Table of ContentsView AllTable of ContentsCausesSymptomsTypesDiagnosisTreatmentPrevention
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Types
Diagnosis
Treatment
Prevention
Performance anxiety is the strong, excessive fear or worry that you will not be able to accomplish something specific, causing emotional distress and physical symptoms.
The treatment of performance anxiety most commonly involvestalk therapyas well as medications like antidepressants or beta-blockers.
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What Causes Performance Anxiety?
Although the terms are sometimes used interchangeably, anxiety is not the same thing as fear.
Fear is a short-term response to something specific that threatens you. With anxiety, you respond to theanticipationof something, resulting in longer-lasting distress. While fear is an appropriate response to a present threat, anxiety is more broadly focused and future-oriented.
Performance anxiety is the anxiety associated with a specific performance. The fears and worries may go well beyond the fear of humiliation, embarrassment, or shame but also involve the fear of rejection and how the failure might impact your future.
Performance anxiety can be a one-time event, recur occasionally, or get progressively worse.
Is Performance Anxiety an Anxiety Disorder?
Anxiety is a normal response that can occur when you worry about things like health, money, or relationship issues. In some cases, anxiety may be considered “healthy,” compelling you to work hard and achieve more at school, work, or sports.
However, if anxiety is persistent, worsening, and interfering with your quality of life, you may very well have ananxiety disorder.
Anxiety disorders are a group of conditions defined in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” (DSM-5). There are many types of anxiety disorders, includingseparation anxiety disorderandpost-traumatic distress syndrome.
In recent years, the DSM-5 added a specifier—called a performance-only specifier—for individuals with SAD whose anxiety is associated with a specific performance whether on stage, on the playing field, or in bed.
In severe cases, a person with performance anxiety may experience an extreme subtype of anxiety called aspecific phobia.
List of Common and Unusual Phobias
Risk Factors
Several personality types are seen to be vulnerable to performance anxiety. According to a 2019 study published inFrontier of Psychology,these traits include:
Symptoms of Performance Anxiety
Emotional symptoms of performance anxiety include:
Somatic symptoms of performance anxiety include:
Do I Have Anxiety? How to Recognize the Signs and Symptoms
Types of Performance Anxiety
Performance anxiety is not a mental disorder classified in the DSM-5. Rather, it is a manifestation of SAD and one that is not always well-defined in the medical literature.
Even so, researchers often break performance anxiety down into three distinct subtypes:
Stage Fright
Stage performance anxiety goes beyond simple “jitters” or “butterflies,” causing heightened apprehension and a negative emotional state that can interfere with or even sabotage the desired outcome.
Studies suggest that most stage performers have experienced performance anxiety at some point in their careers. According to a 2019 study inFrontiers of Psychology,50% to 70% of professional musicians reported compromised performance due to anxiety.
Anxiety levels can vary based on whether you are in a solo or group performance, there are people of importance in the audience, or the level of skill of fellow performers is high.
Social Anxiety Disorder
Athletic Performance Anxiety
Studies suggest that anywhere from 20% to 34% of elite athletes experience performance anxiety.Among all athletes, the number can be as high as 60%.
Athletic performance anxiety can cause more than emotional and physical symptoms; it can increase the risk of injury among athletes who either overcompensate or are overly distracted during a sports competition.
Sexual Performance Anxiety
Sexual performance anxiety is a fear or worry related to having sex. It can be due to uncertainties about your general ability to satisfy a partner. It may also be related to a negative body image, relationship problems, or other factors.
According to a 2020 study inSexual Medicine Review,between 9% and 25% of males and 6% and 16% of females experience sexual performance anxiety.
Sexual performance can have a cause-and-effect relationship withsexual dysfunction. Having conditions likeerectile dysfunction (ED),premature ejaculation, ordyspareunia(vaginal pain) may fuel feelings of anxiety that only make symptoms worse during sex.
Testing and Interview AnxietyThough not typically regarded as forms of performance anxiety, taking tests and having a job interview can fall under the umbrella insofar as they both involve public exposure, either directly or indirectly.With test anxiety, your worries may extend beyond your test results to fears about your future and how others perceive you.The same can occur with interview anxiety in which a person will often sabotage their chances due to overwhelming feelings of inadequacy.
Testing and Interview Anxiety
Though not typically regarded as forms of performance anxiety, taking tests and having a job interview can fall under the umbrella insofar as they both involve public exposure, either directly or indirectly.With test anxiety, your worries may extend beyond your test results to fears about your future and how others perceive you.The same can occur with interview anxiety in which a person will often sabotage their chances due to overwhelming feelings of inadequacy.
Though not typically regarded as forms of performance anxiety, taking tests and having a job interview can fall under the umbrella insofar as they both involve public exposure, either directly or indirectly.
With test anxiety, your worries may extend beyond your test results to fears about your future and how others perceive you.The same can occur with interview anxiety in which a person will often sabotage their chances due to overwhelming feelings of inadequacy.
How to Overcome a Fear of Failure
How Performance Anxiety Is Diagnosed
Performance anxiety that occurs as a once-off event may not be of any concern. However, if the feelings are intense, recurring, and undermining your quality of life, you may benefit from seeing apsychologistorpsychiatrist.
In such cases, the provider may see if you meet the diagnostic criteria for social anxiety disorder (SAD) described in the DSM-5.
To meet the criteria, you must:
To meet the criteria for SAD, these conditions must persist for more than six months with no other explanations.
If the fear is restricted to speaking or performing in public only, SAD would be diagnosed with a performance-only specifier.
Treating Performance Anxiety
Treatment options for performance anxiety depend on the severity of your symptoms. The main form of treatment is talk therapy with or without medications.
Psychotherapy
Psychotherapy, also known as talk therapy, is the primary form of treatment for social anxiety disorder. Different forms can be used, including:
Of these, CBT is the most commonly used for anxiety disorders and often the most effective. It involves identifying and changing negative thought and behavior patterns to develop more effective ways to cope.
Medications
SAD is sometimes treated with treated with medications. A common option is a class of antidepressants calledselective serotonin reuptake inhibitors (SSRIs). Another class is known asserotonin and norepinephrine reuptake inhibitors (SNRIs).
Individual drug agents commonly prescribed for the treatment of SAD include:
Do Beta-Blockers Work for Anxiety?
Prevention Tips for Performance Anxiety
The prevention of performance anxiety involves preparation. This is true whether you are a speaker, athlete, actor, musician, or planning to engage in sex.
Here are 11 self-tips that can help:
Summary
Performance anxiety is an excessive feeling of fear related to not being able to perform well. People with performance anxiety may experience rapid heartbeat, lightheadedness, shallow breathing, sweating, and other symptoms when faced with a situation where they have to perform.
Performance anxiety may occur with public speaking, athletic competition, during sex, or in other similar situations. It can be treated with psychotherapy or medications such as SSRIs or beta blockers.
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20 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychological Association.Performance anxiety.American Psychological Association.Anxiety.Rowland DL, van Lanveld JJDM.Anxiety and performance in sex, sport, and stage: Identifying common ground.Front Psychol. 2019;10:1615. doi:10.3389/fpsyg.2019.01615Rowland DL, Moyle G, Cooper SE.Remediation strategies for performance anxiety across sex, sport and stage: Identifying common approaches and a unified cognitive model.Int J Environ Res Public Health.2021 Oct;18(19):10160. doi:10.3390/ijerph181910160National Institute of Mental Health.Anxiety disorders.National Institute of Mental Health.Social anxiety disorder: More than just shyness.Substance Abuse and Mental Health Services Administration.3. DSM-5 child mental disorder classification. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.MedlinePlus.Phobias - simple/specific.Substance Abuse and Mental Health Services Administration.Table 3.11, DSM-IV to DSM-5 specific phobia comparison - impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. Rockville, MD: SAMHSA; 2016.American Psychiatric Association.Chapter 9: Somatic symptoms and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Washington, DC: APA; 2013.Thomson P, Jaque SV.17 - performing artists and psychopathology, In:Explorations in Creativity Research: Creativity and the Performing Artist. New York, NY: Academic Press; 2017: 281-305. doi:https:10.1016/B978-0-12-804051-5.00017-2Ebrahimi OV, Pallesen S, Kenter RMF, Nordgreen T.Psychological interventions for the fear of public speaking: A meta-analysis.Front Psychol. 2019;10:488. doi:10.3389/fpsyg.2019.00488Neiring M, Monsberger T, Seifert J, Muehlbauer T.Effects of psychological interventions on performance anxiety in performing artists and athletes: A systematic review with meta-analysis.Behav Sci (Basel). 2023 Nov;13(11):910. doi:10.3390/bs13110910Ford JL, Ildefonso K, Jones ML, Arvinen-Barrow M.Sport-related anxiety: Current insights.Open Access J Sports Med. 2017;8:205-212. doi:10.2147/OAJSM.S125845Pyke RE.Sexual performance anxiety.Sex Med Rev. 2020;8(2):183-190. doi:10.1016/j.sxmr.2019.07.001American Psychological Association.Test anxiety.Powell DM, Stanley DJ, Brown, KN.Meta-analysis of the relation between interview anxiety and interview performance.Can J Behav Sci.2018;50(4):195-207. doi:10.1037/cbs0000108Substance Abuse and Mental Health Service Administration.Table 16. DSM-IV to DSM-5 social phobia/social anxiety disorder comparison. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.American Psychological Association.What is cognitive behavioral therapy?Harvard Medical School.Treating social anxiety disorder.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Psychological Association.Performance anxiety.American Psychological Association.Anxiety.Rowland DL, van Lanveld JJDM.Anxiety and performance in sex, sport, and stage: Identifying common ground.Front Psychol. 2019;10:1615. doi:10.3389/fpsyg.2019.01615Rowland DL, Moyle G, Cooper SE.Remediation strategies for performance anxiety across sex, sport and stage: Identifying common approaches and a unified cognitive model.Int J Environ Res Public Health.2021 Oct;18(19):10160. doi:10.3390/ijerph181910160National Institute of Mental Health.Anxiety disorders.National Institute of Mental Health.Social anxiety disorder: More than just shyness.Substance Abuse and Mental Health Services Administration.3. DSM-5 child mental disorder classification. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.MedlinePlus.Phobias - simple/specific.Substance Abuse and Mental Health Services Administration.Table 3.11, DSM-IV to DSM-5 specific phobia comparison - impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. Rockville, MD: SAMHSA; 2016.American Psychiatric Association.Chapter 9: Somatic symptoms and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Washington, DC: APA; 2013.Thomson P, Jaque SV.17 - performing artists and psychopathology, In:Explorations in Creativity Research: Creativity and the Performing Artist. New York, NY: Academic Press; 2017: 281-305. doi:https:10.1016/B978-0-12-804051-5.00017-2Ebrahimi OV, Pallesen S, Kenter RMF, Nordgreen T.Psychological interventions for the fear of public speaking: A meta-analysis.Front Psychol. 2019;10:488. doi:10.3389/fpsyg.2019.00488Neiring M, Monsberger T, Seifert J, Muehlbauer T.Effects of psychological interventions on performance anxiety in performing artists and athletes: A systematic review with meta-analysis.Behav Sci (Basel). 2023 Nov;13(11):910. doi:10.3390/bs13110910Ford JL, Ildefonso K, Jones ML, Arvinen-Barrow M.Sport-related anxiety: Current insights.Open Access J Sports Med. 2017;8:205-212. doi:10.2147/OAJSM.S125845Pyke RE.Sexual performance anxiety.Sex Med Rev. 2020;8(2):183-190. doi:10.1016/j.sxmr.2019.07.001American Psychological Association.Test anxiety.Powell DM, Stanley DJ, Brown, KN.Meta-analysis of the relation between interview anxiety and interview performance.Can J Behav Sci.2018;50(4):195-207. doi:10.1037/cbs0000108Substance Abuse and Mental Health Service Administration.Table 16. DSM-IV to DSM-5 social phobia/social anxiety disorder comparison. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.American Psychological Association.What is cognitive behavioral therapy?Harvard Medical School.Treating social anxiety disorder.
American Psychological Association.Performance anxiety.
American Psychological Association.Anxiety.
Rowland DL, van Lanveld JJDM.Anxiety and performance in sex, sport, and stage: Identifying common ground.Front Psychol. 2019;10:1615. doi:10.3389/fpsyg.2019.01615
Rowland DL, Moyle G, Cooper SE.Remediation strategies for performance anxiety across sex, sport and stage: Identifying common approaches and a unified cognitive model.Int J Environ Res Public Health.2021 Oct;18(19):10160. doi:10.3390/ijerph181910160
National Institute of Mental Health.Anxiety disorders.
National Institute of Mental Health.Social anxiety disorder: More than just shyness.
Substance Abuse and Mental Health Services Administration.3. DSM-5 child mental disorder classification. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.
MedlinePlus.Phobias - simple/specific.
Substance Abuse and Mental Health Services Administration.Table 3.11, DSM-IV to DSM-5 specific phobia comparison - impact of the DSM-IV to DSM-5 changes on the National Survey on Drug Use and Health. Rockville, MD: SAMHSA; 2016.
American Psychiatric Association.Chapter 9: Somatic symptoms and related disorders. In:Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Washington, DC: APA; 2013.
Thomson P, Jaque SV.17 - performing artists and psychopathology, In:Explorations in Creativity Research: Creativity and the Performing Artist. New York, NY: Academic Press; 2017: 281-305. doi:https:10.1016/B978-0-12-804051-5.00017-2
Ebrahimi OV, Pallesen S, Kenter RMF, Nordgreen T.Psychological interventions for the fear of public speaking: A meta-analysis.Front Psychol. 2019;10:488. doi:10.3389/fpsyg.2019.00488
Neiring M, Monsberger T, Seifert J, Muehlbauer T.Effects of psychological interventions on performance anxiety in performing artists and athletes: A systematic review with meta-analysis.Behav Sci (Basel). 2023 Nov;13(11):910. doi:10.3390/bs13110910
Ford JL, Ildefonso K, Jones ML, Arvinen-Barrow M.Sport-related anxiety: Current insights.Open Access J Sports Med. 2017;8:205-212. doi:10.2147/OAJSM.S125845
Pyke RE.Sexual performance anxiety.Sex Med Rev. 2020;8(2):183-190. doi:10.1016/j.sxmr.2019.07.001
American Psychological Association.Test anxiety.
Powell DM, Stanley DJ, Brown, KN.Meta-analysis of the relation between interview anxiety and interview performance.Can J Behav Sci.2018;50(4):195-207. doi:10.1037/cbs0000108
Substance Abuse and Mental Health Service Administration.Table 16. DSM-IV to DSM-5 social phobia/social anxiety disorder comparison. In:DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; 2016.
American Psychological Association.What is cognitive behavioral therapy?
Harvard Medical School.Treating social anxiety disorder.
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