Muscial performance anxiety is a type of anxiety experienced by some people with social anxiety disorder (SAD). Musicians who suffer with this type of anxiety are critical and self-evaluative before, during, and after performances. This negative self evaluation causes disrupted concentration and a host of physical symptoms that result in a performance below the ability of the musician.

Why do some musicians experience such debilitating performance anxiety? When musical performance anxiety is experienced as part of SAD, it is likely due to a combination of factors such as innate temperament and negative early performance experiences. In general, researchers have found that females are more likely than males to experience this type of anxiety.

What does musical performance anxiety feel like? If you suffer with this fear, the following statements probably sound familiar. Questionnaires with statements similar to these have been used by researchers to examine the thoughts and feelings experienced by people with musical performance anxiety.The harder I work to prepare for a concert, the more likely it seems that I will make a mistake.

I worry about a negative reaction from the audience.

I have a sense of dread before performances.

I worry about performing weeks or months in advance.

I never know the night of a performance whether or not I will do well.

There are times during performances when I wonder if I will make it through.

Problematic thinking is often at the root of musical performance anxiety. Thoughts such as “My performance needs to be perfect or I am a complete failure” or “I had a good performance tonight but I must have just been lucky,” create and maintain anxiety. Below are some common thought distortions that may be contributing to your anxiety about performing.Black or white thinking: “If my performance isn’t perfect, I am a failure.”

Overgeneralization:
“I had a bad performance tonight; I have always been a bad performer and always will be.”

Mental filter:
“Everyone must have noticed how I messed up in the middle; it doesn’t matter that the rest was OK, my mistake ruined the performance.”

Disqualifying the positive: “I had a good performance tonight but I must have just been lucky.”

Jumping to conclusions: “The audience was really quiet tonight, they must not have liked my performance.”

When musical performance anxiety is part of SAD, cognitive-behavioral therapy (CBT) with a trained therapist can be helpful to identify cognitive distortions and work towards more positive thought patterns. In addition, behavioral therapy interventions such as cue-controlled relaxation, systematic desensitization, progressive muscle relaxation, and breathing techniques may help to reduce anxiety when performing.

Although cognitive and behavioral interventions can be successful on their own, pairing these treatments with medication may reduce anxiety more quickly and effectively. Medications such as beta blockers can be helpful to manage anxiety symptoms during performances. Beta blockers such as Inderal (propanolol) taken before a performance reduce symptoms of anxiety such as increased heart rate, shaking and sweating. In addition to beta blockers, benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) may be helpful in managing musical performance anxiety.

If you are a musician dealing with severe performance anxiety, it is important to get help. Although some anxiety about performing is normal and may even enhance your performance, excessive anxiety is neither helpful nor inevitable. There are options to overcome your fears and reach your full potential as a musician, but you need to make it a priority to get your anxiety under control.

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Many a performer who has remained calm prior to performing has fallen apart during a performance. If you have prepared well for a concert and used coping strategies to manage pre-performance jitters, it is time to tackle your stage fright during the performance. Below are some tips to help manage anxiety during a musical performance.Positive Thinking. Although positive thinking alone will not prevent performance anxiety, positive thoughts are certainly more supportive of a successful performance than negative thoughts. By making sure that you think positively during rehearsal, it is more likely that you will be thinking positively on stage.

Avoid Self-Medication. Some performers cope with musical performance anxiety by drinking or using street drugs. There are a number of problems with self-medication such as a lower-quality performance, problems with addiction, and negative effects on health.

Act “As If.” Even if you feel nervous, try to act calm and confident. Focusing on feelings of anxiety will only make them worse. If you try hard enough to project an air of confidence you may actually begin to feel more confident.

Stay in the Moment. While you are performing, be sure to stay in the moment. Don’t worry about upcoming parts of the performance or a mistake that you just made. Athletes call this type of state “being in the zone.” A good way to stay in the moment is to avoid internal dialogue when performing. Allow yourself to be carried away by the music and performance and tune out the critical voice in your head.

Acknowledge the Audience. Although it can be tempting to pretend the audience is not there, a more productive approach is to imagine them as a group of supportive friends. Even if you are performing in an evaluative context such as a musical exam, imagining the examiner as warm and friendly will help to reduce your anxiety more than if you imagine him as critical and judgmental.

Acknowledge Some Anxiety. Every performer experiences a little bit of anxiety before going on stage, and many find that a bit of nerves make for a more vibrant performance. Realize that you will not completely eradicate your anxiety, but that you can live with being a little bit nervous.

Trust Yourself. At the end of the performance, before you hear any critiques or reviews, ask yourself how you did. Be honest, and congratulate yourself if you performed well. If later you receive criticism from audience members, know that your own evaluation was positive, and that how you feel about your performance matters the most because you know your abilities best.

If after implementing some of the above strategies you still find that your performance anxiety is out of control, it may be time to seek professional help. Musicians who suffer from social anxiety disorder (SAD) benefit from formal types of treatment such as cognitive-behavioral therapy (CBT) and medication. In addition, if your anxiety is not limited to musical performances but spread across a range of social and performance situations, treatment aimed at the underlying cause of your fear will be more helpful than strategies narrowly focused on musical performance anxiety.

Sources:

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Generalized anxiety disorder (GAD) and social anxiety disorder (SAD) share many similarities but differ in one important way: If you suffer with GAD, your worry tends to be broad and not limited to particular situations or circumstances. On the other hand, if you have SAD, the symptoms you feel are always related in some way to social or performance situations in which you expect scrutiny or evaluation by others.

If you have GAD, you will experience:an unhealthy tendency to worry about a variety of things (e.g., work, family, money, health)

a tendency to anticipate the worst and to worry over trivial matters

the inability to control your worry

physical symptoms, such as fatigue, headaches, restlessness, muscle tension and trouble sleeping

behavioral symptoms, such as irritability

When you suffer with SAD, you will share characteristics, such as a tendency to worry and anticipate the worst, an inability to control anxiety and trouble sleeping, with GAD. Your anxiety, however, is always triggered by social and performance situations. In addition, you know that your anxiety is irrational and out of proportion to the event that triggers it.

When you suffer with GAD, you may fear embarrassment in front of others, but it is not your main focus. As an example, consider a professional athlete with each of these disorders: The athlete with GAD may worry excessively about his ability to compete and provide for his family as well as his physical health — in this way, his anxiety is very broad in scope. On the other hand, the athlete with SAD will also worry excessively, but the worry will be focused on the anticipation of these competitions, where he will be evaluated.

If you believe that you may suffer with GAD or SAD, talk with your doctor about the symptoms that you are experiencing. Ideally, you should receive a referral to a mental health professional for diagnosis and treatment.

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Teaching teenagers with social anxiety disorder (SAD) can be challenging. Schools are an important piece of the puzzle when it comes to SAD in teens. Unfortunately, many teachers and school counselors are not familiar with the symptoms of the disorder; students with severe anxiety may even be mislabeled as oppositional or defiant. Hopefully as more teachers and school professionals learn about SAD, awareness will be raised about the disorder, and treatment programs can be introduced in the schools.

If you are a teacher of a student with SAD, how can you help?

It is important to gain the trust of a teenager with SAD. You may need to change some classroom procedures to adapt to the teen with social anxiety. Although it may be tempting to try and force an anxious teen out of his shell by calling on him often in class, the best strategy is to remove all pressure on the student to speak up.

Let him know that you will only call on him if he raises his hand, and that you will not make a big deal out of his lack of participation in class. By the same token, if he decides to speak up, let him know that you will not make a big deal of this either. If you believe that the student is having difficulty with material, quietly offer to review concepts and instructions — otherwise the student is unlikely to ask for help and may fall behind.

Above all else, be sure to work with parents and any other school personnel when planning how to help the student with SAD. It is through a combined effort with these different parties that the student will benefit the most. Finally, if you suspect that a teenager may be suffering with SAD, it is important to discuss your suspicions as soon as possible with the appropriate professional at your school. Left undiagnosed and untreated, SAD can lead to multiple mental health problems in adulthood.

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It can be a huge hurdle for those looking for work. However, if you suffer with social anxiety disorder (SAD), job interviews can be not only anxiety-provoking, but almost impossible to get through. Not only are you required to meet strangers and talk about yourself, but the strangers are in a position of authority. You are being evaluated and judged on your appearance, your demeanor and your ability to sell yourself. This is not a good combination for those with SAD.

If your suffer from SAD, it is important to seek formal treatment, such as medication or cognitive-behavioral therapy (CBT). However, there are also strategies that you can use to help alleviate nerves before an interview.

If you have SAD, or are simply nervous about a job interview, the following tips may help you to cope with your anxiety. Treat Yourself Well

Avoid caffeine, get enough sleep, and exercise regularly. By following these three simple rules, you will greatly reduce . Visualize Success

Find a quiet space where you won’t be disturbed, close your eyes and visualize yourself being successful in your interview. Visualizing success is more than just positive thinking; when done correctly, you are getting your brain ready to behave in the way that you desire. This technique is used by elite athletes before competitions to improve performance.Reduce Stressors

Reduce stressors unrelated to the actual interview, such as uncomfortable clothing, getting lost, or showing up late. Well in advance, choose an outfit that is comfortable and that looks good on you. If you aren’t familiar with the location of the interview, give yourself plenty of time to find it or do a trial run a day or two before. Do Your Research

Being well-prepared is a great antidote to anxiety. Research your potential employer. Prepare answers to common questions. Every bit of preparation that you can do will help to increase your comfort level and make you feel more confident and capable in the interview. Don’t Succumb to Pressure

Once in a while, you may be interviewed by someone who grills you to see how you handle stress. Although as a person with SAD it can be tempting to start spiraling into negative automatic thinking, such as “He knows I can’t handle this job; I should never have applied” or “They don’t really like me; I’ll never get the job”, stop. If you find yourself in this situation, realize what the interviewer is trying to accomplish and don’t let him ruffle your feathers. Know that the other candidates have been treated the same way and that it is no reflection on you or your capabilities.Interview the Interviewer

A great way to feel less self-conscious in an interview situation is to realize that interviews are a two-way street. You are deciding whether you want to work for an employer just as much as they are deciding whether they want you to come work for them. Try putting yourself in this mindset and see if your focus doesn’t change.Release Anxious Energy

Anxiety has a way of leaking out even when you think that you have it well-hidden. If you find yourself fidgeting, try doing something to release anxious energy that no one will notice, such as wiggling your toes.Take Your Time

Realize that you don’t have to answer questions immediately. Pause before answering and collect your thoughts. If you worry about drawing a blank during interviews, a great technique is to take notes as everyone talks. This takes the focus off of you and allows you to refer to your notes after a question has been asked. If you start to draw a blank, keep making notes and comment that you want to collect your thoughts before responding.Be Prepared

A well-prepared interviewee has an immediate advantage in an interview. In addition, being well-prepared and proactive will take the edge off of . Be sure to bring everything that you think you might need, such as your resume, cover letter, business cards, references, licenses, certifications, and a pen and notepad. Congratulate Yourself

Regardless of how you felt that the interview went, congratulate yourself afterward for taking the chance. Do something that you enjoy as a reward. Above all else, avoid ruminating about how the interview went or what could have gone better.

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Anxiety before a musical performance can be a problem even for seasoned performers. If you are a musician who suffers from anxiety before a musical performance, you know firsthand the terrible impact that anxiety symptoms can have on your performance. If your anxiety is part of social anxiety disorder (SAD), it is important to receive treatment such as medication or cognitive-behavioral therapy (CBT). However, there are also a number of self-help coping strategies that you can use to reduce your anxiety.

In the months, weeks, and days leading up to a performance, work to keep your anxiety at a minimum. Some of helpful strategies include adequate rehearsal, preparation of non-musical matters, use of relaxation techniques, and careful selection of repertoire. Here, some tips to help you manage anxiety while preparing for a musical performance.Rehearsal: Try to fit in at least three to four rehearsals prior to the actual performance. If possible, rehearse in the location where you will perform; this is especially important for piano players in order to get comfortable with the instrument. In addition to actual rehearsals, visualizing a successful performance is a good way to mentally prepare yourself to succeed.

Preparation: Being prepared as a musician means more than being ready to perform. Make sure that you have taken care of all loose ends so that you are not scrambling at the last minute and feeling anxious. Do you need a page-turner? Make sure to arrange one ahead of time. Have you chosen your wardrobe? Be sure to have an outfit that you are comfortable in chosen well in advance of the performance.

Relaxation: There are a variety of relaxation techniques that you can use to help keep anxiety symptoms under control prior to a performance. Deep breathing, progressive muscle relaxation, autogenic training, meditation, yoga, and other eastern disciplines will help to keep you focused and calm.

Memorization: Choose several sections of a piece as designated “memory stations” that you can jump to if you are in trouble. Sometimes simply knowing that you have memory stations makes it easier to relax and worry less about making mistakes.

Assessment: Assess your abilities as a performer, and be realistic in terms of your choice of music. Do not choose a piece that is beyond your skill level or that you do not have enough time to learn. It is better to perform well within your comfort zone than to fail because you chose a piece that was too difficult.

Once you have successfully used coping strategies to manage pre-performance jitters, it is time to face your fears the day of the performance. If you suffer with severe anxiety and self-help coping strategies do not seem to be helping, you may want to see a professional. When musical performance anxiety is part of SAD, formal treatment such as CBT or medication is usually advised.

Sources:

Kenny DT, Osborne MS. Music performance anxiety: New insights from young musicians. Advances in Cognitive Psychology. 2006;2:103-112.

Kirchner J. Managing musical performance anxiety. American Music Teacher. 2004;Dec.

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If you are the parent of a teen with social anxiety disorder (SAD), it can be hard to know how best to help your teen cope. In addition to helping your child obtain a proper diagnosis and effective treatment, such as cognitive-behavioral therapy (CBT) and/or medication, there are a number of steps that you can take to help your teen on a daily basis.Exposure to Social Situations

Although it may be tempting to be overprotective or to shelter your adolescent, it is important to provide her with confidence-building experiences. Gradual exposure to new social experiences will help her build social skills and feel more confident about her abilities. This will inherently involve some pushing beyond her comfort zone, but that should of course be approached in a measured way. A therapist can guide this, and your involvement as a parent is key.

If you have a younger teenager, be sure to give her the opportunity to speak for herself in situations such as ordering in a restaurant or asking for movie tickets. Be sure to offer praise and rewards when your teen faces feared social situations. Listen and Offer Advice

If your teenager is comfortable talking to you about her feelings, listen carefully and offer advice. Let her know that feeling nervous sometimes is normal for all teenagers. Remind her of how she has coped well in the past with difficult situations, and let her know that you have confidence in her ability to cope.

If your teenager is suffering from extreme social anxiety that greatly impairs her daily functioning, has stopped her from attending school, or has posed a danger of self-harm or suicide, it is important to seek professional help immediately.

Sources:

Akron Children’s Hospital. Social phobia and excessive shyness in teens. Accessed Oct 27th, 2009.

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Tips for Teaching Teenagers With Social Anxiety Disorder
Teaching a teenager with social anxiety disorder can be more difficult than working with students who do not suffer from social anxiety. Learn about how to help the student with SAD cope in the classroom.

Three Tricks for Starting a Conversation With a Stranger
Starting a conversation with a stranger can be difficult if you suffer with social anxiety disorder. Here are some tricks to get you help you become better at opening conversations with strangers.

How to Talk to People When You Have Social Anxiety Disorder
It can be hard to know how to talk to people if you have social anxiety disorder (SAD). Having a great conversation with someone can be as simple as doing something together to stimulate conversation.

Public Speaking Anxiety: Preparing to Give a Speech
Public speaking is a common fear among people with social anxiety disorder (SAD) as well as in the general population. One strategy for reducing speech anxiety is to prepare well before a speaking engagement. Here are some tips for making the most of your prep time.

Public Speaking Anxiety: Giving a Speech
Giving a speech can be a nerve-wracking experience if you have social anxiety disorder (SAD). Read more to learn about coping strategies that you use to help manage anxiety and put your best foot forward on the day of a big speech or presentation.

How to Ask Someone on a Date
It can be difficult to know how to ask for a date when you suffer from social anxiety. Here is a relatively painless way to give it a try.

Developing Good Eye Contact
Eye contact is often described as anxiety-provoking by people with social anxiety disorder (SAD). Still, good eye contact is one of the keys to successful social interaction. Use this quick tip to make sure that you are taking advantage of this useful social skill.

How to be Assertive
Assertiveness is an effective means of communication and a skill that you can learn.

How to Make Requests
Making requests of others requires the use of assertive communication.

How to Refuse Requests
Refusing requests of others requires the use of assertive communication.

Social Anxiety and Weddings
Choosing a wedding party can be a little more difficult when you suffer with social anxiety disorder. There are no hard and fast rules about how to choose your attendants and allowing yourself some flexibility can help with this wedding task.

Social Anxiety and Weddings
Giving a wedding speech can be challenging if you suffer with social anxiety. Here are some tips for managing anxiety about delivering a speech at your wedding.

Social Anxiety and Weddings
The first dance at your wedding can be nerve-wracking, particularly for brides or grooms suffering with social anxiety. Here are five tips to ease your nerves before you step out on the dance floor.

Social Anxiety and Weddings
Managing out-of-town guests during your wedding can be challenging when you suffer with social anxiety disorder. Here are some tips to make sure that you don’t become a tour guide instead of a bride or groom.

Social Anxiety and Weddings
Planning a wedding when you suffer from social anxiety disorder can be a challenge. Here are some tips to make the process a little easier.

Social Anxiety and Weddings
There are many reasons to have a receiving line at your wedding if you suffer with social anxiety. Here are five reasons why you may want to consider having a receiving line if you get married.

Social Anxiety and Weddings
Saying wedding vows can be more difficult if you suffer with social anxiety. Here are some tips to help overcome anxiety about saying your wedding vows.

Social Anxiety and Weddings
As a bride with SAD, you may worry about social anxiety while walking down the aisle. Here are some tips to keep anxiety at bay during this special time.

Social Anxiety and Weddings
Bridal shower anxiety can be a problem for shy brides, but for those with social anxiety disorder, nerves can become overwhelming. Here are some tips for managing worry and anxiety when you have to be the center of attention at a bridal shower.

Social Anxiety and Weddings
Wedding photos may be difficult if you suffer with social anxiety. Here are some tips to help relax prior to your photo shoot.

Social Anxiety and Weddings
Social anxiety during your wedding reception can make the process of meeting and greeting guests difficult. Use these tips to help manage anxiety and make mingling during the reception a little easier.

How to Practice Autogenic Training
Autogenic training is a form of relaxation training similar to meditation that induces relaxation by influencing the autonomic nervous system. The technique involves a set of self-statements about the body and is used for reducing anxiety and improving other conditions.

How to Practice Guided Imagery
Guided imagery is a relaxation technique that focuses on visualization. By visualizing images of a serene and relaxing environment, the body, in turn, enters a relaxed state. Guided imagery is often used in combination with other relaxation techniques as part of treatment for anxiety disorders.

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Although we are all capable of breathing this way, very few of us actually do so on a daily basis. Practice this breathing pattern while you are in a relaxed and safe environment. This way, you will be more likely to use this technique when faced with situations that trigger the symptoms of social anxiety disorder (SAD).

For those who suffer with medical conditions, please consult with your doctor prior to beginning any type of relaxation training exercise.How to practice Find a quiet place free of distractions. Lie on the floor or recline in a chair, loosen any tight clothing and remove glasses or contacts. Rest your hands in your lap or on the arms of the chair.

Place one hand on your upper chest and the other hand on your stomach. Inhale, taking a deep breath from your abdomen as you count to three. As you inhale you should feel your stomach rise up. The hand on your chest should not move.

After a short pause, slowly exhale while counting to three. Your stomach should fall back down as you exhale.

Continue this pattern of rhythmic breathing for five to ten minutes.

In addition to following these instructions, you may consider listening to a voice recording such as the free MP3 audio file offered by McMaster University which includes directions on practicing . Use of an audio recording allows you to fully relax and concentrate on the technique.

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The first choice of medication for treating social anxiety disorder (SAD) is usually a class of medications called selective serotonin reuptake inhibitors (). are also used to treat other disorders such as depression. affect your brain chemistry by slowing reabsorption of the neurotransmitter serotonin, a chemical believed to regulate mood and anxiety.Types of

Six are recommended in treating SAD. Your doctor may prescribe any one of the following. Each medication is listed by the brand name followed by the generic name in parentheses: Celexa (Citalopram)Paxil (Paroxetine)Prozac (Fluoxetine)Lexapro (Escitalopram)Luvox (Fluvoxamine)Zoloft (Sertraline)

Three , paxil, zoloft, and luvox have been approved by the FDA for treating SAD. However, all have been shown in clinical studies to offer improvement of symptoms. Paxil was the first SSRI to receive FDA approval and is often the first choice for treating SAD. However, the medication that works for one person doesn’t always work for another. So, your doctor will work with you to find the right prescription for you. How Do I Take an SSRI?

Your doctor will give you specific instructions on how to take your medication. It is important that you follow these directions. Generally, you will take an SSRI once a day, usually in the morning. Your doctor will usually prescribe a low dose initially, which will be increased gradually. The dose that you require does not necessarily relate to the severity of your symptoms. Sometimes it is simply a reflection of your unique metabolism. It may take several weeks for you to notice improvement of your symptoms. What are the Side Effects?

are generally the preferred medication for SAD because the side effects tend to be well-tolerated. Nevertheless, as with all medications, several possible side effects include:Sleep problems: drowsiness, fatigue or insomniaSexual dysfunction: decreased sex drive, delayed or absent orgasm, erectile dysfunctionPhysical ailments: skin rashes, dry mouth, headaches, nausea, dizzinessAnxiety-like symptoms: irritability, nervousness, shaky hands, sweatingEating problems: weight gain or loss, loss of appetite

If you have great difficulty with side effects, your doctor may decide to prescribe a different SSRI. In general, lower initial doses that are gradually increased reduce the likelihood that you will experience problematic side effects.Advisories/Warnings

should never be taken at the same time as monoamine oxidase inhibitors (MAOIs). The results of such a combination can be fatal. In addition, never start taking one of these medications within weeks of stopping the other.

In 2004, the FDA released an advisory concerning and risk of suicidal thoughts and behaviors. Although rare, it is possible during the initial phase of treatment for symptoms to worsen rather than improve. It is important to monitor symptoms during this time and report any negative changes to your doctor.

In addition to the FDA advisory on suicidal thoughts, there has also been an advisory released regarding the use of triptans for migraine headaches in combination with . In combination, there is a risk of serotonin syndrome, a potentially life-threatening condition. In general, it is important to inform your doctor of all medications, both prescription and nonprescription, that you are already taking.Discontinuing Treatment

should always be discontinued under the supervision of a medical professional. Abruptly stopping these medications can result in a relapse of anxiety symptoms and serotonin withdrawal symptoms including trouble with coordination, tingly sensations, vivid dreams, flu-like symptoms, anxiety, and depressed mood. To avoid these serotonin withdrawal symptoms and the possibility of relapse, should always be gradually tapered off.

Sources:

Bezchlibnyk-Butler KZ, Jeffries, JJ, eds. Clinical Handbook of Psychotropic Drugs. Toronto, Canada: Hogrefe & Huber; 2003.

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