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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.
How Can You Overcome a Fear of Public Speaking?
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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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