Beta blockers: do they help reduce nervousness ?

[Tubahokk]

on a related note, I taught people to overcome America's #1 fear for 35 years - glossophobia, or - fear of public speaking. While I am not a good tuba player (getting better though) I CAN give you some real and practical advice to overcome excessive nervousness while "performing" in front of people.

1. Notice, I said excessive. A degree of nervous energy is actually good for you because it gives you the performing "edge". Over confidence can lead to lack of attention to what you are doing and cause slip-ups. Then you regain your nervousness really fast. But, if you can cover your mistake so that it is not noticeable to the audience you get a pass. Being a little nervous is a good thing.

2. Have a plan and practice, practice, practice. My guitar teacher said that I should never play/sing a song in public that I have not done at least 50 times or more to my satisfaction so that it becomes rote. For public speaking I use what is called the Motivated Sequence Outline. But that is not for everyone. If you are really nervous go with manuscript speech. Use LARGE font and put it in binders. TRIPLE space the text. Practice it out loud many times and use a colored marker to high-lite when to slow down, get dramatic, pause, and etc. And if you screw up DO NOT APOLOGIZE by word, expression, or body language. You are the one putting for the effort. Your audience WANTS you to succeed. That is, unless you are at the wrong political convention.

There is a little more but I think I have said enough. I wish you the best success.

Just a little post-note. I once lost my lines on stage in front of a live audience for what seemed like 20 minutes. It was actually only 15 seconds or so. I finally found my place and sweated it through. Nobody in the audience (from my questioning) knew. And, best part - I suffered no ills effects. You can do it.

[Bombardonier]

+1

[bigtubby]

Real bass players don't get nervous.

[Donn]

It's legal where I am, and I love it - no "reefer madness" message here - but I think it's fair to say that it does impair cognitive function in various ways, including short term memory. I would not recommend marijuana as a solution for nervousness, I think that wouldn't work out very well at all.

[tubeast]

I´m sure it´s possible (and necessary) to practise PLAYING TO AN AUDIENCE in order to shake off nerves. Seek seemingly strange situations to perform: practise in Your studio first, then perform to rabbits in the fields, joggers in a park, construction personnel on a jobsite, to passers-by in busy streets, to guests of a pub (if the staff will let You)...

A beneficial concept may be, that YOU are doing the audience a favor by performing, not the other way around. Provided, you practised hard enough to support that theory...

As Tubahokk wrote: The audience wants You to succeed.

[Rick Denney]

Here is a proper medical paper on the use of Propanolol for treating essential tremor:

http://www.ccjm.org/content/78/12/821.long

Key Points

In addition to motor dysfunction, the tremor can also have a significant psychological impact on the patient, especially since it usually gets worse in social situations.
Essential tremor is a clinical diagnosis. After a thorough review of the medical history and medication exposures, laboratory and imaging tests may be ordered to rule out a secondary cause.
The two first-line agents in drug therapy for essential tremor are the nonselective beta-blocker propranolol (Inderal) and the antiepileptic primidone (Mysoline). They can be used alone or in combination.
Botulinum toxin injection and deep brain stimulation are reserved for resistant tremor or for patients who do not tolerate drug therapy.

The article also mentions that highly controlled consumption of alcohol also ameliorates the symptoms of essential tremor.

I suffer from essential tremor, which at first I thought might be Parkinson's. But Parkinson's tremor is mostly seen as a tremor of muscles at rest, while essential tremor affects muscles in use. When I'm under any stress at all, I cannot write by hand--even writing checks at the store is often difficult for me. I can type, but under stress my typing becomes more hammering and erratic. When I play in concert (or even in rehearsal when I have a solo--I'm as concerned about what my colleagues think as I am about the audience), I have tremor that affects my head and torso as much as my hands, sometimes making it impossible to sustain a buzz.

I speak in front of groups of people for a living, doing it every week and often every day. I am not the nervous sort and I have complete confidence in so-called "social situations". It's not "nerves", which brings a negative connotation. I do suffer from the tremor in those situations, but it does not interfere with my effectiveness so I don't take medication for those situations. Even as I type this, as a public statement of a medical condition, my hands are shaking and my head is shaking back and forth. No, this is a genetic disorder brought about by a dysfunction in the cerebellum portion of the brain, as I read the literature. Those who brag about their ability to handle their nerves may someday face essential tremor, and when they do, they might be forced to reckon with their earlier self-assurance on the topic.

Notice that Propanolol, which is a broad beta-blocker (and the generic for Inderal), is the first line recommended medication for this disorder. It works for me. Drinking a single glass of beer has a similar effect. (I do not drink much, and am not in any way an alcoholic. Alcoholics should never use alcohol no matter what the physiological justification.) I also have to control caffeine on performance day and I make sure I'm not suffering from low blood sugar as a result of not eating at the right time (also contributory elements noted in the article linked above). Propanolol does not remove me from the audience or the moment. My dose is very small--10mg--and I take one or two in advance of a stressful situation where the tremor will affect my ability to function.

I used to pride myself on my ability to achieve near 100% of my limited abilities in a performance situation, but essential tremor took that away from me. I've had people think I was taking the "easy" way out by seeking medical advice from my doctor and using what he prescribed, and all I can say is: Wait until it happens to you. Hopefully, it never will. But it might. Let's stop calling it "the audition drug" and looking down on those who use it.

Now, will this help the OP who is nervous about speaking in public? I don't know. But at least he can take real experiences reported here to his doctor and have an intelligent conversation about it.

Rick "not ready to give up tuba playing, thank you very much" Denney

[Three Valves]

How long before these Performance Enhancing Drugs are banned??

[Donn]

Purely by coincidence I guess, this same general subject just came up in another bulletin board kind of thing I follow. Not the drug, not yet anyway, just the nervousness problem. Similar stuff - one player mentioned feeling calm enough despite physical symptoms like shaking like a leaf.

Anyway, then someone posted a little advice that seems kind of obvious in retrospect, but I don't recall anything similar here. Learned by necessity due to nerves vs. a lot of public speaking. Basically: breathe. Take full, deep breaths, which we hopefully know how to do. Breathe it all out. That's the short version, anyway. Breathing isn't just a skill for tuba players, it shows up anywhere people are learning better control over themselves. In the old thread referenced above, someone mentioned Alexander Technique, which I believe would be an example.

[Rick Denney]

Purely by coincidence I guess, this same general subject just came up in another bulletin board kind of thing I follow....
Anyway, then someone posted a little advice that seems kind of obvious in retrospect, but I don't recall anything similar here. Learned by necessity due to nerves vs. a lot of public speaking. Basically: breathe. Take full, deep breaths, which we hopefully know how to do. Breathe it all out. That's the short version, anyway...

The problem is that essential tremor is not caused by lack of oxygen, and many have it even when not particularly under stress, though being nervous makes it worse. In any case, I've tried all the breathing tricks and mind games. I'm even pretty good at them. They help. But for those with real physiological symptoms, they might not be enough.

Music is not a sport, or even a competition (despite the competitiveness of auditions). The object is to serve the music, not to beat the other guy. Auditions are won by those who serve the music most effectively, and that requires a musical awareness and skilled technique that cannot be enhanced by any drug. Those who expect a musical epiphany to result from a beta blocker (or who fear such an epiphany from someone else being auditioned) are fooling themselves and focusing on the wrong thing. I was never able to play a lick I couldn't master in the practice room just because I'd taken a beta blocker. But the beta blocker can prevent a physiological symptom from undermining the musicality and technique one does possess and did work hard to achieve. I've had licks ruined in performance that I could play accurately enough a 100 times out of a hundred in the practice room. It should not be a definition of talent that one does not suffer from this genetic malady.

Those who overuse it or use it for the wrong reasons will go backwards, musically. That should be obvious--there are no shortcuts. But it's possible that breathing won't help an unmusical or unpracticed person who is nervous because of that, either. There is no replacement for confidence that results from preparation and practice, and Propanolol does not treat lack of confidence.

Rick "who suffers from the shakes even when meticulously prepared" Denney

[windshieldbug]

Propanolol does not treat lack of confidence.

+100

[eupher61]

To sum it up, because even after Rick's perfect explanation someone will still ask.

No. Beta blockers do not reduce nervousness. They reduce the physical manifestation of nervousness in some people.

[Donn]

The problem is that essential tremor is not caused by lack of oxygen, and many have it even when not particularly under stress, though being nervous makes it worse. In any case, I've tried all the breathing tricks and mind games. I'm even pretty good at them. They help. But for those with real physiological symptoms, they might not be enough.

Well, of course I was explicitly talking about nervousness. I wouldn't have guessed that breathing, Alexander Technique, etc., would help for essential tremor, which sounds like an essentially different kind of problem.

In physiological terms, deep breathing apparently stimulates the parasympathetic nervous system, and thus moderates the "fight or flight" mode that can come on when we get into a scary situation. Fight-or-flight symptoms could be increased heart rate, dry mouth, tunnel vision ... rapid breathing.

[dave_matheson]

To sum it up, because even after Rick's perfect explanation someone will still ask.

No. Beta blockers do not reduce nervousness. They reduce the physical manifestation of nervousness in some people.

The only thing that matters to me is controlling the PHYSICAL manifestation of symptoms of nervousness. In my case,I become paralyzed at a speakers podium by dry mouth, shortness of breath, increased heart rate. I wasn't "lacking confidence". Far from it. My sympathetic nervous system kicked in and effectively neutralized my physical ability to communicate to an audience.

When I can't speak above a whisper at a podium and need to pause every 45 seconds because of physical symptoms ... I'll be taking a beta blocker, as prescribed by my physician, thanks very much !

I'll let you all know how my "Father of the Bride" speech works out after the wedding May 31st. I'll put propanolol to the test. What do I have to lose ? Nothing.

[Rick Denney]

Well, of course I was explicitly talking about nervousness. I wouldn't have guessed that breathing, Alexander Technique, etc., would help for essential tremor, which sounds like an essentially different kind of problem.

In physiological terms, deep breathing apparently stimulates the parasympathetic nervous system, and thus moderates the "fight or flight" mode that can come on when we get into a scary situation. Fight-or-flight symptoms could be increased heart rate, dry mouth, tunnel vision ... rapid breathing.

(Sorry for the late response--I was traveling by car and in a caregiver role and couldn't keep up the conversation on my end.)

Of course, though the fight-or-flight symptoms are treated as being the same as essential tremor. ET is exacerbated (severely) by nervousness, but then those who fear having debilitating tremor in a clutch situation have reason to be nervous. Propanolol treats the adrenalin reaction, which works for both "nerves" and ET, but it's hard to separate the two.

I've heard many prescribe deep breathing and so on as the cure for severe symptoms, and in my experience, it does help, but is only fully effective with mild symptoms. I managed my situation for some years doing it that way. But it's a little hard to turn the outside in (which is the notion behind meditative deep breathing) when in a performance situation, especially when being uniquely expected to entertain a skeptical audience. It's not quite the same as sitting in a section, except that tuba players are often not in the "section-player" situation for one reason (solos) or another (orchestras).

I had one panic reaction as a younger player that was so unexpected that it took me by surprise. The TubaMeisters played part of a college recital near San Antonio back in 1992, and this was after having played many hundreds of shows in public at Fiesta Texas theme park that year. I had chops of steel in those days and rarely felt any nervousness at all; in fact, we often had to mentally pump ourselves up to give us that entertaining edge. But for this recital, we'd prepared some more serious music for the first half of our set. As we walked out onto the stage, I had this realization that I had sat in that very recital hall attending faculty recitals, and had always come in with high expectations (not always realized). It occurred to me that I did not attain to my own standard and my body was suddenly flooded with adrenalin. I shook, sweated, played with a dry mouth, and felt my heart pumping in my chest, but I could fall back on those chops of steel and get through it (albeit with some unintended vibrato and perhaps a bit more than usual strain in my tone). By the time we jumped into our regular set (and left the music stands behind), it was gone. I never had another attack of nerves like that until a few years ago when tremor set in and I started to be afraid of its effects. The physiological signs are identical, then and now. (They are worse now--in a similar situation, I might not have been able to sustain a buzz at all without bracing my head against the side of the bell.) Meditative deep breathing before walking out on that stage might have been effective on that occasion, and I agree that it should certainly be tried first.

In that instance, the nerves reaction diminished my abilities to express myself musically. The lack of those symptoms would not have enhanced those abilities, it would just have avoided diminishing them. I absolutely do not understand the notion of this being an illicit use of drugs, like steroids or EPO for an athlete.

Part of the reason music students are required to perform in recital and in clutch situations frequently during their studies is so that they learn how to manage those reactions. But there is an age component, and even high-end pros are not always immune to its effects.

Rick "absolutely recommending that the OP have this conversation with his doctor" Denney

[Donn]

Not to put too fine a point on it, but just to address some apparent confusion, I don't see deep breathing as "meditative" at all. It's a physical practice with a physiological basis that I think is fairly well understood in terms of the nervous system, and with specific application having to do with "fight or flight response." No mental practices of any kind required, just air.

Coincidentally, last night I was informed that it's much more effective in this respect to breathe in through the nose, and I see that this is widely advocated, though I'm having a hard time finding much of an academic basis for it.

[Rick Denney]

Not to put too fine a point on it, but just to address some apparent confusion, I don't see deep breathing as "meditative" at all. It's a physical practice with a physiological basis that I think is fairly well understood in terms of the nervous system, and with specific application having to do with "fight or flight response." No mental practices of any kind required, just air.

Coincidentally, last night I was informed that it's much more effective in this respect to breathe in through the nose, and I see that this is widely advocated, though I'm having a hard time finding much of an academic basis for it.

Any deep breathing exercise that is not conducted with a sense of quiet will probably cause whoever is in the vicinity to dial 911. By "meditative", I did not mean anything spiritual. I meant a little quiet time in a corner while doing that deep breathing, in order to rest one's mind and not fall down the stairs because of hyperventilation. But maybe that's why they advocate breathing through the nose.

I always thought it was a little funny to tell tuba players to breathe deeply. Weren't we doing that when we were warming up?

Rick "after the music starts, the breathing is controlled by the music" Denney

[Jay Bertolet]

I always thought it was a little funny to tell tuba players to breathe deeply. Weren't we doing that when we were warming up?

My experience is that this is the very first thing that breaks down when one is experiencing performance anxiety. At least that is how it is for me. Once my breathing patterns are interrupted, then I'm distracted and a whole bunch of other things go wrong in a very bad cascade sort of effect. Perhaps this is why so many focus on the breathing aspect of this problem. While I don't think it would help if one has tremors, it certainly quiets the rapid panting that often accompanies nerves and maybe short circuits a host of other problems before they start. I have definitely had the experience where I took several deep breaths when I felt nerves coming on and the problem stopped. I've also had that same experience where the deep breaths made no difference.

[Donn]

Yes, exactly - that cascade of stuff that you don't need is the work of the oddly named "sympathetic" nervous system, which we need but which has to be held in balance by the "parasympathetic" nervous system - which is supported by deep breath. Right there in the spotlight with your brain bubbling with fear, put your finger in your right nostril and breathe in through your left ... well, OK, how about just breathe in through your nose. I'm not a doctor, so no refunds will be issued for this advice if it doesn't work.

[MaryAnn]

Not having read the thread because of the assumption of the usual screeching about supervision by a doctor and all you have to do is get your head together via recommended means and you will be able to face the entire thing, I have the following wisdom to impart.

Some of us have a genetic variation that renders us chronically low in dopamine; the effects become more obvious in stress situations. There is simply less available to deal with stress, and so some people melt on stage and/or in other stress situations.

I found out I had a genetic SNP called CBSA360A in +\+ form, which is the "variant." Previously to that, I found out that 1000 mg of L tyrosine prior to a performance caused the extreme anxiety to not exist. I said "not exist" and I meant it. The L tyrosine supplies my brain with an adequate amount of dopamine and the rest was able to function normally. None of the plethora of other things I tried worked, including beta blockers. If I got over 2.5 mg, my thinking became so befuddled as to be worse than if I took nothing. You will note that 2.5 mg is a miniscule dose, given the astronomical doses given for medical reasons, and a typical performance anxiety dose is about 40 mg. I can't imagine what would happen to me on 40 mg; perhaps I would die or something.

So....if you get the 23andme genetic test done, for $99, not only will you get a whopping amount of valuable genetic data, you will also find out how much Neanderthal blood you have!! And if you have other problems than performance anxiety, the data you get will allow you to research other nutritional paths that can be of great benefit.

And if you do not have a problem in the dopamine pathway and take 1000mg, you are likely to have extreme agitation and discomfort form an excess of dopamine.

[dave_matheson]

Not only Neanderthal's ... I think that there are likely a few Reptilians, masquerading as Tubists, on Tubenet