Should You Use Medication to Manage Your Fear of Public Speaking?

In my last blog post we discussed a variety of strategies to help overcome your fear or phobia of public speaking. One strategy discussed was the use of medication to aid in reducing your anxiety.  While this isn’t a method recommended to everyone, for those with severe anxiety or a genuine public speaking phobia, this may be considered a suitable option.

If you’re thinking about using medication, discuss it with a qualified doctor or nurse practitioner. But whatever you do, don’t use alcohol or street drugs to counter public speaking anxiety. They don’t work, and you’ll have less physical coordination to get you through the mechanics of standing up to speak. You’ll more than likely also lose your job given it is incredibly hard to mask the effects of drugs and alcohol while public speaking.

The main form of medication used for reducing anxiety when public speaking is the beta-blocker. A beta-blocker is “any of a class of drugs which prevent the stimulation of the adrenergic (adrenaline) receptors responsible for increased cardiac action, used to control heart rhythm, treat angina, and reduce high blood pressure“. Essentially, these are drugs that have a calming effect (reducing the physical symptoms of stress) without the mind numbing effect of drugs such as valium.

You should understand that beta-blockers are not officially drugs for anxiety, but are cardiac medications. However, by reducing some of the symptoms associated with public speaking anxiety, like the ‘shakes’, the idea is that they can help you concentrate on the task at hand.

Since they can lower heart rate, beta-blockers have been used by Olympic marksmen to provide more aiming time between heartbeats. Some musicians use beta-blockers to reduce the adrenaline-driven shaking during auditions and performances. And it’s rumored that many politicians use them for important speeches.

Some of my public speaking friends tell me they have used beta-blockers and that using them has been effective. But while this may help with the immediate stress of a speech, it is likely to be less useful for countering your chronic fear.

So the three questions that need to be answered when deciding to use medication/ drugs to aid your public speaking are:

  1. Do they really work?
  2. Are they safe?
  3. What’s the best way to manage public speaking anxiety?

1. Do they really work?

Nobel prize-winning scientist, James Black, invented beta-blocker drugs to block the effect of adrenaline on the heart. So beta-blockers can reduce the adrenaline-related physical symptoms associated with the stress response. Some studies show that beta blockers significantly reduce symptoms like shaking hands that can hinder some musicians playing. Those in the studies said they felt better about their performance after taking beta blockers, and music critics consistently judged their performances to be better.

One friend that I spoke with recently has used beta blockers for important presentations with no side effects. He said the physical symptoms he usually felt (heart racing and shaking of hands) made him spend too much time thinking about the nerves and how to control them. So he was more formal and stuck closer to his ‘script’.

With the beta blockers reducing those symptoms, he felt free to be more conversational and expansive and was able to act in a more confident manner on stage. So, overall, he found the experience positive.

2. What can’t they do?

My friend did point out, however, that they are useless if you’re not prepared. Public speaking fear is often all about uncertainty and preparedness and if you feel uncertain about your preparation, your anxiety will increase.  If your preparation is not up to scratch, beta-blockers won’t improve things.

Beta-blockers can’t help anxiety of a purely psychological nature. If your public speaking anxiety shows itself mainly in psychological ways (e.g. general uncertainty or negative inner voices), beta blockers will not help you.

Using beta-blockers may cause reduced energy levels

Another thing to consider is that many people feel adrenalin helps them focus, giving them an edge that adds intensity to the performance. Australian actress Cate Blanchett has said, ‘a little bit of fear keeps one on one’s toes’.

When I was 19 and fighting in competitive martial arts, I saw a specialist about the migraine headaches I would get after each fight (and no, these weren’t linked to getting hit in the head too often). ‘Post exertional headaches are a documented condition’, he said. I remember feeling a huge relief that modern medicine understood my pain and would have a cure. He commenced writing me a script.

‘These are drugs to reduce heart rate and blood pressure, which should therefore reduce your headaches.’
‘But won’t that negatively impact my energy and physical performance on the floor?’
‘Well, yes.’
I left the script where he placed it.

2. Are they safe?

Beta blockers are prescription medications for good reason. There’s a fairly long list of side effects, including:

Rash, anaphylactic shock (sudden unconsciousness or death), cold extremities, fainting, dizziness, fatigue, headache, depression, sleep disturbances, nightmares, hallucinations, short term memory loss, high or low blood sugar, stomach ache, flatulence, constipation, nausea, diarrhea, dry mouth, vomiting, heartburn, bloating, impotence or decreased libido, difficulty urinating, bronchospasm, cough, wheezes, naal stuffiness, joint pain, and muscle cramps.

Although this is an exhaustive list, many performers who take beta-blockers in small doses and or special occasions have found no side effects at all from their use.

According to a 2004 New York Times article, the editor of the Harvard Medical Letter, Michael Craig Miller, thinks there is little risk in taking them because they only affect physical, not cognitive anxiety. “Stage fright is a very specific and time-limited type of problem. There’s very little downside except whatever number you do on yourself about taking the drugs” he said.

However note that there are opposing views. Such as these views from musicians:
A common side effect is loss of concentration, and my playing rapidly went downhill because of this… I ended up sounding as if I were sight reading. As soon as I figured out the connection, I quit the pills for good; I never really needed them, anyway.
…in performance, I had 3 quite severe panic attacks, something I never had experienced prior to that year or since. If you ever read any of the books on prescription drugs, a caution often added is that certain drugs may produce the opposite effect from that intended, so – be careful and check it out, as it’s a very individual thing.

3. But what about natural remedies?

If you’re not comfortable with beta-blockers, but you really do need to make use of medication, you may want to try some natural remedies first.  There are a wide range of options available when looking for herbal or natural beta-blockers.  I’ve included some here that some people have reported success with.

Bacopa Monnieri

Bacopa Monnieri is an ancient Indian herb that is most commonly used as a focus and memory enhancer, however the supplement is also effective as a natural beta blocker for anxiety.

Bacopa Monnieri is particularly interesting because it is often used to improve cognition and it does so by reducing anxiety and allowing the brain to perform better. If you’re looking for decreased anxiety, this supplement might bring you some added perks.

The standard dose of Bacopa is about 165 mg of active bacosides. So depending on the percentage of active ingredients you may need to take 1 to two capsules accordingly. Pure Mountain Botanicals has about 100 mg of active bacosides per capsule so you may choose to take 2 capsules/day.


L-Theanine is an uncommon amino acid found in tea that is very useful as a relaxer. Unlike other substances like alcohol, L-Theanine has the unique function of being able to relax and decrease anxiety without sedating the individual.

L-Theanine is usually taken in dosages between 100-200 mg and typically alongside caffeine. L-Theanine has a unique synergistic effect with caffeine that heightens attention, focus, and cognition. Although you can find L-Theanine in teas, you likely won’t be able to get an adequate dose through tea alone.

Rhodiola Rosea

Rhodiola Rosea is a Scandinavian herb and part of traditional Chinese Medicine, which claimed the herb promoted physical and cognitive vitality. Rhodiola Rosea is particularly effective as an anti-fague supplement. Whether fatigue is a result of physical, emotional or mental exertion, rhodiola is effective at reducing the effects of stress on the mind and body.

Supplementation of Rhodiola Rosea has been linked to decreased fatigue depression and stress and improved subjective well-being, and cognition.

Standard dosage of Rhodiola Rosea is around 300-700 mg per day. SupernovaNaturals has a great product that has the appropriate concentration of the active ingredients (rosavins and salidroside) in a 500 mg capsule. One capsule per day should be sufficient to experience the benefits of Rhodiola Rosea.

Note that given these are natural remedies you may find their impact less noticeable than beta-blockers.  Reports of their effectiveness have been variable between public speakers that I have spoken with.

4. What’s the best way to manage public speaking anxiety without the use of medication?

The real objective when speaking in public is to think clearly – and speak clearly. So a better question than “will medication (whether it be chemical or natural) help me?” is “what’s the best way to manage my fear of public speaking?”

People commonly believe they can’t think clearly due to the strength of the physical symptoms. The irony is that the intensity of your physical symptoms is a result of not thinking clearly. Many of the physical symptoms are due to the initial stress response, while the remainder are the result of the way you think about your predicament.

The physical symptoms are real, but their intensity is directly related to the way you process them. For example, if you believe that your shaking hand means that you are “losing control of your body!”, all your physical symptoms will increase with the drama of that thought. In other words, the stress response increases when we perceive a threat to our safety or well-being.

So symptoms can be reduced if we come to the conclusion that there is no real threat. So, when you know what to do and how to do it, your mind is efficiently directed and your  anxiety can be made manageable.

This fight or flight response (and your public speaking fear) can be minimised when we understand what’s going on and realise it’s something we can influence – something we can manage. The key is to practice in a safe setting as often as possible to ensure that when you are up on stage, you are well prepared and able to control your nerves in the best possible way.

At the end of the day, you need to find the best method of managing your fear that works and that you can stick with.  For most, including me, this will be through seeking advice and trial and error.

If you’ve found this information useful you may also be interested in reading some other recent posts; You Don’t Fear Public Speaking More Than Death – But You Still Need to Manage Your Fear or How to Improve Your Public Speaking Through Storytelling.

Also, if you’re after a short online course in public speaking, I cannot recommend ed2go’s online public speaking courses enough.  I’ll be posting  review of their online courses in public speaking very soon.


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