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Performance anxiety, is a type of social anxiety in which you experience intense anxiety caused by a specific event or scenario. Propranolol can help people overcome the physical symptoms of performance anxiety so that they are better able to cope with these situations.
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Reviewed by Dr Roy Kedem, MD
Information last reviewed 07/16/20
Performance anxiety is a specific type of social anxiety that occurs in relation to specific events. Exam-related anxiety, public speaking (glossophobia) and stage fright are all types of performance anxiety. Social anxiety disorder can be limited to performance anxiety, or in its most severe form, it can cause a person to feel anxious any time they are around others.
Most people will experience some level of social anxiety from time to time. This is perfectly normal when working outside your comfort zone. However, some people experience intense feelings of anxiety, which can interfere with their ability to function in stressful situations. This can then lead to avoidance, which can have negative consequences professionally, socially, and in terms of mental health. For people who experience symptoms related to performance anxiety, medications such as Propranolol, and psychotherapies like CBT (cognitive behavioral therapy) can be helpful to get the anxiety under control.
Performance anxiety is very common. Many people will feel nervous before going on stage, making a speech, or taking an exam. This is a natural human response to high-stress situations. Some people may experience severe symptoms of anxiety including panic attacks. This is less common, and medications or psychotherapies may benefit people in this group.
While anxiety can be a normal response to a stressful situation, it rises to the level of a clinical disorder when it is severe enough to interfere with activities of daily living. People with social anxiety disorder may experience panic attacks and other physical symptoms of anxiety such as a rapid heart rate, profuse sweating, tremors, shaking, and nausea.
Social anxiety is caused by the body’s fight or flight response. When the fight or flight response kicks in, the body releases adrenaline. Evolutionarily, this may have occurred to help early humans fight off or escape from predators. Sometimes the body responds to other stressful situations, such as public speaking in the same way as it would to a life-threatening situation. The increased levels of adrenaline can cause shaking, a rapid heart rate, nausea, and profuse sweating, symptoms which are commonly associated with situational anxiety.
The triggers of social anxiety can vary from person-to-person. Common triggers include:
It is not known why some people experience severe anxiety and others do not. However, there are are several factors that may be involved:
Psychological symptoms may include:
Physical symptoms may include:
The physical symptoms of performance anxiety can exacerbate the psychological symptoms. Many people find that once the physical symptoms have been treated, they are better able to manage the psychological aspect.
While diagnostic criteria for social anxiety disorder can be found in the diagnostic and statistical manual, there are no official diagnostic criteria for performance anxiety. If you experience moderate to severe anxiety with related symptoms, in response to a stressful situation, then you have performance anxiety and may benefit from treatment.
It is important to distinguish social anxiety from general anxiety as this affects treatment. An individual with general anxiety disorder (GAD) is unlikely to benefit from treatment with Propranolol in the long term. The two conditions can certainly overlap, however, in the case of general anxiety disorder, treatment is normally handled by a mental health specialist. An easy way to determine if you have general anxiety disorder, is by using a scale known as the GAD-7. If you score a 10 or higher on this scale, you should seek consultation with a mental health specialist and would likely benefit from a daily, long-acting medication.
Situational anxiety commonly leads to panic attacks. During a panic attack people often experience:
These symptoms lead some people to believe that they are experiencing a heart attack or other illness, which can further exacerbate the symptoms. Not everyone who has situational anxiety will also have panic attacks.
Both depression and anxiety commonly occur together and can be triggered by stressful life events. Anxiety can be a symptom of major depression and depression may occur as a result of an anxiety disorder. Therefore, similar treatments can be effective for both depression and anxiety. Antidepressants such as Sertraline and Citalopram may be prescribed alongside beta-blockers to help with situational anxiety and depression. Regular exercise, stress-reduction, and psychotherapies, such as cognitive behavioral therapy (CBT) can also be beneficial for both conditions. If you experience both situational anxiety and depression, you should let the prescribing doctor know so they can advise you on the most appropriate treatment.
The term ‘performance anxiety’ is sometimes used to refer to concerns surrounding sexual performance. This can be a factor in conditions such as premature ejaculation and erectile dysfunction (ED). The anxiety may be related to worries about pregnancy, sexual health, satisfying a partner, or simply maintaining an erection.
One of the main challenges of sexual performance anxiety is that it can often create a negative cycle: The anxiety can affect sexual performance, which increases the anxiety levels for the next sexual encounter. Psychotherapy, sex therapy, or medications such as sildenafil for erectile dysfunction or sertraline for premature ejaculation, may be beneficial in this case. Propranolol is in a class of medications known as beta blockers which can cause transient erectile dysfunction It is therefore not prescribed for sexual performance anxiety.
Beta blockers are often prescribed to treat the physical symptoms of anxiety, such as a rapid or pounding heart rate, nausea and shaking. Reducing the physical symptoms of anxiety can help to reduce anxiety to more manageable levels.
There are several ways to reduce anxiety without medication. These include:
Other psychotherapies and techniques can also be beneficial, but it may take some time to find out what works well for you.
Social anxiety can vary from person-to-person. Some people find that social anxiety goes away as they get used to a situation. Medications such as Propranolol can help this process. Alternatively, some people find social anxiety can be more persistent, for example, they may always feel nervous during exams. In both cases, medications and psychotherapy can be effective treatment methods.
For perfectionists, perfection is the only acceptable outcome. This is often an unrealistic goal. A perfectionist will perceive the only two outcomes as being perfection or failure. This places a lot of pressure on the individual’s performance, which along with a fear of failure, can generate significant anxiety for some people.
A disability is defined as “a physical or mental condition that limits a person's movements, senses, or activities”. However, not all conditions that fall into this category, would be legally recognized as a disability. Situational anxiety is a psychological condition that can limit someone’s participation in certain activities or day-to-day living, therefore, some people may regard it as a disability.
The coronavirus pandemic has led many people to experience increased anxiety levels. People are concerned both about their risk of catching coronavirus and what might happen to them if they do develop COVID-19. Some people may, therefore, experience social anxiety in relation to coronavirus.
Sexual performance anxiety in men can lead to erectile dysfunction and premature ejaculation. It can also cause a self-perpetuating cycle, as additional anxiety can be due to these physical effects and fear of failure.
In females, sexual performance anxiety can manifest as a lack of interest, difficulty with arousal and difficulty achieving orgasm.
Propranolol, which can treat performance anxiety is not appropriate treatment for sexual performance anxiety. It is in a class of medications which can cause transient erectile dysfunction and depressed libido.
If your performance anxiety is related to erectile dysfunction, Viagra may be able to help. After experiencing ED, some people become more concerned that it will happen again, further increasing anxiety levels. Viagra could help to break that cycle. However, other medications or psychological therapies may be more beneficial, so it is worth discussing your options with your doctor.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
Mayo Clinic > Social Anxiety Disorder RTOR > 3 Tips for Managing Situational Anxiety Harvard Health Publishing > Blood pressure drugs and ED: What you need to know Mayo Clinic > Depression and Anxiety: Exercise eases symptoms WebMD > Panic Attack Symptoms Mayo Clinic > Depression and Anxiety FAQs Mayo Clinic > Premature Ejaculation Causes
It’s virtually impossible to go through life without occasionally feeling anxious about certain situations, people and things. Whether it’s about personal health concerns in times of COVID, job security worries or upsetting events in the relationships with our loved ones, in a typical month there can be plenty of things that may give rise to anxiety. It’s the brain’s natural response to perceived future threats and changes.
Occasional feelings of anxiety and panic attacks are normal and, to a degree, a healthy biological response of our brains to sudden changes and difficulties we face in our lives. In everybody’s life, there will be such episodes. The anxiety or panic are meant to make you alert and focus on solving or escaping the situation. Once that is accomplished, the anxiety eases, the nerves cool down, and you can carry on with your normal life. That’s the healthy sort of anxiety and something most people are very familiar with.
Since the beginning of time, stress and anxiety have always been and will continue to be, a part and parcel of life. For our hunter-gatherer ancestors, escaping from predators or physical danger are prime examples of scenarios that would induce anxiety – and rightly so.
Shaking, nausea, sweating, a pounding or racing heart, and a tight chest: If these symptoms sound familiar then you’ve probably had an anxiety attack at some point. In the midst of such an intense bout of terror, some people can mistake what they’re experiencing for a heart attack - after all, many of the symptoms are the same - thereby, further exacerbating their symptoms.
Anxiety is a normal part of life and, in the right moments, can be critical for our survival by warning us of a clear and present danger. In many ways, anxiety can be compared to a guardian angel that gives us the heads up when something is awry, but for those whose anxiety is severe and sustained, it can be the very devil.
Performance anxiety is a common psychological condition that comes in many shapes. It includes stage fright (when you have to speak or perform in front of a large or unfamiliar audience), test anxiety, and — not uncommon among young men — sexual performance anxiety. The situations that trigger anxiety vary but the common emotion is a fear that you won’t live up to other people’s expectations, make a fool of yourself, or mess up an important task.
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