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A Help Guide for Performance Anxiety - causes, signs, treatment and support.

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Performance anxiety self help guide from Harley Therapy - Counselling & Psychotherapy in London

Updated May 28, 2024 by Dr. Sheri Jacobson Dr Sheri Jacobson

Performance Anxiety: A Help Guide

What is performance anxiety?

Performance anxiety is a term used to describe a persistent reaction of fear and anxiousness when faced with the prospect of having to do something while being watched, even if it is only by an audience of one. If you are a sufferer, often just thinking about having to perform for others is enough to trigger an attack of what is also know as 'stage fright'.

Performance anxiety is not a disorder in and of itself, and many people suffer it to some extent. It is quite normal, for example, to get nervous before having to give a speech at a wedding or at work.

But some sorts of performance anxiety can be very psychologically draining and make life quite difficult,  such as having performance issues around intimacy. 

If you suffer from constant performance anxiety and it is increasingly severe, and if your stage fright does not diminish but seems to be growing worse with each performance required of you, it could be that your stage fright is part of a bigger problem such as an anxiety disorder or social phobia.

How common is performance anxiety?

Performance anxiety is experienced by most people at some point in their lives, even if it's just over a school presentation or an interview for a coveted job. And it can strike rather randomly, with someone who is used to being in front of audiences suddenly finding themselves with a bout of stage fright.

Performance anxiety is experienced more often by those in occupations that involve presenting to an audience, such as actors, musicians, politicians, and students.

Severe performance anxiety is less common. This is the kind of performance anxiety that begins to affect your very way of life, such as meaning you have to change jobs, can't reach a goal that is important to you, find relationships difficult, or begin to find having a social life challenging. This sort of performance anxiety is often connected to the development of social phobia or an anxiety disorder.

What are the signs of performance anxiety?

The signs of stage fright are mostly physical. They are similar to that of a panic attack, which is to be expected as both panic and anxiety trigger your innate 'fight or flight' response. 

These signs can include:

  • rapidly beating heart
  • laboured breathing
  • feeling extremely alert or extremely tired
  • shaky limbs
  • feeling dizzy and spaced out
  • mouth gone dry
  • sweating
  • speechlessness or stuttering
  • blushing
  • vomiting, diarrhea, blurred vision (extreme cases only) 


The mental symptoms of stage fright involves negative thoughts and self-doubt, such as thinking "I'm a fraud", "I shouldn't be here", "I am going to make a fool of myself" and "I am useless". Performance anxiety can also trigger black and white thinking. This means you assume the most extreme outcome such as deciding the performance will result in you losing your job, never being able to look anyone in the eye ever again, or put you in jeopardy of a heart attack. 

What causes performance anxiety?

The symptoms of performance anxiety are caused by the triggering of the 'fight or flight' response. The fight or flight reaction causes the body to activate its sympathetic nervous system, releasing chemicals like adrenaline and cortisol. Built into the human brain as a protective measure in prehistoric times when there was a real chance of attack from wild animals or other humans, the response is often overly strong for modern day 'dangers' like feeling we'll make a fool of ourselves. 

But why would the thought of performing trigger a strong fight or flight response in some people, but not others? Various factors can be at play to make one person have stage fright and another not. These can include:

Temperament – some people seem born with a more sensitive nervous system or a tendency to be more introverted than others, meaning they are more anxious in certain situations. 

Past experiences – if you had a bad experience when doing a presentation in the past, or were teased for something as a child like a role in a school play, or otherwise received negative attention you didn't want, this might unconciously be feeding your anxiety around performing in the present.

Level of expertise – it's more common to have performance anxiety if it is your first time doing something, or it's something you don't have a track record of being good at yet.

Situational stress – if the rest of your life is presently stressful, you are more likely to be tired and emotionally sensitive, which might make you more  vulnerable to stage fright.

What are the recommended treatment methods?

Performance anxiety responds well to treatment, and support can help you overcome your issue much more quickly. If your performance anxiety is affecting your life negatively or stopping you from achieving your goals and moving forward it can help to see a coach or counsellor instead of trying to manage by yourself. 

A coach can help you look at what triggered your stage fright, sourcing the fears, regrets, and limiting beliefs that might be behind it. This can be particularly helpful with occupational stage fright.

If your performance anxiety might be connected to events as a child that have left you with low self-esteem, a counsellor or psychotherapist can help you work through your past experiences and become more confident in yourself as an adult.

And if your stage fright has become unbearable and is making it impossible to have relationships, or you suspect you are actually suffering an anxiety disorder or social phobia, a therapist is highly recommended.

Cognitive-behavioural therapy (CBT) can be helpful with occupational performance anxiety and is also evidence-based for anxiety disorders. CBT aims to help you understand your reactions to stress and how your thoughts are behind your stress. It can help you revise your negative perceptions about being in front of an audience.

Psychodynamic therapycan be helpful if your performance anxiety is related to events in your past. A psychodynamic or psychoanalytic therapist is likely to encourage you to explore the meaning and content of your stage fright. Is it linked to inner conflicts and fears, or to childhood experiences and relationships?

What if help is not sought?

If you have one-off performance anxiety, it's not likely to cause you long term problems. Once your presentation, interview, or show is over, you are likely to feel good again.

But if performance anxiety is a constant issue for you and you do not seek support, there can be long-term consequences. You might never get ahead in your career, or find yourself in jobs that do not match your skill level. You might feel unable to attract the relationships or life experiences you desire. Over time, not living up to your potential can wear down your self-esteem. Given that low self-esteem is a leading cause of depression, performance anxiety can set off a cycle that leads to mood disorders, or in some cases anxiety disorders and phobias.

Well-known people with performance anxiety

Many top performers have admitted to debilitating performance anxiety. This includes the singers Lorde, Adele, Andrea Bocelli, Rod Stewart, Barbara Streisand, and Robbie Williams, whose stage fright became so overwhelming at one point he even cancelled a string of concerts.

Actors who suffer from performance anxiety include Amanda Seyfried, Kim Cattrall, William Shatner, and Hugh Grant, who claims that stage fright is behind his early retirement.

Useful tips for managing your performance anxiety

Put your attention on the work

Performance anxiety has a tendency to blind us to the obvious – that an audience is less interested in the performer than the deliverables. Combat stage fright by consciously noticing when you are obsessing more on your anxiety and what others will think of you than the work itself.

And remember, although performance anxiety can operate in mysterious ways, it is self-evident that the more prepared you are for your time in front of an audience, the more confident and in control you are likely to feel. Consider asking someone who is already accomplished at what you will be doing for their advice or mentoring.

Accept your anxiety

Performance anxiety has a tendency to feed on resistance. The more you try to fight it off, the greater the panic can feel. Accept that some level of stage fright is normal.  Notice your bodily reactions (heart racing, sweating) and accept that they are normal 'fight or flight' responses. This tends to have the result of soothing the body and helping it relax. You might even try reframing your stage fright. How much is really anxiety, and how much is a more positive feeling of excitement?

Be mindful

Mindfulness is a tool that has become popular with therapists. It helps you cultivate a stronger awareness of the present moment. This is very useful when it comes to anxiety, because anxieties tend to be based in the past (I didn't do well last time) and the future (what if it goes so badly I lose my job). If you focus on what is going on for you right now instead, it's often not such a bad picture.

In fact mindfulness helps you recognise the negative thoughts behind your self-doubt in the first place, meaning you have more opportunity to replace such thoughts with more realistic ones. For example, if you are mindful enough to catch that you just thought you are useless at public speaking, you can remind yourself that you gave a speech in school that went over just fine.

Notice black and white thinking

Anxiety often speaks in black and white. In other words, you will think of worst case scenarios instead of rational thoughts. Try to notice when you are doing this, and practice choosing a more balance thought (this is actually a tool that CBT therapy teaches).

For example, if you have to give a speech at a friend's wedding and find yourself thinking you will be laughed at, assess the logic of this. Have you ever been at a wedding where someone laughed meanly or mocked a speaker? Have you not given a speech in the past and managed to get through it? What is a more realistic thought? That some people might enjoy your speech and others won't but it isn't the focus of the evening?

Relax Your Body

Learning tools to quickly relax your body can be very helpful as they lower the fight or flight response that leaves you feeling anxious. You might want to look into a process used by some psychotherapists called progressive muscle relaxation. Or learn deep relaxing breathing, such as the steady breathing that can be part of a mindfulness practise.

Change perspective

Performance anxiety can have you only seeing from the very narrow perspective of your inner critic. Try to see the bigger picture. What does your audience really think – are they even half as concerned as you? How important is this performance, really, in the grand scheme of things? What would your 80 year-old self feel about it, would they tell you not to sweat it? You can even experiment with different perspectives entirely. If you were Madonna or Richard Branson, how would you feel about having to perform?

Up your self care

Feeling exhausted or poorly put together makes it far easier to feel anxious. During the week you know you will be experiencing performance anxiety make a greater effort to take care of yourself. Say no to social engagements that might leave your drained or having a late night. Eat well, take time for exercise, and get enough sleep.


Disclaimer: This Guide has been produced to complement but does not replace any advice, guidance or information from a health professional. See here for full disclaimer.
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