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How Can You Overcome a Fear of Public Speaking?

Medications may help you overcome fear of public speaking, but cognitive behavioral therapy and practicing the skill could help even more.
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Some people are afraid of spiders, while others are terrified of heights. One of the most common phobias appears to be a fear of public speaking. Nonetheless, people often need to speak up in a gathering, whether it is at a work meeting or the PTA. What can you do about this problem?

Overcoming a Fear of Public Speaking:

Q. I have a crippling fear of public speaking. Nothing I’ve done has worked to overcome it. Are there any medications for this?

Medications to Treat Performance Anxiety:

A. Doctors sometimes prescribe a beta blocker such as propranolol or metoprolol for performance anxiety. Such drugs have been FDA-approved for hypertension and heart problems, not stage fright.

They work in part by blocking the effects of adrenaline (epinephrine) on the body. When people are under stress, they may experience symptoms such as sweating, tremor, dry mouth, rapid pulse, shallow breathing and a tight throat. Musicians, athletes, public speakers and test takers have been known to take beta blockers to calm the jitters.

Sadly, though, there are not many well-controlled trials to test this class of medicines for stage fright. Some people may react to beta blockers by developing insomnia, disorientation, asthma and impaired performance. You can learn more about their side effects here.

If your doctor prescribes a beta blocker to treat your fear of public speaking, make sure to test drive the drug beforehand. You wouldn’t want to experience unpleasant side effects unexpectedly when you are striving to present your thoughts.

There is an interesting but impractical footnote here. Psychologists have been experimenting with a combination of exposure to the public setting along with the medication scopolamine (Biological Psychiatry, Nov. 1, 2019). Although people taking scopolamine reacted less strongly to the setting after several exposures than those taking placebo, scopolamine interfered with their ability to remember things. That could be a significant drawback in overcoming a fear of public speaking.

Other Ways to Manage Performance Anxiety:

You might also consider cognitive behavioral therapy or a group such as Toastmasters to overcome your anxiety. Researchers have found that meditation, mindfulness practices and targeted cognitive behavioral therapy can help students overcome anxiety, depression and stress (International Journal of Environmental Research and Public Health, Nov. 10, 2019). Since many young people suffer from test phobias as well as fears of public speaking, these treatments could be very helpful. Psychotherapists have noted that Toastmasters can be a helpful forum for individuals who manage to overcome crippling social anxiety and now need to develop confidence and public speaking skills (Psychiatric Clinics of North America, Dec. 2001).

Have you found a way to overcome your anxiety about speaking in public? If so, please share your story below.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • Craske MG et al, "Cholinergic modulation of exposure disrupts hippocampal processes and augments extinction: Proof-of-concept study with social anxiety disorder." Biological Psychiatry, Nov. 1, 2019. DOI: 10.1016/j.biopsych.2019.04.012
  • González-Valero G et al, "Use of meditation and cognitive behavioral therapies for the treatment of stress, depression and anxiety in students. A systematic review and meta-analysis." International Journal of Environmental Research and Public Health, Nov. 10, 2019. DOI: 10.3390/ijerph16224394
  • Lipsitz JD & Marshall RD, "Alternative psychotherapy approaches for social anxiety disorder." Psychiatric Clinics of North America, Dec. 2001. DOI: 10.1016/s0193-953x(05)70265-3
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I too want to put in a plug for Toastmasters. We had a chapter at work, and joining was transformative for me. I was nearly ill at having to give my first icebreaker speech, and thanks to continuing with Toastmasters after awhile I was able to speak in front of groups of people, sometimes large groups of people. I also saw how formerly shy colleagues were able to master speaking in front of the group. Yay, Toastmasters.

I am involved in Toastmasters. It is an excellent way to practice public speaking. You can find a small club that works for you. You are taught the building blocks of a speech, receiving feedback on each speech, which is based on what you have learned so far. You are not compared to others with more experience. You can choose when you want to sign up to give a speech. You can also sign up to lead the group for that day’s meeting. Clubs meet in the evening, over the lunch hour and maybe even early morning.

Toastmasters with stage fright have gone on to become public speakers. In my club one member was practicing to offer a full day meeting and she valued our feedback on each 10-minute portion she presented. Another needed to go to court but could not afford a lawyer. At first we could not understand what he was talking about, but after less than a year he had become a wonderful public speaker. He won his case and continued participating – even in competitions.

My son is part of an organization called Toast Masters. They have meetings all over the country. Small groups that give support and helpful suggestions to short speeches.

Ativan (Lorazipam) was helpful; one needs to experiment beforehand to find a dose that is not sedating.

I used to have that problem. It was cured by becoming a teacher. So, I would suggest reading to a group, possibly at a daycare. Then graduate to older and larger groups. Good luck.

As a girl and young woman I hated standing up in front of people, even if I didn’t have to speak. Singing in choirs in school and in church helped because others shared my situation. But reports in school and, later, speeches were difficult. I eventually overcame it by doing the following:
1) I prepare my material so well that even if someone walked into the room naked while I spoke, I could recover and continue.
2) I wear comfortable shoes while I speak.
3) I start off with something humorous or amusing so that my audience is relaxed. I also include something unexpected during the rest of the speech. I once wore a long colorful necklace and took it off during my report in a college level class to demonstrate a concept. Then I put it back on and continued speaking. The instructor gave me an “A+” for my “creative use of a prop”.
4) I focus on two friendly faces in different areas of my audience and speak to them.
5) I try to remember that it’s not about me but it’s about my listeners receiving what they need to know.
6) I started using “body English” after I became a teacher of English as a Second Language. It helped my students understand because they didn’t understand English well. I am now in front of people every week and am a public speaker so I have lost count of how many speeches I have delivered.
I hope this helps others.

A fear of public speaking can be ameliorated in many cases by skilled individual coaching techniques. As a business speech coach, I use a variety of methods, including virtual reality, to make public speaking a more comfortable experience. The sessions are designed to move at the pace each client needs, and are done online. Clients have different reasons for their fear of public speaking, and so a one-size-fits-all solution is not likely to work for most people. Some companies will pay for this coaching as part of professional development.

Many years ago, in my Wall Street career, I had a high-potential employee who was overwhelmingly shy and rarely spoke in group meetings although he was highly intelligent, and his ideas were excellent. He functioned fine in one-on-one situations.

I asked my HR Department for assistance, and they recommended Dale Carnegie training. If my memory is correct, he attended a twice weekly evening program for 6 months. The improvement was amazing. He morphed into a clearly much more self-confident individual and eventually climbed the corporate ladder becoming the CFO of a major Wall Street firm. He had been painfully shy around women never having had a girlfriend. His love life prospered as well. He is now married with children. For those for whom attendance at a course is not possible, there are books and on-line training available.

I never realized there was even a drug for this. Can’t wait for a drug that helps me be successful in the stock market or with dating women! Big Pharma will sell you anything to make a buck. The fear of speaking in public boils down to the fear of rejection. If you are speaking your truth in an honest and meaningful way, who cares what others think? Never sell your soul to get what you think you want or need.

Valerian, a gentle herb, works very well for me. I take one or two capsules a few hours ahead of the performance, then evaluate and take another capsule an hour later, if needed, and repeat as necessary. It is easy to calibrate the dose in this way. It does seem, however, to take about an hour to really work. But then will help for several hours. Propranolol also works extremely well. It is important to get the right dose, and to try it out ahead of time. For me, it never took away the focus, but took the edge off the anxiety.

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