiatrists such as myself use to make a diagnosis. The criteria attempt to be objective and clear-cut, but, in practice, we have to use a lot of judgment to decide whether or not a patient meets each of the criteria. One caveat is that Performance/Speech Anxiety is considered a “specifier” under the larger heading of “Social Anxiety Disorder”, so look at the end of the criteria in order to find it. The DSM-V criteria are copyright protected, but if you google “DSM-V Performance Anxiety” you will find similar criteria on-line and also on-line scales (such as the PSAS) to assist you.
What are the treatments for Performance/Speech Anxiety?
Generally speaking, psychotherapy and medications are the most effective treatments for managing anxiety disorders, including Performance/Speech Anxiety. Combining both approaches is usually the most effective, though either method can work alone.
Cognitive Behavioral Therapy is the most effective and the most well-researched form of psychotherapy for the treatment of Performance/Speech Anxiety. It is a collection of techniques including relaxation training, cognitive therapy, gradual exposures, and assertiveness training which are taught over the course of 5-8 sessions with a skilled professional.
Medications are also highly effective for Performance/Speech Anxiety (more so when they are combined with Cognitive Behavioral Therapy). The best way to learn about medication options and whether or not they are right for you is through a one-on-one evaluation with a qualified medical professional such as a psychiatrist.