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How to Get Over Performance Anxiety

Introduction and Summary

Many people experience nervousness, jitters, and, in some cases panic, when expected to complete a task under pressure. Performance anxiety, or stage fright, can prevent you from doing tasks such as giving a speech or presentation, meeting or interacting with new people, being in large crowds, and performing sexually or on stage. There are many different types of performance anxiety, including social anxiety disorder and sexual performance anxiety. The latter is more popular than you may think. In fact, it affects 9-25% of men and 6-16% of women. Thankfully, there are plenty of methods to help you overcome your performance anxiety.

In this article, I’ll cover:

What Is Performance Anxiety?

Performance anxiety, sometimes known as stage fright, is when you’re so nervous before a performance that you physically can’t function or can’t function as well as possible. Feeling nervous before singing karaoke (music performance anxiety) or throwing a foul shot (sports performance anxiety) is totally normal and not a cause for concern. However, if your nerves make it so that you physically can’t function, it is worth discussing with a professional. Some people—both men and women—consider sex to be so anxiety-inducing that they either cannot perform or have no sexual desire. For women, they may have a severely inhibited sexual desire and for men, some may ejaculate prematurely while others may not be able to develop an erection.

Sexual performance anxiety is not another name for erectile dysfunction (ED), though some cases of ED may be due to performance anxiety. Erectile dysfunction involves the brain, hormones, emotions, nerves, muscles, and blood vessels, and can be the result of an issue with any of these matters.

The anxiety you feel when presented with a challenge can manifest mentally, physically, or some combination of the two.

What Are the Symptoms of Performance Anxiety?

Though the circumstances are different in each case, the feelings of performance anxiety are similar to those of associated conditions, such as ED, social anxiety disorder, and panic disorder. Common symptoms of performance anxiety include:

  • Feeling nervous and/or tense
  • Experiencing a sense of impending doom or panic
  • Increased heart rate
  • Rapid breathing (hyperventilation)
  • Sweating
  • Trembling or shaking
  • Inability to concentrate
  • Trouble sleeping
  • Gastrointestinal problems such as nausea or vomiting
  • Dizziness or sense that you may faint

If you’re experiencing sexual performance anxiety, additional symptoms include:

  • Inability to develop or maintain an erection
  • Premature ejaculation
  • Minimized or no sexual desire
  • Inability to orgasm

Knowing the underlying cause of your anxiety may help you identify the best course of treatment.

What Causes Performance Anxiety?

Identifying the cause of mental conditions and disorders can be challenging and it may be difficult to pinpoint a specific cause or trigger. For most people suffering from any type of anxiety, including stage fright, the causes are a combination of genetic and environmental factors, including:

  • Inherited traits: Many anxiety disorders are genetic. Still, it isn’t entirely clear if the presence of an anxiety condition is due to genetics or due to learned behavior. It is likely a combination of both.
  • Brain structure: The amygdala, a collection of nuclei deep within the temporal lobe (the area of your brain near your ears), perceives emotions such as anger, fear, and sadness. The amygdala also stores memories of events and emotions to help you recognize what they are and why you are feeling them. People with anxiety disorders may have an overactive amygdala, which heightens their emotional response to certain situations.
  • Environment: Some people develop anxiety disorders in response to an embarrassing, unpleasant or shameful experience. For instance, if you are singing in front of a crowd and they boo you off stage, you may feel so embarrassed that you develop anxiety about performing in front of others again. Similarly, if you have trouble getting an erection during a sexual encounter, you may develop performance anxiety and have trouble getting an erection in a future sexual encounter.

How to Diagnose Performance Anxiety

Mental and psychiatric conditions can be challenging to diagnose. A provider will usually discuss your symptoms, assess for any underlying medical illness, and may use surveys or worksheets to help quantify your symptoms. Performance anxiety isn’t technically classified as a psychiatric condition, so there is no specific test or worksheet that can be used to diagnose this. However, a provider, or you, can diagnose this by a history of your symptoms alone.

Sexual performance anxiety presents itself differently from person to person. Ejaculating prematurely, inability to orgasm or get aroused, becoming anxious when engaging in sexual activity, or losing interest in sex can all be signs of sexual performance anxiety- but may also signify an underlying medical condition or be signs of another condition. Just because performance anxiety is not a specific clinically established mental condition does not mean you can’t seek treatment from a medical professional.

Overcoming Performance Anxiety

Many people become overcome by a sense of dread or fear that they won’t be able to perform under pressure. If your performance anxiety regularly interferes with everyday life, including your relationships, work, sports or arts performance, and /or mood, you may want to seek help from a medical professional to see what options are available to treat your performance anxiety.

Therapy

Unlike generalized therapy, which can last for an extended period of time, cognitive behavioral therapy (CBT) is a short-term therapy that helps you change your patterns of thinking to help you regulate your emotions in stressful or triggering situations. This can be very effective in reducing performance anxiety and improving performance.

Medication

Medication alone is not usually effective in treating social or performance anxiety- but can be very helpful in combination with therapy. A commonly used medication is a beta blocker called propranolol. This medication is most commonly used for high blood pressure, heart disease, or chest pain. Beta blockers are medications that counteract the effects of epinephrine, also known as adrenaline. Taking this medication can help reduce the sensations of heart racing, anxiety, and shakiness associated with performance anxiety and may help you better accomplish your normal activities or participate in therapy more comfortably. Propranolol has relatively few side effects. There are other medication options, such as traditional medications for anxiety, that your provider may consider as well.

When to See a Doctor

Similar to other mental illnesses or conditions, performance anxiety is easier to treat the sooner it’s addressed. If you notice that you’re experiencing panic attacks, avoiding activities or social situations due to your performance anxiety, or feel that your relationships, work, or activities are impacted by your symptoms, you should consult a healthcare professional.

How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

 

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $19/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

Dr. Sarah Malka, MD

Dr. Sarah Malka is a board certified emergency medicine physician with K Health. She completed her residency at Harvard Medical School.

Start free assessment to see if you’re eligible.

Anxiety treatment starting at $19/month.