Overview
Performance anxiety is an adrenaline-driven response to a feared situation such as public speaking, exams, auditions, interviews or social events. Adrenaline produces tremor, palpitations, sweating and a shaky voice, which in turn increases the anxiety.
Beta blockers work by blocking the physical effects of adrenaline without sedation or affecting thinking. They treat the bodily symptoms, while cognitive and exposure techniques address the underlying fear.
When to seek urgent medical help
- • Asthma, very low blood pressure or a slow heart rate, which make beta blockers unsuitable
- • Panic attacks occurring unpredictably, or anxiety affecting most days
- • Low mood, hopelessness or thoughts of self-harm - seek urgent support
Symptoms and signs
- Racing or pounding heart before or during performance
- Hand tremor, shaky voice or trembling legs
- Sweating, flushing or dry mouth
- Nausea or butterflies in the stomach
- Blanking out or losing your train of thought
- Avoiding presentations, meetings or social situations
Management and treatment
Propranolol taken 30-60 minutes before a specific event reliably reduces tremor and palpitations. It is used situationally rather than daily, and a trial dose at home before an important occasion is recommended.
Your ChatDoc doctor screens for asthma, cardiac and blood pressure contraindications, advises on dose and prescribes a supply, alongside psychological strategies that build lasting confidence.
Prescription treatment options
Propranolol (as required)
Beta blocker taken before an event to control tremor, palpitations and sweating without sedation.
Exposure and rehearsal strategies
Graded practice and simulation that reduces anticipatory anxiety over time.
Breathing and relaxation techniques
Paced breathing and grounding methods that lower physiological arousal immediately.
Referral for CBT
Cognitive behavioural therapy remains the most effective long-term treatment for social anxiety.
Any prescription is issued only after a doctor has reviewed your case and considers the treatment safe and appropriate for you.
Your online Performance & Social Anxiety assessment
- 1
Tell us about your concern
Share symptoms, past treatments, medicines and relevant health information.
- 2
Upload clear photos
Upload photos of your concern where applicable.
- 3
Doctor reviews your case
Technology helps organise your answers, but every assessment and prescription decision is made by a doctor, who may message you if they need more information.
- 4
Get your personalised plan
A personalised prescription is issued if treatment is clinically appropriate.
Prognosis and outlook
Propranolol works within an hour and most people notice a clear reduction in physical symptoms at the first event they use it for.
Combining medication for key events with exposure practice and CBT allows many people to reduce or stop medication entirely over time.
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One payment. No subscription. Any prescription depends on clinical suitability.
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This page is general medical information and does not replace a personal consultation. Always seek urgent care for severe or rapidly worsening symptoms. ChatDoc is not an emergency service. Call 999 (UK) or 112 (EU) for life-threatening emergencies or 111 for urgent non-emergency help. Do not wait for an online reply.