If you experience anxiety symptoms before walking out on stage for a performance, it is quite likely that you’ve heard about beta-blockers to cope with your performance anxiety.
Whether you’re a musician, actor, or public speaker, you might have colleagues that you know take beta-blockers before they go into an audition, speech, or performance.
And you might be wondering if beta-blockers would work for you and if they’re safe?
Here, we’ll cover how beta-blockers work for performance anxiety, as well as their potential benefits and downsides, so you can decide if they’re right for you.
We’ll also cover some natural remedies that might work as alternatives to beta-blockers.
How do beta blockers work for performance anxiety
To gain an understanding of why so many performers take beta-blockers to deal with anxiety, it would be helpful if you first understood what happens inside your body when you experience performance anxiety.
Then you can better grasp the mechanism through which beta-blockers prevent the symptoms.
What happens when you experience performance anxiety
In a nutshell, you experience anxiety symptoms like sweating, trembling, racing heart, etc., because performing in front of an audience is a stressful event for you.
Performance anxiety falls under the broader umbrella of social anxiety disorder (SAD). People with SAD tend to get nervous in various social situations, including performing for an audience .
You might have developed social anxiety because you had parents/teachers who were overly critical, or you were bullied as a child, or it could also be that social anxiety runs in your family.
Regardless of the reason, when you’re about to walk on stage, your fear and worry sets in. You perceive that there is a threat to your reputation, or that the audience will reject you and you will experience humiliation.
Perhaps you also fear that a bad performance could lead to a loss of future career opportunities.
Your fear and worry about the consequences of a bad performance trigger a stress response within your body . This is commonly referred to as the “fight-or-flight” response.
The “fight-or-flight” response
When in the fight-or-flight mode, your brain signals to the rest of your body that you’re in danger (even though you’re not actually in physical danger backstage), and that it needs to get ready to fight or flee to survive.
In response, your body releases a bunch of stress hormones that are meant to amp up your physical performance abilities (like fighting or running as fast as possible).
Your body amps you up by pumping epinephrine (also known as adrenaline) into your bloodstream. The Epinephrine hormone elevates you to a heightened state and causes your heart to pump blood with greater force .
This results in high blood pressure, racing heartbeat, sweaty palms, and other physical symptoms of social anxiety.
Beta-blockers are also known as beta-adrenergic blocking agents. Their main function is to block the release of adrenaline and other stress hormones .
They are usually prescribed for health conditions like high blood pressure, angina (chest pains), irregular heart rhythm (arrhythmia), and migraines.
But it is well-known that beta-blockers have also long been used by performers to deal with anxiety .
As we explained above, you experience the physical symptoms of social anxiety because of the adrenaline pumping through your bloodstream and your heart working with greater force.
By blocking the release of stress hormones, beta-blockers prevent your heart from going into overdrive, they keep your blood pressure low, and keep your performance anxiety symptoms at bay .
Benefits of beta blockers for anxiety
As we’ll discuss below, many performers, whether it’s actors, musicians, or public speakers, rely on beta-blockers to get through their performances and speeches.
To these performers, beta-blockers can be the difference when it comes to being able to pursue a life and career they’re passionate about.
The reason beta-blockers are so effective is that they essentially block the physical symptoms of social anxiety as we explained in the previous section.
By preventing physical symptoms like sweating, nausea, trembling, etc., you’re able to maintain your composure. It allows you to focus on the task at hand, which is to go out and perform for your audience.
Beta blockers and classical musicians
One group of performers that we know have heavily relied on beta-blockers are classical musicians.
One 2012 German study found that 30 percent of the orchestra musicians surveyed reported that they experienced performance anxiety. Among them, the anxiety was severe among 13 percent .
Another survey back in 1987 by the International Conference of Symphony Orchestra Musician, representing the largest group of orchestras in America, found that almost 30 percent of their musicians had used beta-blockers for performance anxiety .
That number is most likely higher today.
Holly Mulcahy, a violinist and concertmaster of the Chattanooga Symphony & Opera , provides some insight about the use of beta-blockers in a chat with WQXR, New York Public Radio .
She tells WQXR that “in some backstage areas, beta-blockers are passed around as mints among performers”.
She also explains that in an industry where the use of beta-blockers is so common, not taking one could be a competitive disadvantage.
If you’re at an audition competing for a spot in the orchestra, and others are using beta-blockers to stay calm, you could potentially be at a disadvantage if you’re jittery and it affects your performance.
But still, Mulcahy is aware that beta-blockers are not magic pills. They don’t improve your performance. But they do help prevent too much of a panic, so you can get through a performance or audition.
What are the most popular Beta Blockers?
Here’s a list of the most popular beta-blockers and how they’re used for performance anxiety.
If you’re considering any of these beta-blockers, or any other medications for performance anxiety, you must speak to your doctor before you begin taking them. And that is especially critical if you’re currently on any other medications.
Propranolol (Inderal) for anxiety
Propranolol is used for short-term relief from performance anxiety symptoms. It can help bring your heart rate back to normal, and reduce sweating and trembling.
One of the more popular beta-blockers among performers due to its minimal side-effects, when used only occasionally before a big performance, speech, or audition.
For anxiety, the typical dosage is around 40 mg once a day .
Atenolol (Tenormin) for anxiety
Atenolol is another beta-blocker popular among performers.
Atenolol has one advantage over Propranolol because it is longer lasting. So, if you have a long day of multiple performances or auditions, and you don’t want to take a beta-blocker before each performance, Atenolol (Tenormin) might be the way to go.
The only risk of Atenolol is that if you take it too often, then sudden withdrawal might cause very high blood pressure.
Dosage varies between 25mg – 100mg for adults depending on various factors. Ask your doctor what would be a safe dosage for you for anxiety symptoms .
Metoprolol (Lopressor) for anxiety
Metoprolol is less popular than the other two due to a higher risk of side effects, dizziness, tiredness, or nausea. It is typically used for treating high blood pressure .
Performers seem to prefer Atenolol and Propranolol because they can be equally effective and have a lower risk of side effects. We specifically compare Metoprolol and Propranolol for anxiety purposes in this article.
Another commonly prescribed beta-blocker is Bisoprolol (sold under the brand ‘Zebeta‘) and while it is still effective against anxiety symptoms, it’s just not as popular as the other beta-blockers listed here.
Are beta-blockers safe?
As long as you only use it occasionally, beta-blockers seem to be quite safe with minimal risk of side effects.
But the problem could be that if you need beta-blockers to be able to perform, then you might start using them frequently.
And if you use them too much, then it could get to a point where you become dependent on beta-blockers, and withdrawal could cause other problems like high blood pressure.
So, it is safe to use when you need a quick fix, but it might be a good idea to start incorporating some natural alternatives to beta-blockers, as we’ll discuss below.
What are some natural alternatives to beta blockers?
Let’s look at some natural alternatives to beta-blockers.
The obvious advantages are that you don’t need a prescription, and all of them are beneficial to your health.
But the other benefit of these natural alternatives is that you’re strengthening your mind and body to be less susceptible to stress, and also better equipped to handle a stress response.
So, instead of artificially blocking the release of adrenaline with beta-blockers, you’re releasing less adrenaline in the first place, and therefore experiencing less performance anxiety.
Brain boosting supplements
The first natural alternative is to use a brain-boosting supplement like PerformZen.
PerformZen uses natural ingredients like GABA, L-theanine, and others, to reduce stress and help you remain calm under pressure .
There are also other ingredients like magnesium and vitamin B6 that work together to increase mental focus .
So, you get the best of both worlds. On one hand, you feel calm and relaxed, and on the other hand, you’re better focused so you can concentrate and deliver a great speech or performance.
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Green, black, and oolong tea
Green, black, and oolong tea are all excellent sources of L-theanine.
L-theanine is one of the ingredients that increase the availability of GABA in your brain. As we mentioned above, GABA helps you feel more relaxed by reducing excess activity in your brain .
So, before a performance, it can calm the nerves by reducing excessive mental chatter and helping you focus on your performance more constructively.
Cognitive-behavioral therapy (CBT)
Cognitive-behavioral therapy (CBT) helps you take challenges you find overwhelming, such as social anxiety, and to shift your mindset around them.
CBT seeks to replace your harmful thought patterns by breaking them down into smaller parts, and then by replacing them with positive ones .
You would work with a therapist and he or she will help you identify specific aspects of performing that you find stressful.
Then you would do mental exercises and assignments that create new positive associations with those performance aspects to make it less stressful, and eventually, something you look forward to.
Deep belly breathing
Deep belly breathing is the process of taking long breaths in and out of your stomach, instead of your chest. It’s the type of breathing that is the foundation for most meditation or relaxation techniques.
When you’re having a stress response, your body switches gears. It turns on something known as the sympathetic nervous system (which admittedly is a strange name for how it feels).
Deep belly breaths deactivate the sympathetic nervous system and switch back to the parasympathetic nervous system. It brings your blood pressure down and restores equilibrium in your body .
Next time you start feeling jittery before a performance, close your eyes and start taking deep breaths into your stomach. Repeat till you feel your heart rate getting back to normal. Take a look at our Tactical Breathing guide as an option, too.
Key takeaways about using beta-blockers for anxiety
If you feel like your social anxiety is keeping you from pursuing a career as a performer or speaker, then beta-blockers might help you maintain your composure and help you get through your performances.
But know that they’re not a long-term solution to your anxiety. Beta-blockers are only blocking the release of adrenaline and stopping the physical symptoms at the moment.
And if you need a quick fix, beta-blockers could be exactly what works best for you. But in the long-term, you might only reach your true potential if you address the root causes of your anxiety, and train your brain and body to better deal with stress.
To become more resilient to stress, try some of the natural alternatives to beta-blockers like supplements, CBT, and breathing exercises.
And please, if you do want to try beta-blockers for performance anxiety, be sure to check with your doctor first.
Beta Blockers For Anxiety Frequently Asked Questions
I received some emails from readers who had more specific questions about beta blockers for anxiety. I’m publishing my responses here to refer people to in future. If you have your own questions, leave a comment down below or get in contact here.
- Q: Is it OK to take beta blockers for anxiety?
- A: Many performers like actors, musicians, or public speakers rely on beta-blockers to get through their performances and speeches. For them, beta-blockers can be the difference when it comes to being able to pursue a life and career they’re passionate about. The reason beta-blockers are so effective is that they essentially block the physical symptoms of social and performance anxiety. By preventing physical symptoms like sweating, nausea, trembling, etc, you’re able to maintain your composure. It allows you to focus on the task at hand.
- Q: Which is the best beta blocker for anxiety?
- A: Propranolol is the most prescribed beta-blocker within the US, but it is unclear (and unlikely) that the purpose for most of these prescriptions is managing anxiety symptoms. Propranolol is used for short-term relief from performance anxiety symptoms. It can help bring your heart rate back to normal, and reduce sweating and trembling. Propranolol is popular among performers due to its minimal side-effects, when used only occasionally before a big performance, speech, or audition. Atenolol is another beta-blocker popular among performers, and is typically longer-lasting than Propranolol. So a long day of performances, Atenolol (Tenormin) might be the better option.
- Q: What are the risks of taking beta blockers?
- A: As long as beta blockers are only used occasionally, beta-blockers have shown to be relatively safe with minimal risk of side effects (speak to a healthcare professional before usage, however). A problem could be that if you need beta-blockers to be able to perform, then you may use them frequently. With frequent use, you could become dependent on beta-blockers, and withdrawal could cause other problems like high blood pressure. So, beta blockers may be OK for quick irregular use, but consider incorporating some natural alternatives to beta-blockers if performing regularly and suffering from anxiety symptoms.
- ^ https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml
- ^ https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056281/
- ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
- ^ https://www.health.harvard.edu/newsletter_article/performance-anxiety
- ^ https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/beta-blockers
- ^ http://www.spiegel.de/karriere/berufsleben/lampenfieber-bei-profimusikern-stress-vor-dem-auftritt-a-886446.html
- ^ https://www.jstor.org/stable/26513061
- ^ http://www.hollymulcahy.com/
- ^ https://www.wqxr.org/story/312920-musicians-use-beta-blockers-relieve-stage-fright/
- ^ https://www.nhs.uk/medicines/propranolol/
- ^ https://reference.medscape.com/drug/tenormin-atenolol-342356
- ^ https://medlineplus.gov/druginfo/meds/a682864.html
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527439/
- ^ https://pubmed.ncbi.nlm.nih.gov/16846100
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836118/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610618/
- ^ https://www.psychologytoday.com/us/blog/the-athletes-way/201705/diaphragmatic-breathing-exercises-and-your-vagus-nerve
4 thoughts on “Beta-Blockers for Performance Anxiety & Social Anxiety: The Facts”
How much is too much use of a beta blocker! Is one a week too much?
Hi Carol; as I’m not a licensed medical professional I do not want to hand out specific dosage information as there is no way of telling how any recommendations may affect you. My recommendation is to speak to your beta blocker prescription provider and/or your doctor about dosage for using beta blockers for anxiety and limitations on how often you should/can take your specific prescription. Also ask about any potential side effects of prolonged usage and, if possible, ask about interactions of the beta blocker with any other medication you may be taking.
For non-specific general advice about Propranolol dosage for anxiety purposes, we have a new page covering this here: https://performanceanxiety.com/propranolol-dose-for-anxiety/
Please note that this is NOT medical advice, and you should run everything by a licensed medical professional for your own safety and peace of mind!
Hello Carol: atenolol 50-100 mg or propranolol 40mg-80mg once a week is very safe, with little risk, the risk to benefit ratio is favorable for benefit, with very low risk. In fact Atenolol is taken on a daily basis for many patients. Check if you have pre-existing low blood pressure or other cardiac problems: these problems may preclude you from taking them.
Gray Blacks: Clinical Pharmacist, clinical nutritionist
Appreciate the feedback Gray, but a reminder to Carol and anyone else reading: this is NOT medical advice, and you should run everything by a licensed medical professional for your own safety and peace of mind!