Performance Anxiety

Written By Jamie Ang Hui Hsien

Picture this. Let’s say something important is happening an hour later. It could be a test, a performance, a competition, or worse, speaking in front of an audience! The truth is – you may have prepared for it, or you have done it multiple times. Still, you can’t help but feel the jitters. Your heart could be pumping faster than a sprint and you could feel the pins and needles all over your body. This phenomenon is commonly known as performance anxiety.

Performance anxiety is characterized as a strong, excessive feeling of fear in anticipation of poor and negative outcomes before and during important tasks (Olivine, 2024). Synonymously referred to as stage fright, it is recurrent and can affect people across different ages and genders (Marks, 2021). According to Angelidis et al. (2019), an estimated amount of 10 to 40 percent of students experienced test anxiety and this figure is higher among other communities such as the ethnic minorities and students with disabilities. Managing stress levels is crucial because it can either enhance or debilitate results (Kremer et al., 2019).

Ford et al. (2017) asserts that performance anxiety causes individuals to be in an apprehensive psychological state. This is in response to the perceived stress concerning the outcomes of a task under pressure which is commonly experienced by athletes, students, and employees (Biswal & Srivastava, 2022). It can manifest and develop in personality, known as trait anxiety, or as a temporary, more malleable, situation-specific state anxiety (Weinberg & Gould, 2015). Various categories for anxiety symptoms include somatic, emotional, cognitive, and behavioral (Forsyth & Eifert, 2016; Laguaite, 2021; Ford et al., 2017; Marks, 2021; Olivine, 2024; Marks, 2024; Weinberg & Gould, 2015).

The symptoms of performance anxiety range from mild to severe. It differs between people and can be diverse within the same individual who experiences multiple episodes (Olivine, 2024). Single-handedly or combined, these symptoms create significant distress and result in a spiral of negative affect, reducing one’s self-confidence and ability to focus.

Somatic symptoms

-          Increased heart rate & blood pressure

-          Fast or shallow breathing

-          Tremors

-          Dizziness & light-headedness 

-          Sweating & cold hands or feet

-          Dry mouth & tight throat

-          Unsettled stomach & difficulty controlling bladder

-          Muscle tension

-          Pale or flushed skin

Emotional symptoms

-          Fear

-          Worry

-          Apprehension

-          Embarrassment

-          Self-doubt

-          Helplessness

Cognitive symptoms

-          Excessive self-criticism

-          Unrealistic expectations

-          Heightened focus on failure

-          Tunnel vision

-          Inattention

Behavioral symptoms

-          Avoid situations that trigger anxiety

-          Withdraw from social interactions

-          Display impaired performances

-          Deciding not to complete tasks

-          Self-sabotage

-          Fidgeting (biting fingernails etc)

Past research has explored the origins of performance anxiety that occurs across generally. The top three causes include unrealistic expectations, lack of confidence, and fear of failure (Kremer et al., 2019; Angelidis et al., 2019).

Unrealistic expectations

Most individuals fall prey to perfectionism. Humans generally commit to an all-or-nothing thinking where they set unrealistic expectations and judge themselves poorly when they do not reach their personal standards. With a mindset that only consists of success and failure, it is inevitable that anxiety develops in challenging and competitive settings.

Lack of confidence

The degree of anxiety people experience is influenced by their perceived ability to succeed or achieve goals. When one deems little of their potential and is overwhelmed, he/she becomes less motivated and unwilling to try, expecting failure.

Fear of failure

Commonly known as the “what-if” thinking, people often spend too much time wondering if they would fail and worse, if they would let people down. The notion of fearing failure results in individuals becoming tunnel visioned and fixated on what could go wrong, instead of figuring out alternatives to get the job done.

These causes of performance anxiety trigger the body’s fight or flight response such that it releases adrenaline, increases the heart rate and activates other symptoms associated with anxiety (Paese & Egermann, 2023). This can result in the affected individual to socially isolate and become distant from others due to increased pressure. Anyone can experience performance anxiety from anything (Angelidis et al., 2019) Before it becomes a pattern, it is crucial that individuals can identify, seek treatment and overcome this challenge.

The treatment for performance anxiety is dependent on the severity of its symptoms, the frequency of symptoms experienced, and how they impact daily life. Psychotherapy, mindfulness, and medication can be used to manage performance anxiety.

Cognitive-Behavioral Therapy (CBT) has been recognized as one of the most effective and successful evidence-based treatments in managing performance anxiety (APA, 2017). The exposure to anxiety-inducing settings is proven to reduce bodily sensations associated with anxiety and increases the threshold to manage its symptoms.

Through CBT, individuals can identify and challenge negative thoughts to reduce performance anxiety in 4 steps (Nagel, 2010; Gustafsson et al., 2016).

1.    Identifying negative thoughts – negative thinking such as “I’m not good enough” or “I’m going to let everybody down” often occur before anxiety-inducing situations. You can write those thoughts down and acknowledge how they contribute to your anxiety.

2.    Challenging negative thoughts – face the unpleasant thoughts by considering if it is realistic or true. You should come up with a more balanced and practical statement to replace the negative one, “I have done this before. I can handle it.”

3.    Visualizing a positive outcome – picture a successful outcome! Keep that feeling of satisfaction and work backwards to try and achieve the same process. Having the visualization of a successful performance can help us to walk through the process, build confidence and counteract any negative thoughts.

4.    Take action – now that you are aware of the negative thoughts and have a nice picture of you succeeding, prepare well, practice, and do what you can to achieve success! Focus on the process instead of the outcome and remember that you can learn and grow from each experience!

Mindfulness interventions promote psychological capital and reduce the occurrence and impact of performance anxiety (Biswal & Srivastava, 2022). Strategies such as deep breathing (Gomez-Lopez & Sanchez-Cabrero, 2023) can help people to relax before and during an anxiety-inducing situation. Examples of these breathing techniques include anchor breathing, square breathing (Nestor, 2020), and grounding.

Two types of medication are commonly used for performance anxiety (Rocha, 2021), the selective serotonin reuptake inhibitor, SSRI, or the serotonin and norepinephrine uptake inhibitor, SNRI. SSRI works by increasing the levels of one neurotransmitter, serotonin, while SNRI increases the levels of two neurotransmitters, serotonin and noradrenaline.

Some examples include:

-          Paroxetine or Sertraline (SSRI)

-          Venlafaxine (SNRI)

-          Lorazepam or Clonazepam (Benzodiazepines used to manage anxiety disorders)

Performance anxiety is inevitable because the outcome of something important tends to induce stress and anxiety. The more important thing is to keep in mind that you should accept your strengths and flaws. Identify and replace your irrational thoughts with compassionate, kinder, and less critical ones. Remember that nobody is perfect, nobody expects you to be perfect, and it is completely fine to make mistakes.

References

American Psychology Association. (2017). What is cognitive behavioral therapy? Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

Angelidis, A., Solis, E., Lautenbach, F., van der Does, W., Putman P., & Kavushansky, A. (2019). I’m going to fail! Acute cognitive performance anxiety increases threat-interference and impairs WM performance. PloS One, 14(2), 1 – 25. DOI: 10.1371/journal.pone.0210824

Biswal, K., & Srivastava, B. L. (2022). Mindfulness-based practices, psychological capital, burnout and performance anxiety. Development and Learning in Organizations, 36(6), 4 – 7.

Ford, J. L., Ildefonso, K., Jones, M. L., & Arvinen-Barrow, M. (2017). Sport-related anxiety: Current insights. Open Access Journal of Sports Medicine, 8, 205 – 212. DOI: 10.2147/OAJSM.S125845

Forsyth, J. P., & Eifert, G. H. (2016). The mindfulness & acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias & worry using acceptance & commitment therapy. New Harbinger.

Gomez-Lopez, B., & Sanchez-Cabrero, R. (2023). Current trends in music performance anxiety intervention. Behavioral Sciences, 13(9), 720 – 735. DOI: 10.3390/bs13090720

Gustafsson, H., Lundqvist, C., & Tod, D. (2016). Cognitive behavioral intervention in sport psychology: A case illustration of the exposure method with an elite athlete. Journal of Sport Psychology in Action, 8(3), 152 – 162.

Kremer, J., Moran, A. P., & Kearney, C. J. (2019). Pure sport: Practical sport psychology. Routledge.

Laguaite, M. (2021, April 5). Workplace anxiety: Causes, symptoms, and treatment. WebMD. https://www.webmd.com/anxiety-panic/guide/stage-fright-performance-anxiety.

Marks, H. (2021, November 13). Overcoming performance anxiety in music, acting, sports, and more. WebMD. https://www.webmd.com/anxiety-panic/guide/stage-fright-performance-anxiety.

Marks, H. (2024, February 27). Stage fright (performance anxiety). WebMD. https://www.webmd.com/anxiety-panic/stage-fright-performance-anxiety

Nagel, J. J. (2010). Treatment of music performance anxiety via psychological approaches: A review of selected CBT and psychodynamic literature. Medical Problems of Performing Artists, 25(4), 141 – 148.

Nestor, J. (2020). Breath: The new science of a lost art. Penguin Books.

Olivine, A. (2024, April 1). What is performance anxiety? Very Well Health. https://www.verywellhealth.com/performance-anxiety-5200716#:~:text=Performance%20anxiety%20is%20an%20excessive,where%20they%20have%20to%20perform

Paese, S., & Egermann, H. (2023). Meditation as a tool to counteract music performance anxiety from the expert’s perspective. Psychology of Music, 52(1), 1  16. DOI: 10.1177/03057356231155968

Rocha, S. D. (2021). Musical performance anxiety (MPA). Anxiety Disorders – The New Achievements, 1 – 10. DOI: 10.5772/intechopen.91646

Weinberg, R. S., & Gould, D. (2015). Foundations of Sport and Exercise Psychology (6th ed.). Champaign, IL: Human Kinetics.