Treating a performance of stage fright

Tue, Oct 9, 2012, 01:00

MEDICAL MATTERS:Performance anxiety is a form of social phobia, writes DR MUIRIS HOUSTON

I’M SURE many readers will empathise with my childhood memory of standing on the stage of a local feis with knees knocking from the terror of reciting a poem or playing a musical instrument for the first time in front of an audience.

For those of us who do not pursue a performance career, that distant memory is probably as bad as it gets. The late Maureen Potter famously described how she routinely retched before a performance, although she also maintained that on the occasions she did not get physically sick, her stage act was not as polished.

But stage fright can be disabling for the professional and is now recognised as a diagnosis in its own right. And it will be the subject of a talk at Ireland’s first ever musicians health conference to be held at the Radisson Blu hotel, Galway next Saturday, October 13th.

Irish German expert Dr Deirdre Mahkhorn from the University of Bonn, herself a fully trained soprano, will speak on Don’t be scared – it’s only Mozart.

Working as a consultant psychiatrist at Bonn University Hospital, the UCC medical graduate founded the Bonn Stage Fright Clinic in 2010; she will speak about her experience treating performers with stage fright.

Performance anxiety or stage fright is classified by psychiatrists as a particular form of social anxiety disorder (also known as social phobia).

Social phobia affects about eight per cent of the population and is characterised by blushing, excessive sweating and stammering, all of which are triggered by a persistent fear of being judged harshly when in others’ company.

Those with social phobia are intensely self-critical of themselves while in company and experience a fear of being judged harshly by others.

For a professional performer, it is normal to feel some symptoms of stress before going on stage. Some will be unable to eat, others will be ravenous, while for some they will notice a fast heart rate which settles just before they begin their performance. But in full-blown stage fright, the actor or musician may experience a form of psychological de-realisation or may develop either increased or decreased muscle tone.

These muscle changes are critical in say a violinist or cellist, who must use a bow in a delicate and purposeful way.

Irrational and catastrophic thinking leads to performance avoidance which, if left untreated, could be career threatening. It seems the size of an audience, its status and whether the audience includes peers of the performer are factors. And solo performances tend to elicit greater symptoms than when the musician is part of an orchestra or is involved in teaching rather than performing publicly.

Among adult musicians, females are more prone to stage fright than males.

Just like someone with a social phobia, performers turn to drugs in the hope they will act as props to get them through the experience. Alcohol is often the first port of call, followed by beta blockers (not always specifically prescribed by a doctor).

Some healthier preventive options used by performers include the Alexander technique, yoga, hypnosis, relaxation techniques and even special practising techniques.

In some cases, psychiatrists bring the performer through a series of densensitisation manouevres. However, for most people with stage fright a combination of lifestyle changes and cognitive behavioural therapy (CBT) work effectively.

The CBT identifies the musician or dancer’s negative thoughts around their fright, helps them challenge these and gives them ways of changing certain behaviours to help the performance-related anxiety disappear.

Of course, performance anxiety doesn’t just involve the stage. Anyone involved in regular public speaking may develop it, as can sportspeople and anyone taking an examination. But all relate back to an intense fear of what others might think of us, allied to high levels of self-criticism and a catastrophisation around “what if”.

For more details about the Galway conference go to

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