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Performance anxiety is a particular type of Social Anxiety Disorder in which a fear of negative evaluation occurs when faced with the prospect of speaking or performing in public. Acting, singing, playing music, competitive sports, or speaking up at school or university are all situations that can trigger performance anxiety. But what exactly is performance anxiety, and what an be done about it?

Features of performance anxiety include[1]:

  • The anxiety occurs specifically in performance situations, and such situations almost always trigger anxiety.

  • The anxiety is out of proportion to the actual threat posed by the situation.

  • There is a fear of negative evaluation.

  • The performance situations are avoided or endured with distress.

  • The fear, anxiety, or avoidance, causes significant distress or impairment in functioning.

In some instances panic attacks may co-occur with performance anxiety.


Performance anxiety can occur in any setting where speaking or performing in public is involved. It could be performing at an end of year school concert, giving a speech at a friend’s birthday, being interviewed for a job, receiving an award in front of a group of colleagues, speaking at a work meeting, or even walking up the aisle where all eyes might be on you. Below are some of the more common types of performance anxiety that we work with here at The Skill Collective.


Nerves or anxiety surrounding public speaking is extremely common, affecting 25% of individuals. [2] Fears of blushing, stammering, feeling your anxiety ‘leaks out’ and will be visible to the audience, looking dumb…these fears can really affect you socially and professionally. This may then lead to avoidance behaviours such as speaking quickly to finish up as quickly as possible, or not looking at someone so as to avoid scrutiny.



Anxiety around musical performance can affect the quality of performance – fine motor control required for playing may be affected, a dry mouth and tightness in the throat can impact on singing or playing a woodwind or brass instrument, there may be forgetfulness around the musical piece (notes, lyrics), or you can simply just freeze. [3] A heightened state of anxiety may even lead to self-medication (e.g. beta-blockers) to dampen down the anxiety, which while helpful in the shorter term only serves to reinforce the anxiety in the longer-term.



Practical or oral exams such as defending your thesis, presenting at ward rounds, or even demonstrating clinical skills you’ve practised many times over - the prospect of scrutiny as you try to perform at your best can often trigger anxiety. This can lead to a ‘fuzzy head’ and result in not focusing properly on the question at hand, or forgetting what steps are involved in completing a routine clinical skill.



‘Choking’ in sport is a phenomenon that we’ve all seen happen or perhaps even experienced ourselves. Heightened levels of anxiety can trigger physical changes that impact negatively on performance, for example your muscles may tense up which is counter to where you want your body to be come match day. Tuning in to your body’s signs of anxiety and how it doesn’t feel ‘right’ can lead to hesitation in executing your game plan.



Anxiety can take hold in competitive dance environments (e.g. ballet, contemporary, ballroom) where fear can set in regarding being open to scrutiny by others and also remembering complex routines.


As with any type of anxiety, there are a typical categories of symptoms to look out for - cognitive, behavioural, and physical. Here’s how they may look in performance anxiety:


At the core of performance anxiety is a fear of being judged negatively. This could relate to judgements of your performance, or even that your anxiety might be ‘on show’ for everyone to see. Related to this, you then become hypervigilant for signs of anxiety and failure or scrutiny, and worrying becomes a feature.

Unhelpful thinking styles and unhelpful interpretations can then come into play, and you focus on any small error that occurs and magnify it out of proportion. Catastrophising can also dial up your anxiety levels and lead to uncomfortable physical symptoms that can interfere with performance (e.g. fine motor control).

An important feature of cognitive symptoms of performance anxiety is the tendency for the brain to feel ‘fuzzy’, which has a significant impact when you consider that thinking clearly is an important part of performance (e.g. remembering what to say and do, recalling strategies for playing against the opponent, knowing which notes to play or lyrics to sing).


When we feel anxious our body goes through a series of physical changes designed to keep us safe - be it through fighting, running away, or freezing. It’s common in situations of performance anxiety to experience symptoms such as butterflies in the stomach, nausea, racing heart, tightness in your chest, and sweating. Some of these symptoms can be very distressing (and even lead to panic) - at its extreme fine motor control may be affected and, in turn, performance may be compromised.


Avoidance is a core feature of anxiety, and when it comes to performance anxiety the avoidance may be overt (e.g. not participating in competitions, concerts, or not putting your hand up in class). The difficulty is that prolonged avoidance can come at a cost to you - for example, when you opt out of apply for a promotion because it involves a public speaking component, or you decide to give up playing an instrument you love because of the fear of others judging you. There may also be subtler forms of avoidance, an example of which may include taking beta blockers or using alcohol.


When it comes to treatment options for performance anxiety, consider the following:

  • COGNITIVE BEHAVIOUR THERAPY (CBT). Cognitive Behaviour Therapy is a highly effective treatment for performance anxiety. It teaches you how to re-appraise self-talk that heightens your anxiety, and teaches you how to manage your anxiety with time and practice. Exposure therapy is used as part of CBT to increase distress tolerance.

  • ACCEPTANCE AND COMMITMENT THERAPY (ACT). A variation of CBT (part of the ‘new wave’ of CBT treatments), ACT teaches acceptance, mindfulness, and detaching from thoughts and discomfort that are part of performance anxiety. Exposure therapy is also used as part of ACT to decrease experiential avoidance. Together these help an individual move towards living a values-based life.

  • PSYCHOPHARMACOLOGY. At times performance anxiety may be so significant that medication may be indicated so that individuals are better able to engage in the ‘talking therapy’ and undertake exposure exercises. If this is the case, speak to your GP about medication options.

If you’re ready to work on Performance Anxiety, why not Contact Us for a tailored approach?

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[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.

[2] Furmark, T., Tillfors, M., Everz, P., Marteinsdottir, I., Gefvert, O., & Fredrikson, M. (1999). Social phobia in the general population: Prevalence and sociodemographic profile. Social Psychiatry and Psychiatric Epidemiology, 34, 416-424.

[3] Papageorgi, I., Hallam, S., & Welch, G.F. (2007). A conceptual framework for understanding musical performance anxiety. Research studies in music education, 28, 83-107.