Overcoming performance anxiety: The role of Beta Blockers
When Robert Downey Jr announced "I took a beta blocker so this is going to be a breeze" at the 2024 Golden Globes, many were likely shocked to discover that someone who has been in the public eye for decades would require medications for performance anxiety. However, the utility of beta blockers for performance anxiety was established in the early 1960s and they have been widely used in all areas of performance since then.
Photo attribution: Author: Gage Skidmore; Title: Robert Downey Jr; Source: Flickr; License: CC BY-SA 2.0
Singers and actors are very familiar with the feeling of stage fright or performance anxiety. Previous articles here have described how performance anxiety affects vocal muscles, creating laryngeal tension and tightness in the vocal apparatus. We've also discussed effective strategies to manage stage fright. What Robert Downey Jr brought to center stage (literally) is the true prevalence of this phenomenon. From first graders at show and tell to professional actors like RDJ, nearly everyone experiences some degree of performance anxiety.
The feeling of sweaty palms, a racing heart, and a trembling voice are just a few symptoms that have to be managed to allow for effective performance. While we may assume that professional actors just don't experience this, what Robert Downey Jr demonstrated is that, at all levels, performance anxiety exists and medications can help.
What are beta blockers?
Beta-blockers are well-named - they block beta receptors. Beta receptors are found throughout the body, and the beta-1 receptors are part of the sympathetic nervous system (flight or flight system). The body's response to fear or excitement is to release hormones (epinephrine and norepinephrine) that activate beta receptors in the heart and blood vessels, increasing heart rate and pumping blood faster. (1)
Beta-blockers prevent the released hormones from activating the receptors, preventing a rapid heart rate (and other similar fight or flight responses).
How do beta blockers help with stage fright?
Beta-blockers prevent the racing heart and elevated blood pressure that come from anxiety. When we feel anxious, our fight-or-flight response is activated. As we feel our hearts race and our palms sweat, we can become more anxious and release more fight-or-flight hormones. This further increases our anxiety and produces a vicious cycle that builds on itself.
Beta-blockers work by interrupting the increase in heart rate. When our heartbeat doesn't increase, we don't get an increased stress response from a pounding heart. The cycle is interrupted allowing us to breathe more easily. We shake/tremor less, feel less dry mouth, and feel more stead, which further diminishes our anxiety. It becomes a virtuous cycle instead. (2)
Some beta-blockers can cross the blood-brain barrier and produce effects accordingly. Studies have shown the effectiveness of using beta blockers in patients with PTSD because they can help to prevent fear memory consolidation, which may help to prevent a fear response when entering the same triggering environment (stage). (3)
Do beta blockers make my performance boring?
Many performers are concerned they'll miss the adrenaline response of performance, and have a less connected performance while on beta blockers. However, most studies indicate the opposite is true. Beta blockers like propranolol were shown to cause no impairment of performance, and instead, may improve performance by controlling the severe anxiety associated with stage fright.
Many performers take a "muscle through it" approach to their stage fright. Unfortunately, this often backfires, where one missed note becomes a consolidated memory. This makes future performances even more likely to cause stage fright.
By speaking so casually about something so widely experienced, Robert Downey Jr hopefully empowered professional voice users to seek help to manage performance-related symptoms. There should be no stigma in seeking care, especially for something as widespread as performance anxiety. In collaborating with your vocal health team, you can find your way to a more effective, less nerve-wracking performance.
Contact us here if you are interested in getting started on your vocal health and optimization journey.
References
Alhayek S and Preuss CV. Beta 1 Receptors. https://www.ncbi.nlm.nih.gov/books/NBK532904/
Szeleszczuk L, Frączkowski D. Propranolol versus Other Selected Drugs in the Treatment of Various Types of Anxiety or Stress, with Particular Reference to Stage Fright and Post-Traumatic Stress Disorder Int J Mol Sci. 2022 Sep; 23(17): 10099. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9456064/
Brewer C. Beneficial effect of beta-adrenergic blockade on “exam. nerves” Lancet. 1972;2:435.
Interested in working with the best professionals in LA for voice care and rehabilitation?
Meet Dr. Gupta, the top voice doctor in LA, and Tressa Cox, the leading voice therapist specializing in voice rehabilitation.
Learn more about their expertise and services at the Center for Vocal Health.
