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Medical Treatment of Performance Anxiety: A Statement in Favor

Richard J. Lederman
From: Medical Problems of Performing Artists: Volume 14 Number 3: Page 117 (September 1999)

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Abstract: Performance anxiety consists of behavioral, cognitive, and physiologic symptoms and signs that may precede and/or accompany a performance or presentation and that seem out of proportion to the specific situation. Some degree of performance anxiety is common, if not universal, but disabling symptoms may necessitate professional intervention. Medical treatment is aimed primarily at the physiologic manifestations of performance anxiety, which represent increased sympathetic nervous system activity. While many approaches have been utilized, beta-adrenergic blocking agents are very effective in counteracting the often debilitating tachycardia, sweating, and tremor that may accompany this disorder. A number of studies of instrumental musicians have demonstrated the effectiveness of this approach as well as its relative safety. The medication should be prescribed by a physician after an adequate assessment and discussion of potential risks and benefits. A single low dose of a beta-blocker (e.g., 10-40 mg of propranolol) administered 60-90 minutes before the performance is usually sufficient. Instrumentalists who require more than occasional or intermittent medication should probably consider alternative approaches, which may represent better long-term solutions for the problem. Obviously, both medication and nonpharmacologic methods may be used concurrently, if needed.

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