SWISS MEDICAL EXPERTISE: ZURICH, MALLORCA, LONDON, NEW YORK

9 Minutes

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It is normal to experience anxiety now and then. Going through a high level of distress when you are giving a presentation, taking a test, regaling a crowd with a musical performance, or competing in sports is natural and happens to most. It is even natural to experience anxiety during physically intimate moments. But what happens when this anxiety keeps coming back again and again? This continuous cycle of anxious and nervous thoughts might depict an underlying performance anxiety.

Performance anxiety exists on a spectrum with varying degrees of severity. While some may experience it casually from time to time, others encounter it in almost every social situation. Fortunately, like any other type of anxiety disorder, performance anxiety is manageable with appropriate treatment.

Performance anxiety refers to a sudden intense feeling of panic that occurs just before you are about to perform. For some, it is the crowd chanting their name while for others, it may be the thoughts of passing an upcoming exam. Regardless of the specifics of the triggering situation, the pressure can be extremely high and lead to several emotional and physical symptoms.

Performance anxiety can be of different types, such as:

Stage Fright

Stage fright is performance anxiety triggered by the fear of performing on stage. Actors, dancers, musicians, and other stage performers primarily suffer from this type of performance anxiety. For some, stage fright stems from a social phobia called glossophobia, i.e., the fear of public speaking.

Sexual Performance Anxiety

Sexual performance anxiety is the worry related to sexual intercourse and occurs just before or during sex. It associates with the perceived ability to satisfy a partner, relationship challenges, body image, and other factors. Up to 25% of men and 16% of women experience sexual performance anxiety.

Athletic Performance Anxiety

Athletic performance anxiety refers to a fear or worry associated with athletic training or competition. This type of performance anxiety also stems from the fear of acquiring injury during an athletic performance.

Test-Taking Anxiety

Test-taking anxiety includes the fear or worry related to taking exams or being able to perform well on these exams. It often carries a tendency to impact test results negatively.

Interview Anxiety

Interview anxiety refers to worry or fear associated with an upcoming interview for a job or other role. It often leads to poor performance in the interview and negatively impacts hiring decisions.

Other

The types of performance anxiety mentioned above are just a few of the many. Many people with performance anxiety may experience it under various other circumstances, depending on their life factors and situations.

Most symptoms of performance anxiety occur due to the activation of the fight or flight response in the body. This fight or flight reaction causes the body to activate its sympathetic nervous system, triggering the release of cortisol and adrenaline. This built-in response has been integrated into the human brain since prehistoric times as a protective measure to avoid any impending risk or harm. But if the fight or flight response occurs in everyone, why does the thought of a performance trigger it in some people but not others? Multiple factors contribute to stage fright and performance anxiety in some but not others. These include:

Temperament

Some individuals are born with a more sensitive nervous system or a natural tendency to be more introverted than others. Hence, they tend to feel more anxious in certain situations than others.

Past Experiences

If you have had a bad experience while doing some tasks in the past, or have a history of being bullied for something in childhood, these events may unconsciously feed your performance anxiety.

Level of Expertise

It is more common to experience performance anxiety if it is your first time doing a task or if you are doing something that you are not good at yet.

Situational Stress

If the rest of your life is stressful, you are likely to be emotionally sensitive and tired. This exhaustion can fuel your performance anxiety and make things difficult to handle.

The key difference between performance anxiety and other types of anxiety is context. As with performance anxiety, an individual suffers from a real or imagined pressure to perform well that manifests in the form of the following physical signs:

  • Chills
  • Chest pain
  • Headache
  • Dizziness
  • Tremors
  • Dryness of mouth
  • High blood pressure
  • Shallow breathing
  • Blurry vision or tunnel vision
  • Accelerated heart rate
  • Stomach cramps
  • Nausea
  • Clamminess
  • Excessive sweating, especially on the brows and palms
  • Problems with bladder control

Additionally, some mental and emotional signs of performance anxiety include:

  • Irritability
  • Trouble focusing
  • Task avoidance
  • Hypervigilance

In cases of sexual performance anxiety, individuals may experience premature ejaculation, erectile dysfunction, decreased sex drive, or vaginal dryness.

Fortunately, it is possible to get rid of performance anxiety with a bunch of treatment modalities. The treatment choice for this condition depends on the severity of symptoms, how the symptoms manifest, and how they impact everyday life. Most cases of performance anxiety require a combination of medications and psychotherapy under the supervision of a psychiatrist and psychologist.

Psychotherapy

Psychotherapy or talk therapy is a method of treating performance anxiety without using pharmaceutical medications. Different types of psychotherapy can benefit people with performance anxiety, such as:

  • Cognitive behavioral therapy or CBT identifies and changes the behaviors and thoughts contributing to performance anxiety. It also helps individuals develop coping strategies against this condition.
  • Counseling is a type of talk therapy that empowers people with strategies to overcome daily challenges while improving their sense of well-being.
  • Miscellaneous coping strategies such as deep breathing, pre-performance rituals, and visualization keep performance anxiety in check.

Medication

Some types of performance anxiety, such as social anxiety disorder, require medication. Two common types of medication used for treating it are selective serotonin reuptake inhibitors (SSRIs) like paroxetine and serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine.

Mentioned below are some performance anxiety cures to overcome years of fear on the field, on stage, or at the podium:

  • Be well-prepared for the upcoming event by practicing enough
  • Limit your caffeine intake and minimize the consumption of sugar on the day of the performance.
  • Try having a healthy meal a few hours before you are due to perform so you do not feel hungry. Aim for a low-fat meal with complex carbohydrates, such as whole-grain pasta, yogurt, lentil soup, or rice burrito
  • Shift your focus off of yourself and your fear and focus more on what you are providing to the spectators. Close your eyes and imagine yourself on the stage with an audience cheering for you to make yourself feel good
  • Avoid any thoughts that lead to self-doubt
  • Instead of focusing on what can go wrong, emphasize the positive and visualize your success
  • Try to act natural and be yourself
  • Practice techniques like biofeedback, meditation, and controlled breathing to help yourself relax and redirect your thoughts when they become negative
  • Go for a walk or jump up and down for a minute to shake out your muscles and release the feelings of anxiety before your performance
  • Try to connect with your audience by making eye contact, smiling, and thinking of them as friends
  • Live a healthy lifestyle by eating well, exercising daily, and getting adequate sleep

Lastly, remember that whatever you are experiencing is temporary and will end as soon as the big event passes.

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