In a 2010 article, Violinist Dottie Goldfarb stated that she uses beta-blockers every time she plays a solo or first violin in a performing chamber group ^[1]. Dottie elaborates that “without it I don’t have control over my vibrato or my bow because my hands shake. I still hesitate to play solos but do not fear them as much as I used to.”

For Dottie and many other professional violinists, musicians, actors, public speakers and performers; beta-blockers, a class of prescription drugs that work by blocking the effects of adrenergic hormones such as adrenaline, are an essential tool for getting their jobs done despite the (sometimes crippling) performance anxiety & stage fright issues they may be dealing with. Beta-blockers have become known as the “stage fright pill” amongst performers and anxiety sufferers.

In this article we look at why performers use ‘the stage fright pill’ (beta-blockers like Propranolol) to overcome their anxiety issues, whether they really work, what the alternatives are (is there a ‘natural’ stage fright pill?) and finally answer the question: Does a Stage Fright pill even exist?

What is Stage Fright?

There’s a great article on this website dedicated to defining Stage Fright (or Performance Anxiety). Here’s a quote:

[Stage fright] is the fear someone experiences before and/or during a specific type of performance. When someone has stage fright/performance anxiety, they might fear that the performance will be a failure even if they are well prepared.

Often, the fear is tied to the potential humiliation or rejection that might result from a failed performance. And although performance anxiety can exist around any type of task, it is usually more prevalent among people that have to perform under pressure.

Musical performers, actors, public speakers, and professional athletes are some of the professions where performance anxiety is common. This is why performance anxiety is also known as stage fright ^[2].

It is natural to experience a little bit of nervousness before one has to perform or speak in front of an audience. Some performers even use it to increase their mental focus and intensity on stage.

But for others, performance anxiety can be debilitating to the point of panic attacks. It severely impacts their ability to perform and may even end their performance career.

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Symptoms of Stage Fright

The symptoms of stage fright vary from person to person, both in severity and the actual symptoms. Here are some of the typical symptoms of stage fright ^[3]:

• Heart palpitations (racing heartbeat)
• High blood pressure (may cause dizziness)
• Too much sweating
• Chills
• Trembling of hands
• Shaky voice
• Nausea
• Fainting (in rare and severe cases)

How do beta-blockers work for Stage Fright?

Beta-blockers are also known as beta-adrenergic blocking agents. The main function of beta-blockers is to block the release of adrenaline and other stress hormones ^[4].

Beta-blockers are typically prescribed for cardiac-related health conditions like high blood pressure, angina (chest pains), irregular heart rhythm (arrhythmia), and sometimes migraines.

It is, however, very well-known that beta-blockers have also long been used by performers (like public speakers) to deal with stage fright & anxiety ^[5].

We experience the physical symptoms of social anxiety because of the adrenaline pumping through our bloodstream and your heart working with greater force during/before being in the spotlight.

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 stage fright symptoms at bay ^[6].

Why Do Performers Use Beta Blockers to fight Stage Fright?

In short; performers use beta-blockers because it is too much adrenaline that is responsible for their anxiety symptoms.

When you’re about to go on stage, or you’re about to walk in for an interview or an audition, it is to be expected that you’ll feel some level of stress. Naturally, you will feel somewhat of an adrenaline rush as a part of that stress response.

Some people are actually able to use this stress response to their advantage, perhaps using it to up the intensity of their performance. But if you experience stage fright or performance anxiety, then the stress response is going too far. You are experiencing a much greater effect of the adrenaline hormone, which causes your heart rate to skyrocket, along with other symptoms of stage fright.

Since beta-blockers block the effects of adrenaline, they also prevent you from experiencing the physical symptoms of stage fright. Remaining physically calm has an overall calming effect, which then allows you to get through your engagement.

And this is why a lot of performers and celebrities use beta-blockers. But is it really helping them in their fight against stage fright in the long run? We cover that later, but let’s first look at the different over-the-counter beta blockers on the market today that are used ‘off-script’ for performance anxiety and stage fright.

Propranolol

Propranolol is one of the most popular and commonly prescribed beta-blocker medications in the US. Doctors typically prescribe Propranolol to treat various heart conditions, if lifestyle adjustments fail to do the job.

Here are some of the typical conditions for which your doctor might recommend Propranolol ^[7]:

• High blood pressure
• Irregular heartbeat
• Angina (chest pain)

Propranolol is sold under the following brand names:

• Inderal
• Inderal LA
• Hemangeol
• Inderal XL

Propranolol requires a prescription from your doctor, whether you need it for a heart condition, or you’re considering beta-blockers for stage fright.

Metoprolol

Metoprolol is another very popular beta-blocker that works similarly to Propranolol. It blocks the effects of adrenaline, and it is also usually prescribed to treat cardiovascular issues like high blood pressure, irregular heartbeat, etc.

The brand name version of Metoprolol is Lopressor. Back in 1978, the FDA approved the use of Metoprolol under the name Lopressor ^[8].

Just like Propranolol, Metoprolol also requires a prescription from your doctor. It is prescribed around 27 million times each year in the United States.

Other Beta Blockers

Here are other common beta-blockers available on the market today (and their ingredients):

• Sectral (Acebutolol)
• Coreg (Carvedilol)
• Tenormin (Atenolol)
• Zebeta (Bisoprolol)

All of these beta-blockers are prescription drugs. There are also other medications that people commonly use off-script for anxiety (not including benzodiazepines like Xanax), like Clonidine and Depakote, but these are not technically beta-blockers so we will not cover them here.

It is critical to remember that everyone responds to medications and treatments differently. If you’re considering using beta-blockers for stage fright, or any another condition, be sure to consult a medical professional before you start.

Do Beta blockers really work?

Dr V. Rajashekhar, Senior Interventional Cardiologist & Electrophysiologist at Yashoda Hospitals was quoted saying the following ^[9]:

“Stress and anxiety cause several physical responses in the body. Some of these responses are mediated by a hormone called adrenaline. Adrenaline mediates what is called the flight and fright response in reaction to danger or perceived danger”

As long as you only use beta-blockers occasionally, beta-blockers do really work, are quite safe and have minimal risk of side effects.

Problems can arise if you need beta-blockers to even be able to perform. In this case, you might start using them frequently. If you use beta-blockers too much, it may get to a point where you become dependent on them, and withdrawal could cause other problems like high blood pressure.

So, it is safe to use Beta-blockers 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.

Is there a Natural Beta Blocker Pill?

In some ways, yes, but ultimately we should look at all of the natural alternatives to beta-blockers.

The obvious advantages to natural alternatives are that you don’t need a prescription, but the other benefit 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 stage fright.

One of the natural beta-blocker alternatives that I recommend to clients and people who reach out to me is the brain-boosting supplement PerformZen.

PerformZen uses natural ingredients like GABA, L-theanine, and others, to reduce stress and help you remain calm under pressure ^[11].

There are also other ingredients like magnesium and vitamin B6 that work together to increase mental focus ^[12].

So, you get the best of both worlds with PerformZen. 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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What If I don’t want to take pills at all?

Here are some other techniques for overcoming stage fright & performance anxiety without using medications like beta-blockers or ‘pills’ of any form:

Breathing Techniques

When you are having a stress response and experiencing stage fright symptoms, there’s something called the sympathetic nervous system that is activated in your body. The sympathetic nervous system is responsible for shifting your body to a new gear of elevated stress and tension.

I recommend trying a breathing technique called deep belly breathing, that will deactivate the sympathetic nervous system and restore you into a more regular state ^[12].

As the name suggests, take deep breaths into your belly. Hold the breath for a couple of seconds, then slowly breathe all the way out. Then repeat the process over and over until you feel calmer.

While breathing in and out, focus on the sensations in your body. Where is the breath going, what part of your body are you most aware of, how does it feel in your chest, belly, etc.

When your mind wanders, just gently bring the focus back to the breathing.

Try this for around 15 minutes, about a half-hour before a performance, speech, or other events where you have to perform under pressure.

Exercise & Yoga

If you’ve ever done a hard session at the gym, gone for a long run, or finished an intense hour of yoga, you’ve probably experienced the blissful and almost euphoric feeling that you get after intense exercise. It’s quite difficult to feel anxious and nervous when you’ve just given everything you have on the mat or out on the trail.

You can leverage the same principle to combat stage fright! 15-20 minutes of intense exercise before a performance or speech can do wonders for your mood and confidence.

Exercise, including yoga, has been shown to improve heart rate variability (HRV), which is a measure of how well your body handles stress. Meaning, regular exercise can teach you to remain calm under pressure in stressful situations ^[13].

Focus Outwards

George Clooney used to be terrified of auditions. Before he was successful as an actor, he used to suffer from performance anxiety during auditions.

This changed for him when he was able to shift his mindset. Instead of focusing on what others thought of him, and how it affected his career, he started thinking of auditions as a way to solve a problem for the casting directors.

Clooney realized that the casting directors were desperately hoping that the next person walking in could be the ideal person for the role, and that he was in a position to make it happen for them.

You can also shift the focus away from yourself.

If you’re a speaker, instead of worrying about how the audience might be judging your every word and movement, think of the problems or curiosities that led your audience to show up for your speech.

If you’re an athlete, maybe your teammates also experience anxiety like you, and you can become the person they rely on when the game is on the line.

By focusing on how you can help others, you shift your thoughts away from your own insecurities and reduce your nervousness before a performance.

Does a Stage Fright Pill really exist? And Should I take it?

Stage fright is no joke. If it’s more than a minor case of the jitters, it may even have a significant impact on your life.

Stage fright can hold you back from pursuing your passion as a musician, actor, or a comedian. It can impact your career as an athlete if you repeatedly let anxiety get the better of you during “clutch” moments. And if you’re always feeling anxious at parties, that could be detrimental to your social life.

But the good news is that you don’t have to let stage fright control your life. There are ‘stage fright pills’ in the form of beta-blockers and natural supplements. But there are also techniques that you can use in the eternal fight against stage fright like deep-belly breathing, exercise & yoga to improve HRV and focusing outward, as explained above.

If you are considering beta-blockers, you should know that although it can provide temporary relief, it is not a long term solution. Not to mention, there could be side effects, and you may need a prescription.