Performance anxiety, also called stage fright, is an outsized feeling of fear, nervousness or dread that surrounds completing a specific task. It is a common mental health concern but not a diagnosable condition, and it falls under the umbrella of anxiety disorders, alongside social anxiety and generalized anxiety disorder.¹

The “stage” is often metaphorical. Performance anxiety can show up any time you feel watched or evaluated, like giving a work presentation, taking a test or being called on in class. Common physical symptoms include a racing heart, sweating, trembling, dry mouth and shortness of breath.^2,3

Performance anxiety starts with your body’s fight-or-flight response. When your brain reads a situation as a threat, it triggers a stress response that shows up as a racing heart, sweating or shaking.⁴

Several factors can make you more likely to experience it:⁵

• Inherited traits: Anxiety tends to run in families.

• Brain structure: An overactive amygdala, the part of the brain that controls the fear response, may cause heightened anxiety in social situations.

• Past experiences: Anxiety can be a learned behavior. An unpleasant or embarrassing experience in front of others can make you anxious about repeating it.

• Temperament: People who are naturally shy, timid or withdrawn in new situations may be at greater risk.

• New demands: Meeting new people, giving a speech or making an important work presentation can trigger symptoms for the first time.

Triggers vary between individuals. Common ones include:^6,7

• Public speaking or giving a presentation

• Taking a test or exam

• Competing in a sport

• Auditions and musical performances

• Job interviews

• Being called on in class or in a meeting

• Giving a toast or speech at a wedding

• Meeting unfamiliar people

• Going on a date

Most people get the best results by combining in-the-moment techniques, therapy and, in some cases, medication.

In-the-moment strategies include:⁸

• Exercise: Moving your body releases endorphins that can help override your stress response. A quick walk or a few jumping jacks can be enough.

• Deep breathing: Slow, controlled breathing helps calm your nervous system before you perform.

• Grounding: The 5-4-3-2-1 technique has you name five things you see, four you feel, three you hear, two you smell and one you taste to interrupt anxious thoughts.

• Shake it out: Flailing your arms, shrugging your shoulders or hopping around helps release built-up tension and signals to your body that you are safe.

• Preparation: Rehearsing until the material feels familiar reduces uncertainty.

Therapy is the most established long-term treatment. Cognitive behavioral therapy (CBT) has the strongest evidence for treating social anxiety. It helps you identify and manage the thoughts and behaviors that keep anxiety going, and it uses gradual exposure to progressively more challenging situations.⁹

In addition to these longer-term strategies, medication can also help manage physical symptoms in the moment. See the medication questions below for details.

Yes. You can easily find treatment online through providers like RedBox Rx. Start an online consult to see if treatment is right for you.

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There is no medication FDA approved specifically for performance anxiety, so the medications used for it are prescribed off-label.¹⁰

• Beta blockers: These work by blocking the stimulating effect of epinephrine (adrenaline). They may reduce heart rate, blood pressure, pounding of the heart, and shaking voice and limbs.¹¹ Propranolol (Inderal®) is the most commonly used.

• SSRIs and other antidepressants: Typically used for diagnosed social anxiety disorder rather than one-off events. It may take several weeks to several months of treatment before symptoms noticeably improve.¹²

• Benzodiazepines: These may reduce anxiety and often work quickly, but they can be habit-forming and sedating, so they are typically prescribed only for short-term use.¹³

Immediate-release propranolol usually starts working within 30 to 60 minutes. Its concentration in the blood is highest between one and four hours after taking a dose.¹⁴ For this reason, providers typically direct patients to take a single dose shortly before the event.

Extended-release propranolol reaches peak blood levels at about six hours, so it is not generally prescribed for situational anxiety.¹⁵

Everyone responds to medication differently, so be sure to follow your provider’s instructions for when and how to take your medication.

No. There are no over-the-counter beta blockers available.¹⁶ All beta blockers, including propranolol, require a prescription from a licensed medical provider.

You may see supplements marketed as “natural beta blockers.” Dietary supplements are not FDA approved to treat or prevent disease, which means the FDA does not review them for safety or effectiveness before they are sold.¹⁷ Beta blockers should not be used without a prescription. Your provider can determine whether you are a good candidate.¹⁸

RedBox Rx offers propranolol starting at $1.00 per tablet. Get started today with a low-cost telehealth consult.

There is no single best medication. The right one depends on your symptoms, health history and how your body responds.

Beta blockers are best suited to people who experience anxiety in specific situations, like stage fright, rather than people living with a diagnosed anxiety disorder.¹⁹ They are most useful when physical symptoms like a racing heart, trembling or a shaking voice are the main problem.

It is worth understanding what they do not do. Beta blockers only address the physical effects of anxiety, not the underlying psychological reasons for it.²⁰ For ongoing anxiety, therapy or a longer-term medication may be more effective. Talk with a medical provider about which approach fits your situation.

Beta blockers have been used and studied extensively since the 1960s and are generally well tolerated by most people. Common side effects include:^21,22

• Cold hands or feet

• Fatigue or extreme tiredness

• Dizziness

• Dry mouth or eyes

• Nausea or stomach upset

• Insomnia, sleep changes and vivid dreams

• Slow heart rate

• Low blood pressure

• Weight gain

Some people, including those living with asthma, COPD or diabetes, should not take beta blockers. Do not stop taking a beta blocker suddenly without checking with your provider first. Some conditions can get worse when the medicine is stopped abruptly.²³

Performance anxiety medications can be prescribed by a traditional doctor’s office and also through online providers like RedBox Rx. We offer propranolol starting at $1.00 per tablet. Get started with a low-cost telehealth consult.

You can get a prescription for performance anxiety medication online with RedBox Rx. Take a quick online assessment and one of our U.S. licensed medical providers will determine if medication is right for you.

In most cases, yes. However, plans do differ, so check with your HSA or FSA administrator before you pay.^24,25

10. Cleveland Clinic

11. Mayo Clinic

12. Mayo Clinic

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14. MedlinePlus

15. Drugs.com

16. Cleveland Clinic

17. U.S. Food and Drug Administration

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24. IRS Publication 502

25. IRS Publication 969