The Management of Performance Anxiety with Beta-Adrenergic Blocking Agents

Performance anxiety consists qf several symptoms experienced in the context qf public performance and is classified in DSM-III-R under social phobia. Performance anxiety must be distinguished from panic disorder, generalized social phobia, and generalized anxiety disorder. Petformance anxiety symptoms can be detrimental to both petformer and performance. These symptoms can be controlled by the j udicious use ofbeta-adrenergic blocking agents. The use qf beta-adrenergic blocking agents should be considered as part ofa psychiatric stress-management programJor these patients. The ph en omenon of pe rformance a nxiety (or "s tage fri ght ") has been a pprec ia ted for man y years . The sym pto ms a re not ed immed iat ely prior to a nd du ri ng va rious performance tasks , e.g., music, public speaking, a thletics, and test tak ing, a nd a re referabl e to th e sympathetic nervous syste m. Althou gh no standard series of sym ptoms spec ific to this cond ition has been develop ed , tachyca rd ia / palpita t ions, tremor, a nd swea t ing a re cite d most commonly, with various other sym pto ms list ed less cons iste n t ly (116, T abl e I) . A small, manageable a mo unt of a u to no m ic arousal may well be adapt ive by se rving to incr ease th e performer's ene rgy . For many other performers , however , th ese symptoms are excessive a nd coun terprod uct ive. Wit ness the viol in ist or arch er with excessive tremor, th e trumpet er with dry mouth and short ness of br eath , or th e ac to r with excessive swea ting. This paper will examine th e evalua t ion and ma nagement of performance a nxie ty sym ptoms. DESCRIPTION AND DIFFERENfIAL DIAGNOSIS Performan ce anxiety is classifi ed in DSM-III-R as soc ia l ph obia (300 .23) ( 17). These crite r ia include: a persist ent fear of situa tions in wh ich th e person is expose d to scru t iny by othe rs, a nd fears th at he / sh e may act in a humilia t ing or e mba rrass ing manner; expos ure to th e st im ulus provokes a n anxie ty response; th e phobic sit ua t ion is avo ide d or end ure d with grea t a nxie ty; a nd th e avo idant be havior interferes with occupa t iona l functioning. DSM-III-R distingui sh es bet ween thos e person s with "gene ra lized" socia l phobia from those with "d iscre te" soc ia l ph ob ia whic h is limit ed to performance situations by th e cavea t that th e ge ne ralized type desc rib es those persons for whom th e phobia situation includes most soc ia l situa t ions. A study by