Social anxiety and performing. Can they coexist? The short answer is: yes.

Here's the long answer: Social anxiety and performance anxiety (stage fright) are in the same family of emotional and somatic experiences involving the preoccupation with how one is being perceived by others, heightened fear of being humiliated and a series of physical symptoms such as dizziness, shakiness, rapid heartbeat, sweatiness and overall discomfort. In most cases, performance anxiety does not require the existence of social anxiety. It is very common for people to struggle with tension and anxiety when they have to make a public appearance but they can be very comfortable in other types of social settings, completely undisturbed by such feelings.  
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It is also possible to have social anxiety disorder without having it interfere with the experience and quality of a performance. Many performers, those who often transform into bursting energies of confidence, experience this type of anxiety before and after the performance, when they are often expected to interact with audience members and people from the entertainment industry.  Throughout the duration of a performance, a performer may feel more secure, present and comfortable being the center of others' attention. As soon as the performance is over, the same person may begin to feel a sense of pressure stemming from increased expectations, negative thoughts about how they are perceived and discomfort associated with social anxiety. It is a common paradox experienced by many performers. 

The key to managing social anxiety during a performance is to bring attention to the performer identity. Performers take on a different persona when on stage. They embody the stage character and this parallel identity often becomes an additional source of confidence and a safe detachment from the non-performing self. When someone already has social anxiety, they are used to feeling vulnerable in their most natural state; when they are themselves. However, the state of performing allows for the person to become someone else, or perhaps to access another version of a deeper self, and to interact with others through this temporary persona. Accentuating this antithesis can become a source of emotional safety that protects the performer from the distracting effects of the social anxiety he/she experiences as their non-performing self. 

As a therapist who works with many performing artists, I am always very interested in contemporary research addressing clinical methodologies to treat performance anxiety. In the March 2014 issue of Medical Problems of Performing Artists Vol 29, No 1, pp. 3-7 there is an article discussing the effectiveness of ISTDP (Intensive Short-term Dynamic Psychotherapy) for Severe Music Performance Anxiety. To find out more about ISTDP you can go here. 

The article discusses how psychological defenses, developed in early childhood to protect us from disrupted attachments with caregivers, are rendered completely useless during the vulnerable process of performing in front of an audience. As a result, anxiety becomes the manifestation of the body and brain's perception of a threat. As we have seen in past blog entries, such threats can be external i.e. "if I don't do well I will not get the gig and will not make money/will not succeed" or internal i.e. "being judged or evaluated is shameful and an inherently negative experience." 

I was glad to see that the article made references to the concept of attacking the self, a process in which one directs aggression to the self in order to avoid directing it towards the external source. As seen in the article's description of a 10 week ISTDP treatment, the goals of treatment were to help the patient become aware of the aggression and develop transference with the therapist, resulting in the effective resolution of previously misdirected emotions. Now, what does all this have to do with performance anxiety? For one thing, performers who experience severe anxiety often go through some form of self-attack when they experience thoughts such as "I'm not good enough", "I will fail", "they will laugh at me" etc. In addition, the relationship between performer and audience may be one that symbolizes pivotal relationships in one's past, particularly during childhood. Unresolved feelings, such as anger, neglect, embarrassment etc, which are primarily dealt with by repressing, pushing and turning inwards, may become triggered by entering a relationship where one is assessed, evaluated and judged. The goal is to become both intellectually and emotionally aware of such emotions in order to resolve them through the process of transference in the therapy room. By safely expressing negative emotions in the presence of an external agent and by redirecting them effectively externally rather than internally, the performer will be able to diminish the powerful impact of dropping the defenses - since there will not be such a need for these defenses in the first place. 
In the study described, all this took place within 10 sessions. In my experience, these complex stages tend to take a lot longer; but nevertheless, I am pleased to read about the success of ISTDP in this particular case.

You can read the full article here.   

Performance anxiety is the most common reason driving performers to seek out help from performance coaches, counselors and therapists. It can be debilitating and severely hinder performers' experience and enjoyment from being on stage. 

In a previous blog entry we looked at how therapy can benefit performers. The most common techniques to overcome this type of anxiety involve breathing and meditation exercises, focusing on pre-performance preparation, exploring what each performance means to the performer (what am I getting out of it?), magnifying emotions in order to feel that we can control them and, finally, embracing the feeling and, if possible, using it creatively during performances (for example a spoken word performer may allow their vulnerability and anxiety to come out during the performance).

A new study from the Harvard business school has a new recommendation. It involves reinterpreting the feeling of stage fright and labeling it excitement rather than anxiety. The idea is that this positive spin to the experience will decrease arousal and physical symptoms such as sweaty palms, shortness of breath and dry mouth. In fact, saying things such as "calm down" may not be as effective as telling oneself "you are so excited right now! you love this feeling!"


You can find a summary of the study and an interview with clinical psychologist, Guy Winch, here.  And you can go here to read that study itself. 

Achieving professional success in music involves more than just technical and musical excellence. It requires a set of psychological tools that will ensure the musician's emotional well-being and prevent the common experience of burnout. 

There is a significant amount of stress involved in a professional career in music. At times, stress is inevitable; however, it can be substantially managed by raising awareness and preparing for high demands during musicians' training. For example, injuries or strains are very common in musicians. The process of recovery can be time-consuming and set one's career back. Proper training on how to avoid straining and injuries, the relationship between anxiety and injuries and knowing how to prepare for such setbacks can help musicians handle stress, thus decreasing the chances of experiencing burnout. 

Another explanation for the phenomenon of musicians' burnout is the very young age at which formal training begins. Typical age begins at around 4-5 years old. By the time some of these children reach adolescence or adulthood, they start to confront the effects of their unique lifestyles: rigorous schedules, lack of balance with other life areas (such as social and academic), highly competitive environment etc. Incorporating "wellness skills" courses in young musicians' training can be very beneficial later on.

In addition, formal musical training needs to address the anxiety and mental demands associated with performing. Identifying and coping with the susceptibility to performance anxiety is instrumental in preventing burnout. If a young musician does not explore, from an early age, the complex combination of personal, environmental and non-controllable factors that affect his/her chances of sustaining a successful career, he/she may internalize develop of guilt, discouragement, anxiety and depression when things do not go as planned. 

Burnout can result from failure to pay attention to the necessary psychological and performance skills. Clark and Lisboa (2013), in Training for Sustained Performance: Moving Toward Long-Term Musician Development, discuss the importance of skills such as focus, confidence, motivation, ability to communicate with audience and express emotions.  When these skills are ignored, their absence becomes increasingly noticed as the musician enters a world of highly competitive and mentally demanding engagements. 

Burnout is very common in professional musicians' careers. Merely acknowledging and raising awareness regarding its prevalence can be helpful. Furthermore, incorporating training that addresses the psychological and physical demands of a career in music is another important step in decreasing the chances of feeling burned out. 

There is a relatively old entry on Athletic Insight, the Online Journal of Sport Psychology (September, 1999, Vol.1, issue 2) that recently got me thinking. 

In this article, Tom Ferraro applies a psychoanalytic perspective on anxiety-related issues in athletes. Taking a different direction from cognitive-behavioral and relaxation training techniques, Ferraro looks at unconscious conflicts. In particular, he examines the connection between object-relations theories, the unconscious dread of success and the inner processing of the experience of winning. Some of his theoretical arguments discuss concepts of narcissistic disturbance when performing in front of an audience, the fear of separation from the "non-winner identity" when facing the possibility of winning, the negative associations one attaches to the exhibitionism involved in performing  and the fragmented self-identity when under pressure.

Popular approaches to managing anxiety in athletes focus on symptom-relief, positive thinking, visual imagery, preparation and breathing. Many of my clients benefit from these approaches; but I have also found that, the more inquisitive ones, tend to ask questions. They want to know WHY certain automatic physical, cognitive or emotional behaviors persist. Recently, this desire came up with a couple of client-athletes I worked with. Drawing on ideas relevant to Ferraro's, sessions focused on some free association, and disinhibited discussion on what certain experiences mean or represent to my clients. For example, one basketball player revealed that the discipline involved in training, represents clear-cut, black and white decision-making; however, this athlete admitted to feeling uncomfortable with making and sticking to decisions. This general tendency trickled down to her approach on basketball training which, in turn, affected her ability to remain focused on her task. In this situation, apart from helping her create a training schedule she felt comfortable with, the goal was to explore and identify hidden conflicts about the pressure of decision-making, self-doubt and commitment to one way of doing things. By correctly recognizing the unconscious conflicts, and by making in conscious, it becomes easier to manage and respond to them. 

Of course, no 2 cases are always the same. Still, I wanted to call attention to this point; perhaps athletes would benefit from a deeper exploration of their difficulties, anxieties and psychological obstacles. 

Counseling interventions for Performance Anxiety:

Unlike professions where being in front of an audience might feel like an occasional nuisance to some (think of an employee who might enjoy every aspect of his/her work "except for having to speak publicly") performers are faced with a task that is integrally tied into their artistic and professional identity. Performing artists are performers; no way around it!

To the best of my knowledge, there is a limited number of evidence-based counseling interventions for performing artists (if you have resources to any please feel free to comment below). Sport psychology, a neighboring field, has approaches of helping athletes perform well. But things become slightly different when a performing artist is expressing an inner state, or trying to convey a message to audiences, and not just trying to improve a skill such as speed, accuracy etc.  Here's a list of counseling approaches one can take when trying to reduce symptoms of performance anxiety, and to maximize satisfaction deriving from self-expression.  

1. Body mindfulness: Using the principles of mindfulness we help performers use conscious attention and awareness as a way of centering and grounding oneself. When disconnected from the process of performing due to anxiety, negative thinking or lack of confidence, performers are encouraged to try sharpening their skill of body-part mindfulness. By doing so, the body relaxes and we feel connected to what physically contains our thoughts in the present moment. 

2.  "Who am I doing this for" exploration: Clients may often lose sight of why their are performing and who they are doing this for. The motivation behind performing may start with a heartfelt "this is what I love doing" and turn into a pressure to satisfy audiences, to prove something to someone, to make a living, to please, to provoke etc. In therapy, we may explore what connects the performer to what they are doing and what they are attempting to express; we find the fundamental essence of the driving force motivating someone to want to perform. 

3. Emotion-magnification: Inspired by the Gestalt approach performers are encouraged to try magnifying the emotions they typically try to hide while performing (this should be done off-stage). For example, actors trying to hide a shaky voice, singers trying to hide shortness of breath, dancers trying to hide low energy etc, are encouraged to exaggerate these behaviors/feelings during practice, and to alternate between the two extremes. This is a way of getting used to "dialing them" up and down and acquiring some sense of control over these involuntary behaviors and emotions. 

4. Goal-setting: Another counseling intervention used with performers is to predetermine a goal for every time the person is about to perform. This may look something like: "today my goal is to hold this note until the end" or "next time my goal will be to make more eye contact with the audience" etc. This helps performers break down the parts they want to work on or achieve rather than holding onto a vague and abstract pressure to perform well.

5. Embracing the feeling: The process of performing involves artistic expression and the display of an inner, emotional or cognitive process. A performer may often feel like their emotional state ought to be suppressed because the audience expects to see a performer who is calm, confident, angry, or expressive etc. Working on counseling for performers often involves identifying the genuine, authentic emotions one is having at the moment, embracing and releasing them during the performance. Thus, instead of fighting sadness I allow it to become part of what I'm doing. It may not be what the audience expects or is used to, but it's genuine and creates less anxiety for the performer. 

These are just a few interventions or clinical approaches that can be used when working with performers. Feel free to comment below or to add your thoughts.  

Many performers ask me about ways to balance out their naturally shy, introverted disposition with their desire to be in the spotlight when on stage.  There seems to be a perceived dichotomy between the image of a confident, dynamic performer and the quiet individual who does not crave interpersonal interaction off-stage. 

First off, lets begin by acknowledging that this is NORMAL. Just because a performer wants to be looked at or listened to while they are showing their skills or character, this does not mean that he/she wants to connect on a personal or social level with others.  

Secondly, I encourage my clients to start off by ACCEPTING that this dichotomy may occur, and to avoid fighting it. For example, a singer may feel like he/she is portraying a role when performing; that the equipment, the stage, the performance outfits and the lights are all some type of "mask" behind which he/she hides. Coming to terms with the fact that this "mask" comes off only to reveal a different but equally valuable persona, will relieve the stress of feeling like the confident performer has to exist in day-to-day life as well. A person learns to accept both sides as equally genuine and powerful without feeling like there has to be an amalgam of the two, or that one is better than the other.

Thirdly, we work on identifying and EXPLORING the extent to which shyness affects the performer. If it's shyness which translates into anxiety while on stage, then we work on stage fright management skills. Shyness is one thing; debilitating fear of being negatively evaluated is another!

Finally, my clients and I spend some time incorporating their "true nature" into their artistic IDENTITY. If what one truly wants to do is to perform contemporary dance pieces in an intimate setting, there is no need to push an identity of someone who likes to dance jazz pieces in front of thousands of guests. Of course, one would have to take practical concerns into consideration (how easy it is to turn down jobs nowadays?); however, being able to use one's perceived shyness as a tool that gives them artistic uniqueness rather than an enemy that needs to be fought off, can also pay off emotionally and artistically.  

The verdict on the relationship between creativity and mental illness is far from conclusive. There are conflicting beliefs, ambiguous accounts of personal experiences, limited studies, and even doubts about the usefulness of even exploring such a connection. However, whether it's in casual discussions among friends following an art show, in news reports analyzing famous musicians' mental illness and substance abuse history, or whether it's in commonly used phrases such as “tortured artists”, we often get exposed to ideas linking mental illness and creativity. This article draws attention to some of the research, personal accounts, and theoretical approaches regarding the question of whether or not having a diagnosable mental illness can be associated with increased creative expression and, perhaps, even success in artistic endeavors. 

Stage fright: treat it RIGHT!

Having an audience often triggers a wide range of uncomfortable feelings and physical sensations. Performance anxiety is a reaction to the perceived threat that we will be negatively evaluated by others (or sometimes by ourselves, such as in fear of being in front of a camera). The greater the perceived threat (i.e. if it's a final examination, if we are performing in front of someone we consider important) the more anxious we will feel.

Some start to feel "stomach butterflies" hours or days before the performance, others shake and sweat, others experience nausea and diarrhea and others even get panic attacks! The result is often to develop an aversion to performing which hinders your growth as a performer and your chances of succeeding in what you do. What makes this particular type of anxiety so important to overcome is that it is integrally tied into an experience that would otherwise be meaningful, exciting and fulfilling! The goal is to find out how to handle our brain and body's reaction to the perceived threat. We will examine 4 simple ways to decrease the frequency and intensity of performance anxiety.

1) The 3 Ps: Prepare-Practice-Perform: Before hitting the stage, it is very important that you feel confident about what you are about to do. This is because during moments of intense anxiety we may be consumed by worries about how we're doing, what people are thinking, how we look etc. When a speaker has practiced the speech many times, he/she will be on "autopilot" and will be able to think about relaxing rather than what he/she is saying during the speech. The focus moves from getting it right onto "nailing it"! Prior to practicing however, there is another extremely important stage: the stage of preparing and caring about the content of your work/art. If you hate blues and you are about to perform a blues song in front of blues fans your anxiety level may increase as your level of personal satisfaction is reduced. Of course, there are times when a performer has no choice over what they will be performing but the more comfortable you feel with the content of the work you are about to showcase, the better it will feel while you are doing it.

2) What are you telling yourself? The second part of managing performance anxiety is learning to identify "negative self-talk" during stressful times. Self-talk is our inner dialogue, our thought process. Many of these internal dialogues are so quick and automatic that we do not pay attention to them. Some have been shaped through early experiences and messages we receive from our environment. For example, if we grew up being told that showing emotions is bad we might experience some discomfort when performing a piece that requires emotional expression. The 1st step is to learn to identify such thought patterns and the 2nd step is to learn to challenge and dispute them.

3) Who are you trying to impress? The next topic has to do with our own unique relationship with the process and experience of showcasing our work. We tend to focus on others' judgement and we develop a skewed perception of the performing experience. One that asks the question "what will they think?" instead of "what do I think?" When you're about to get on stage and begin performing you want to ask yourself the following questions: Why am I doing this? What do I hope to get out of this performance? What do I find fun and rewarding about this? When we perform we often have the underlying assumption that the only goal is to impress and satisfy others. Naturally, this kind of thinking creates a lot of unrealistic expectations as it is impossible to always count on a positive reaction from our audience. Once the emphasis is placed on what we are getting out of it, then we feel more confident.

4) Breath-Relax-Visualize: Let us assume that a writer is about to present her book in front of hundreds of people. She is impatiently waiting to be notified to get on stage. If the writer knows her body and signs of anxiety, she will immediately become aware of her dry mouth and will begin to monitor any negative thinking. Then, as she reminds herself that anxiety will quickly reach its peak and begin to diminish, she is calming herself down and reassuring herself that "she will be ok". She will start taking deep breaths to ease physical tension and shortness of breath. She will imagine that her stomach is a balloon that inflates and deflates with every inhalation and exhalation. She will visualize a safe space around her; one that is filled with positive thoughts, images of comfort and self-affirmations. Repeating this 4-5 times reduces the threatening interpretation of the moment and increases comfort and positivity.

Hopefully the above tips will help you enjoy the process of performing to the fullest!