Performance anxiety: symptoms, causes and what helps

Performance anxiety is a common human response to situations in which you feel evaluated or exposed. BAPAM, a UK charity supporting the health of performing artists, says everyone suffers from it at some point, describing examples such as your mind going blank during an interview, your heart racing before a keynote presentation, or palms sweating as you walk on stage. It quotes famous performers who have described years of nerves and fear of fainting before going on stage.

The term is not a diagnosis in itself. The NHS describes social anxiety disorder, also called social phobia, as a long-term and overwhelming fear of social situations, including finding it difficult to do things when others are watching. Performance anxiety can overlap with social anxiety.

What distinguishes ordinary nerves from a problem is how much they interfere with life. The NHS says that if anxiety, fear or panic is affecting your life, there are things you can try, and support is available if you are finding it hard to cope.

The NHS lists physical symptoms of anxiety, which are also typical of performance anxiety: a faster, irregular or more noticeable heartbeat, feeling light-headed and dizzy, headaches, sweating, breathlessness, feeling hot, shaking, and stomach upsets such as nausea. Mental symptoms include feeling tense or nervous, being unable to relax, difficulty concentrating and fear of the worst happening.

BAPAM stresses that the experience is unique to each person and suggests that performers describe exactly how performance anxiety feels, physically and mentally, rather than using predetermined measures. Writing down how you felt physically, how you felt emotionally, what thoughts went through your mind and how you behaved can reveal patterns.

• Racing heart, sweating, shaking, dry mouth or feeling sick before or during the event.

• Mind going blank or difficulty concentrating.

• A flood of negative thoughts about making mistakes or being judged.

• The urge to avoid or escape the situation.

• Feeling worried before, during and after the performance.

BAPAM says performance anxiety often brings a flood of negative self-talk that can come from deep-rooted beliefs about needing to be perfect to be accepted, constantly comparing yourself to others, harsh feedback and comments from teachers, parents or others, and the brain’s threat system interpreting the situation as dangerous and setting off a fight, flight, freeze or fawn response.

The NHS says that when you feel anxious or scared your body releases stress hormones, which explains why the symptoms are physical as well as mental. It also says there are many different causes of anxiety, and that it is different for everyone, so the same task can trigger very different reactions in different people.

BAPAM’s performance psychologist describes techniques drawn from cognitive behavioural therapy (CBT), relaxation and visualisation, which help people reframe negative thoughts, reduce physical tension and focus on the present moment. Rather than just calming nerves, the approach aims to identify individual triggers and reshape unhelpful beliefs and patterns of behaviour.

The NHS advises seeing a GP if you are struggling to cope with anxiety, fear or panic, if the things you are trying yourself are not helping, or if you would prefer a referral to an NHS talking therapies service. If you are 18 or over (or 16 or over in some areas) you can refer yourself directly to an NHS talking therapies service without talking to a GP.

For social anxiety the NHS says it is a good idea to see a GP if it is having a big impact on your life, and that cognitive behavioural therapy with a therapist is generally considered the best treatment, with guided self-help and, in some cases, antidepressant medicines also used. The NHS’s anxiety pages also recommend avoiding using alcohol, cigarettes, gambling or drugs to relieve anxiety, as these can contribute to poor mental health.

The sources read for this guide do not describe a medicine specifically licensed for performance anxiety, and the NHS pages cited discuss treatment of anxiety disorders more generally. For social anxiety the NHS lists CBT, guided self-help and SSRI antidepressants. Any decision about medicines should be made with a GP or psychiatrist, who can consider your health, other medicines and the pattern of your symptoms.

BAPAM offers information for performers, with resources on performance psychology and visualisation. Practising skills in varied settings, as BAPAM suggests, helps you use them under pressure. Preparation also matters: the cognitive restructuring examples emphasise being well prepared, knowing you can pause, breathe and use prompts to get back on track.

NHS talking therapies services provide CBT-based help for anxiety and can be self-referred, and the NHS also lists Every Mind Matters self-help CBT techniques and free mental wellbeing audio guides. These are suitable if performance anxiety sits within wider anxiety or social anxiety.

For performers, BAPAM provides health information and performance psychology resources. Some people also choose private performance psychologists or CBT therapists, particularly where the issue is specific to a profession such as music, sport or public speaking. If you choose private care, check the practitioner’s professional registration and experience with your type of performance.