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How to Manage Public Speaking Anxiety

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Speech Anxiety and SAD

How to prepare for a speech.

Public speaking anxiety, also known as glossophobia , is one of the most commonly reported social fears.

While some people may feel nervous about giving a speech or presentation if you have social anxiety disorder (SAD) , public speaking anxiety may take over your life.

Public speaking anxiety may also be called speech anxiety or performance anxiety and is a type of social anxiety disorder (SAD). Social anxiety disorder, also sometimes referred to as social phobia, is one of the most common types of mental health conditions.

Public Speaking Anxiety Symptoms

Symptoms of public speaking anxiety are the same as those that occur for social anxiety disorder, but they only happen in the context of speaking in public.

If you live with public speaking anxiety, you may worry weeks or months in advance of a speech or presentation, and you probably have severe physical symptoms of anxiety during a speech, such as:

• Pounding heart
• Quivering voice
• Shortness of breath
• Upset stomach

Causes of Public Speaking Anxiety

These symptoms are a result of the fight or flight response —a rush of adrenaline that prepares you for danger. When there is no real physical threat, it can feel as though you have lost control of your body. This makes it very hard to do well during public speaking and may cause you to avoid situations in which you may have to speak in public.

How Is Public Speaking Anxiety Is Diagnosed

Public speaking anxiety may be diagnosed as SAD if it significantly interferes with your life. This fear of public speaking anxiety can cause problems such as:

• Changing courses at college to avoid a required oral presentation
• Changing jobs or careers
• Turning down promotions because of public speaking obligations
• Failing to give a speech when it would be appropriate (e.g., best man at a wedding)

If you have intense anxiety symptoms while speaking in public and your ability to live your life the way that you would like is affected by it, you may have SAD.

Public Speaking Anxiety Treatment

Fortunately, effective treatments for public speaking anxiety are avaible. Such treatment may involve medication, therapy, or a combination of the two.

Short-term therapy such as systematic desensitization and cognitive-behavioral therapy (CBT) can be helpful to learn how to manage anxiety symptoms and anxious thoughts that trigger them.

Ask your doctor for a referral to a therapist who can offer this type of therapy; in particular, it will be helpful if the therapist has experience in treating social anxiety and/or public speaking anxiety.

Research has also found that virtual reality (VR) therapy can also be an effective way to treat public speaking anxiety. One analysis found that students treated with VR therapy were able to experience positive benefits in as little as a week with between one and 12 sessions of VR therapy. The research also found that VR sessions were effective while being less invasive than in-person treatment sessions.

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If you live with public speaking anxiety that is causing you significant distress, ask your doctor about medication that can help. Short-term medications known as beta-blockers (e.g., propranolol) can be taken prior to a speech or presentation to block the symptoms of anxiety.

Other medications may also be prescribed for longer-term treatment of SAD, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). When used in conjunction with therapy, you may find the medication helps to reduce your phobia of public speaking.

In addition to traditional treatment, there are several strategies that you can use to cope with speech anxiety and become better at public speaking in general . Public speaking is like any activity—better preparation equals better performance. Being better prepared will boost your confidence and make it easier to concentrate on delivering your message.

Even if you have SAD, with proper treatment and time invested in preparation, you can deliver a successful speech or presentation.

Pre-Performance Planning

Taking some steps to plan before you give a speech can help you better control feelings of anxiety. Before you give a speech or public performance:

• Choose a topic that interests you . If you are able, choose a topic that you are excited about. If you are not able to choose the topic, try using an approach to the topic that you find interesting. For example, you could tell a personal story that relates to the topic as a way to introduce your speech. This will ensure that you are engaged in your topic and motivated to research and prepare. When you present, others will feel your enthusiasm and be interested in what you have to say.
• Become familiar with the venue . Ideally, visit the conference room, classroom, auditorium, or banquet hall where you will be presenting before you give your speech. If possible, try practicing at least once in the environment that you will be speaking in. Being familiar with the venue and knowing where needed audio-visual components are ahead of time will mean one less thing to worry about at the time of your speech.
• Ask for accommodations . Accommodations are changes to your work environment that help you to manage your anxiety. This might mean asking for a podium, having a pitcher of ice water handy, bringing in audiovisual equipment, or even choosing to stay seated if appropriate. If you have been diagnosed with an anxiety disorder such as social anxiety disorder (SAD), you may be eligible for these through the Americans with Disabilities Act (ADA).
• Don’t script it . Have you ever sat through a speech where someone read from a prepared script word for word? You probably don’t recall much of what was said. Instead, prepare a list of key points on paper or notecards that you can refer to.
• Develop a routine . Put together a routine for managing anxiety on the day of a speech or presentation. This routine should help to put you in the proper frame of mind and allow you to maintain a relaxed state. An example might be exercising or practicing meditation on the morning of a speech.

Practice and Visualization

Even people who are comfortable speaking in public rehearse their speeches many times to get them right. Practicing your speech 10, 20, or even 30 times will give you confidence in your ability to deliver.

If your talk has a time limit, time yourself during practice runs and adjust your content as needed to fit within the time that you have. Lots of practice will help boost your self-confidence .

• Prepare for difficult questions . Before your presentation, try to anticipate hard questions and critical comments that might arise, and prepare responses ahead of time. Deal with a difficult audience member by paying them a compliment or finding something that you can agree on. Say something like, “Thanks for that important question” or “I really appreciate your comment.” Convey that you are open-minded and relaxed. If you don’t know how to answer the question, say you will look into it.
• Get some perspective . During a practice run, speak in front of a mirror or record yourself on a smartphone. Make note of how you appear and identify any nervous habits to avoid. This step is best done after you have received therapy or medication to manage your anxiety.
• Imagine yourself succeeding . Did you know your brain can’t tell the difference between an imagined activity and a real one? That is why elite athletes use visualization to improve athletic performance. As you practice your speech (remember 10, 20, or even 30 times!), imagine yourself wowing the audience with your amazing oratorical skills. Over time, what you imagine will be translated into what you are capable of.
• Learn to accept some anxiety . Even professional performers experience a bit of nervous excitement before a performance—in fact, most believe that a little anxiety actually makes you a better speaker. Learn to accept that you will always be a little anxious about giving a speech, but that it is normal and common to feel this way.

Setting Goals

Instead of trying to just scrape by, make it a personal goal to become an excellent public speaker. With proper treatment and lots of practice, you can become good at speaking in public. You might even end up enjoying it!

Put things into perspective. If you find that public speaking isn’t one of your strengths, remember that it is only one aspect of your life. We all have strengths in different areas. Instead, make it a goal simply to be more comfortable in front of an audience, so that public speaking anxiety doesn’t prevent you from achieving other goals in life.

A Word From Verywell

In the end, preparing well for a speech or presentation gives you confidence that you have done everything possible to succeed. Give yourself the tools and the ability to succeed, and be sure to include strategies for managing anxiety. These public-speaking tips should be used to complement traditional treatment methods for SAD, such as therapy and medication.

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Goldstein DS. Adrenal responses to stress . Cell Mol Neurobiol. 2010;30(8):1433-40. doi:10.1007/s10571-010-9606-9

Anderson PL, Zimand E, Hodges LF, Rothbaum BO. Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure . Depress Anxiety. 2005;22(3):156-8. doi:10.1002/da.20090

Hinojo-Lucena FJ, Aznar-Díaz I, Cáceres-Reche MP, Trujillo-Torres JM, Romero-Rodríguez JM. Virtual reality treatment for public speaking anxiety in students. advancements and results in personalized medicine .  J Pers Med . 2020;10(1):14. doi:10.3390/jpm10010014

Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A. Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis . J Psychopharmacol (Oxford). 2016;30(2):128-39. doi:10.1177/0269881115612236

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Understanding And Overcoming Public Speech Anxiety

Most of us might experience what is commonly known as stage fright or speaking anxiety, nervousness and stress experienced around speaking situations in front of audience members. Even for experienced speakers, this can be a normal response to pressurized situations in which we are the focus of attention—such as we might encounter in front of an audience. For some people, though, the fear of public speaking and nervous energy can be much more severe, and can be a sign of an anxiety disorder. 

What is speech anxiety?

Speaking anxiety is considered by many to be a common but challenging form of social anxiety disorder that can produce serious symptoms, and can possibly impact an individual’s social life, career, and emotional and physical well-being. 

In this article, we’ll explore what speaking anxiety is, common symptoms of it, and outline several tips for managing it.

Identifying public speaking anxiety: Definition, causes, and symptoms

According to the American Psychological Association,  public speaking anxiety  is the “fear of giving a speech or presentation in public because of the expectation of being negatively evaluated or humiliated by others”. 

Often associated with a lack of self-confidence, the disorder is generally marked by severe worry and nervousness, in addition to several physical symptoms. The fear can be felt by many, whether they are in the middle of a speech or whether they are planning to speak at a future point. They may also generally fear contact with others in informal settings.

Public speaking anxiety can be a common condition, with an with an  estimated prevalence of 15-30%  among the general population.

Public speaking anxiety is considered by many to be a form of social anxiety disorder (SAD). The Diagnostic and Statistical Manual of Mental Disorder (DSM-V) includes a  performance specifier that allows a SAD diagnosis to relate specifically to anxiety surrounding public speaking or performing. For some extreme forms of this mental health condition, a medical professional may prescribe medication that can help overcome severe symptoms—although for most people this won’t be necessary.

Symptoms of performance-type social anxiety

• Worry or fear surrounding public speaking opportunities or performing, even in front of friendly faces
• Avoiding situations in which public speaking or performing may be necessary
• Shaky voice, especially when one has to speak in public
• Stomach pain or gastrointestinal discomfort
• Rapid breathing

Coping skills and strategies for social anxiety disorders

There are several strategies for addressing the symptoms of this and feeling more confident with your oratory skills, whether you need to use them at work, in formal social settings or simply in front of friends. 

The following are several strategies you can employ to address the fear of public speaking and manage your fear when it arises.

Identify possible causes of fear of public speaking

While the primary concern for those who experience speaking anxiety might typically be the fear of judgment or embarrassment when speaking publicly, there can be other causes contributing to distress. To figure out how to address this, it can help to understand potential contributing factors—as well as how others may be dealing with it on their own. 

First, it can be helpful to determine where the fear came from in the first place. Here are some  common sources of public speaking anxiety :

• Negative past experiences with public speaking
• Lack of preparedness
• Low self-esteem (this possible cause can cause feelings of overwhelm if one has to give a speech) 
• Inexperience with public speaking 
• Unfamiliar subject matter
• Newness of environment
• Fear of rejection (such as from an audience) 

Practice deep breathing to quell speaking anxiety

Public speaking anxiety might often be accompanied by feelings of stress, and also often affects physical factors such as increased speed of heart rate, tension, and rapid breathing. If you’re dealing with speaking anxiety and want to calm your nerves before a public speaking event, it can be helpful to practice deep breathing exercises. Deep breathing is considered by many to be a widely utilized technique  that can help bring your nervous system out of fight-or-flight mode, relax your body, and quiet your mind. Many find it to be one of the most convenient ways to manage symptoms, as many can do it anywhere as needed. 

To practice deep breathing prior to speaking, consider using a method called box breathing: breathe in for a four count, hold for a four-count, breathe out for a four count and hold again for a four count. You can repeat this process three to four times, possibly incorporating it with other relaxation techniques. It can also help to be mindful of your breathing as you’re presenting, which can help you steady your voice and calm your nerves.  

Practice visualization

When we experience nervousness, we can sometimes focus on negative thoughts and worst-case scenarios, despite the reality of the situation. You can work to avoid this by practicing positive visualization—such as imagining friendly faces in the crowd or you acing the main content of your speech. Positive thinking can be an effective technique for managing performance anxiety. 

Visualization is generally regarded as a research-backed method of addressing speaking anxiety that involves imagining the way a successful scenario will progress in detail. 

Having a clear idea of how your presentation will go, even in your mind’s eye, can help you gain confidence and make you feel more comfortable with the task at hand.

Understand your subject matter 

The fear of speaking in front of others can be related to potential embarrassment that may occur if we make a mistake. To reduce the risk of this possibility, it can help to develop a solid understanding of the material you’ll be presenting or performing and visualize success. For example, if you’re presenting your department’s sales numbers at work, familiarizing yourself with the important points and going over them multiple times can help you better retain the information and feel more comfortable as you give the presentation. 

Set yourself up for success

Doing small things to prepare for a speech or performance can make a big difference in helping to alleviate public speaking anxiety. If possible, you may want to familiarize yourself with the location in which you’ll be speaking. It can also help to ensure any technology or other media you’ll be setting up is functional. For example, if you’re using visual aids or a PowerPoint deck, you might make sure it is being projected properly, the computer is charged and that you can easily navigate the slides as you present.

You might even conduct run-throughs of the presentation for your speaking experience. You can practice walking the exact route you’ll take to the podium, setting up any necessary materials, and then presenting the information within the time limit. Knowing how you’ll arrive, what the environment looks like and where exactly you’ll be speaking can set you up for success and help you feel more comfortable in the moment.

Practice frequently

Practicing your presentation or performance is thought to be a key factor in reducing your fear of public speaking. You can use your  practice time  to recognize areas in which you may need improvement and those in which you excel as a speaker. 

For example, you might realize that you start rushing through your points instead of taking your time so that your audience can take in the information you’re presenting. Allowing yourself the chance to practice can help you get rid of any filler words that may come out during a presentation and make sure all your points are clear to keep the audience’s interest. Additionally, a practice run can help you to know when it is okay to pause for effect, take some deep breaths, or work effective body language such as points of eye contact into your presentation. 

It may also be helpful to practice speaking in smaller social situations, in front of someone you trust, or even a group of several familiar people. Research suggests that practicing in front of an audience of supportive, friendly faces can improve your performance—and that the larger the mock audience is, the better the potential results may be. 

To do this, you can go through the process exactly like you would if they were real audience. Once you’re done, you can ask them for feedback on the strengths and weaknesses of your presentation. They may have insights you hadn’t considered and tips you can implement prior to presenting, as well as make you feel confident and relaxed about your material. 

Maintain healthy habits

Self-care leading up to the moment you’re speaking in public can go a long way in helping you reduce nervousness. Regular physical activity is generally considered to be one proven strategy for reducing social anxiety symptoms . Exercise can help to release stress and boost your mood. If you’re giving a big presentation or speech, it may be helpful to go for a walk or do some mild cardio in the morning. 

Additionally, eating a healthy diet and drinking enough water can also help promote a sense of well-being and calm. You may choose to be mindful of your consumption of caffeinated beverages, as caffeine may worsen anxiety. 

How online therapy can help

If you experience anxiety when you need to speak in front of other people and want additional support for your communication apprehension, it can help to talk to a licensed mental health professional. According to the American Psychiatric Association, a therapist can work with you to find effective ways to manage public speaking anxiety and feel more confident performing in front of others.

Is online therapy effective for speech anxiety?

Studies suggest that online therapy can help individuals who experience anxiety related to presenting or performing in public. In a study of 127 participants with social anxiety disorder, researchers found that online cognitive behavioral therapy was effective in treating the fear of public speaking , with positive outcomes that were sustained for a year post-treatment. The study also noted the increased convenience that can often be experienced by those who use online therapy platforms. 

Online therapy is regarded by many as a flexible and comfortable way of connecting with a licensed therapist to work through symptoms of social anxiety disorder or related mental disorders. With online therapy through  BetterHelp , you can participate in therapy remotely, which can be helpful if speaking anxiety makes connecting in person less desirable. 

BetterHelp works with thousands of mental health professionals—who have a variety of specialties—so you may be able to work with someone who can address your specific concerns about social anxiety.

Therapist reviews

“I had the pleasure of working with Ann for a few months, and she helped me so much with managing my social anxiety. She was always so positive and encouraging and helped me see all the good things about myself, which helped my self-confidence so much. I've been using all the tools and wisdom she gave me and have been able to manage my anxiety better now than ever before. Thank you Ann for helping me feel better!”

Brian has helped me immensely in the 5 months since I joined BetterHelp. I have noticed a change in my attitude, confidence, and communication skills as a result of our sessions. I feel like he is constantly giving me the tools I need to improve my overall well-being and personal contentment.”

If you are experiencing performance-type social anxiety disorder or feel nervous about public speaking, you may consider trying some of the tips detailed above—such as practicing with someone you trust, incorporating deep breathing techniques and visualizing positive thoughts and outcomes. 

If you’re considering seeking additional support with social anxiety disorder, online therapy can help. With the right support, you can work through anxiety symptoms, further develop your oratory skills and feel more confidence speaking in a variety of forums.  

Additional information on online therapy for fear of public speaking

Studies suggest that online therapy can help individuals who experience nervousness related to presenting or speaking in public. In a study of 127 participants with social anxiety disorder, researchers found that online cognitive behavioral therapy was  effective in treating the fear of public speaking , with positive outcomes that were sustained for a year post-treatment. The study also noted the increased convenience that can often be experienced by those who use online therapy platforms.

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PUBLIC SPEAKING ANXIETY

The fear of public speaking is the most common phobia ahead of death, spiders, or heights. The National Institute of Mental Health reports that public speaking anxiety, or glossophobia, affects about 40%* of the population. The underlying fear is judgment or negative evaluation by others. Public speaking anxiety is considered a social anxiety disorder. * Gallup News Service, Geoffrey Brewer, March 19, 2001.

The fear of public speaking is worse than the fear of death

Evolution psychologists believe there are primordial roots. Our prehistoric ancestors were vulnerable to large animals and harsh elements. Living in a tribe was a basic survival skill. Rejection from the group led to death. Speaking to an audience makes us vulnerable to rejection, much like our ancestors’ fear.

A common fear in public speaking is the brain freeze. The prospect of having an audience’s attention while standing in silence feels like judgment and rejection.

Why the brain freezes

The pre-frontal lobes of our brain sort our memories and is sensitive to anxiety. Dr. Michael DeGeorgia of Case Western University Hospitals, says: “If your brain starts to freeze up, you get more stressed and the stress hormones go even higher. That shuts down the frontal lobe and disconnects it from the rest of the brain. It makes it even harder to retrieve those memories.”

The fight or flight response activates complex bodily changes to protect us. A threat to our safety requires immediate action. We need to respond without debating whether to jump out of the way of on oncoming car while in an intersection. Speaking to a crowd isn’t life threatening. The threat area of the brain can’t distinguish between these threats.

Help for public speaking anxiety

We want our brains to be alert to danger. The worry of having a brain freeze increases our anxiety. Ironically, it increases the likelihood of our mind’s going blank as Dr. DeGeorgia described. We need to recognize that the fear of brain freezing isn’t a life-or-death threat like a car barreling towards us while in a crosswalk.

Change how we think about our mind going blank.

De-catastrophize brain freezes . It might feel horrible if it happens in the moment. The audience will usually forget about it quickly. Most people are focused on themselves. We’ve handled more difficult and challenging situations before. The long-term consequence of this incident is minimal.

Leave it there . Don’t dwell on the negative aspects of the incidents. Focus on what we can learn from it. Worry that it will happen again will become self-fulfilling. Don’t avoid opportunities to create a more positive memory.

Perfectionism won’t help . Setting unachievable standards of delivering an unblemished speech increases anxiety. A perfect speech isn’t possible. We should aim to do our best instead of perfect.

Silence is gold . Get comfortable with silence by practicing it in conversations. What feels like an eternity to us may not feel that way to the audience. Silence is not bad. Let’s practice tolerating the discomfort that comes with elongated pauses.

Avoidance reinforces . Avoiding what frightens us makes it bigger in our mind. We miss out on the opportunity to obtain disconfirming information about the trigger.

Rehearse to increase confidence

Practice but don’t memorize . There’s no disputing that preparation will build confidence. Memorizing speeches will mislead us into thinking there is only one way to deliver an idea. Forgetting a phrase or sentence throw us off and hastens the brain freeze. Memorizing provides a false sense of security.

Practice with written notes. Writing out the speech may help formulate ideas. Practice speaking extemporaneously using bullet points to keep us on track.

Practice the flow of the presentation . Practice focusing on the message that’s delivered instead of the precise words to use. We want to internalize the flow of the speech and remember the key points.

Practice recovering from a brain freeze . Practice recovery strategies by purposely stopping the talk and shifting attention to elsewhere. Then, refer to notes to find where we left off. Look ahead to the next point and decide what we’d like to say next. Finally, we’ll find someone in the audience to start talking to and begin speaking.

Be prepared for the worst . If we know what to do in the worst-case scenario (and practice it), we’ll have confidence in our ability to handle it. We do that by preparing what to say to the audience if our mind goes blank. Visualizing successful recovery of the worst will help us figure out what needs to be done to get back on track.

Learn to relax

Remember to breathe . We can reduce anxiety by breathing differently. Take slow inhalations and even slower exhalations with brief pauses in between. We’ll be more likely to use this technique if practiced in times of low stress.

Speak slowly . It’s natural to speed up our speech when we are anxious. Practice slowing speech while rehearsing. When we talk quickly, our brain sees it is a threat. Speaking slowly and calmly gives the opposite message to our brain.

Make eye contact with the audience . Our nerves might tell us to avoid eye contact. Making deliberate eye contact with a friendly face will build confidence and slow our speaking.

Join a group . Practice builds confident in public speaking. Groups like Toastmasters International provide peer support to hone our public speaking skill. Repeated exposure allows us to develop new beliefs about our fear and ability to speak in public.

The fear of our mind going blank during a speech is common. Job advancement or college degree completion may be hampered by not addressing this fear.

Get additional practical suggestions on overcoming public speaking anxiety in this CNBC article by the director of NSAC Brooklyn, Chamin Ajjan, LCSW, A-CBT, CST.

How to Get Help for Social Anxiety

The National Social Anxiety Center (NSAC) is an association of independent Regional Clinics and Associates throughout the United States with certified cognitive-behavioral therapists (CBT) specializing in social anxiety and other anxiety-related problems.

Find an NSAC Regional Clinic or Associate which is licensed to help people in the state where you are located.

Places where nsac regional clinics and associates are based.

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Social Anxiety Disorder: More Than Just Shyness

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Are you afraid of being judged by others? Are you self-conscious in everyday social situations? Do you avoid meeting new people due to fear or anxiety? If you have been feeling this way for at least 6 months and these feelings make it hard for you to do everyday tasks—such as talking to people at work or school—you may have social anxiety disorder.

Social anxiety disorder is an intense, persistent fear of being watched and judged by others. This fear can affect work, school, and other daily activities. It can even make it hard to make and keep friends. The good news is social anxiety disorder is treatable. Learn more about the symptoms of social anxiety disorder and how to find help.

What is social anxiety disorder?

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in situations where they may be scrutinized, evaluated, or judged by others, such as speaking in public, meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things, such as eating or drinking in front of others or using a public restroom, also may cause anxiety or fear due to concerns about being humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so intense that they feel it is beyond their control. For some people, this fear may get in the way of going to work, attending school, or doing everyday things. Other people may be able to accomplish these activities but experience a great deal of fear or anxiety when they do. People with social anxiety disorder may worry about engaging in social situations for weeks before they happen. Sometimes, they end up avoiding places or events that cause distress or generate feelings of embarrassment.

Some people with the disorder do not have anxiety related to social interactions but have it during performances instead. They feel symptoms of anxiety in situations such as giving a speech, competing in a sports game, or playing a musical instrument on stage.

Social anxiety disorder usually starts during late childhood and may resemble extreme shyness or avoidance of situations or social interactions. It occurs more frequently in females than in males, and this gender difference is more pronounced in adolescents and young adults. Without treatment, social anxiety disorder can last for many years, or even a lifetime.

What are the signs and symptoms of social anxiety disorder?

When having to perform in front of or be around others, people with social anxiety disorder may:

• Blush, sweat, or tremble.
• Have a rapid heart rate.
• Feel their “mind going blank,” or feel sick to their stomach.
• Have a rigid body posture, or speak with an overly soft voice.
• Find it difficult to make eye contact, be around people they don’t know, or talk to people in social situations, even when they want to.
• Feel self-consciousness or fear that people will judge them negatively.
• Avoid places where there are other people.

What causes social anxiety disorder?

Risk for social anxiety disorder may run in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety and that genetics influences how these areas function. By studying how the brain and body interact in people with social anxiety disorder, researchers may be able to create more targeted treatments. In addition, researchers are looking at the ways stress and environmental factors play a role in the disorder.

How is social anxiety disorder treated?

If you’re concerned you may have symptoms of social anxiety disorder, talk to a health care provider. After discussing your history, a health care provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms. A health care provider may refer you to a mental health professional, such as a psychiatrist, psychologist, or clinical social worker. The first step to effective treatment is to get a diagnosis, usually from a mental health professional.

Social anxiety disorder is generally treated with psychotherapy (sometimes called “talk therapy”), medication, or both. Speak with a health care provider about the best treatment for you.

Psychotherapy

Cognitive behavioral therapy (CBT), a research-supported type of psychotherapy, is commonly used to treat social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations to help you feel less anxious and fearful. CBT also can help you learn and practice social skills, which is very important for treating social anxiety disorder. CBT has been well studied and is the gold standard for psychotherapy.

Exposure therapy is a CBT method that focuses on progressively confronting the fears underlying an anxiety disorder to help you engage in activities you have been avoiding. Exposure therapy is sometimes used along with relaxation exercises. CBT delivered in a group therapy format also can offer unique benefits for social anxiety disorder.

Another treatment option for social anxiety disorder is acceptance and commitment therapy (ACT). ACT takes a different approach than CBT to negative thoughts and uses strategies such as mindfulness and goal setting to reduce your discomfort and anxiety. Compared to CBT, ACT is a newer form of psychotherapy treatment, so less data are available on its effectiveness. However, different therapies work for different types of people, so it can be helpful to discuss what form of therapy may be right for you with a mental health professional.

For more information on psychotherapy, visit the National Institute of Mental Health (NIMH) psychotherapies webpage .

Health care providers may prescribe medication to treat social anxiety disorder. Different types of medication can be effective in treating this disorder, including:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Beta-blockers
• Anti-anxiety medications, such as benzodiazepines

SSRI and SNRI antidepressants are commonly used to treat depression, but they also can help treat the symptoms of social anxiety disorder. They may take several weeks to start working. Antidepressants may also cause side effects, such as headaches, nausea, or difficulty sleeping. These side effects are usually not severe, especially if the dose starts off low and is increased slowly over time. Talk to your health care provider about any side effects that you may experience.

Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. Beta-blockers are commonly the medication of choice for the “performance anxiety” type of social anxiety disorder.

Benzodiazepines, which are anti-anxiety sedative medications, are powerful and begin working right away to reduce anxious feelings. These medications can be very effective in rapidly decreasing anxiety, but some people build up a tolerance to them and need higher and higher doses to get the same effect. Some people even become dependent on them. Therefore, a health care provider may prescribe them only for brief periods of time if you need them.

Both psychotherapy and medication can take some time to work. Many people try more than one medication before finding the best one for them. A health care provider can work with you to find the best medication, dose, and duration of treatment for you. People with social anxiety disorder usually obtain the best results with a combination of medication and CBT or other psychotherapies.

For basic information about these and other mental health medications, visit NIMH’s Mental Health Medications webpage . Visit the U.S. Food and Drug Administration (FDA) website  for the latest warnings, patient medication guides, and information on newly approved medications. 

Support Groups

Many people with social anxiety find support groups helpful. In a group of people who all have social anxiety disorder, you can receive unbiased, honest feedback about how others in the group see you. This way, you can learn that your thoughts about judgment and rejection are not true or are distorted. You also can learn how others with social anxiety disorder approach and overcome the fear of social situations.

Support groups are available both in person and online. However, any advice you receive from a support group member should be used cautiously and does not replace treatment recommendations from a health care provider.

Both psychotherapy and medication can take some time to work. A healthy lifestyle also can help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support. To learn more ways to take care of your mental health, visit NIMH’s Caring for Your Mental Health webpage .

How can I support myself and others with social anxiety disorder?

Educate yourself.

A good way to help yourself or a loved one who may be struggling with social anxiety disorder is to seek information. Research the warning signs, learn about treatment options, and keep up to date with current research.

Communicate

If you are experiencing social anxiety disorder symptoms, have an honest conversation about how you’re feeling with someone you trust. If you think that a friend or family member may be struggling with social anxiety disorder, set aside a time to talk with them to express your concern and reassure them of your support.

Know When to Seek Help

If your anxiety, or the anxiety of a loved one, starts to cause problems in everyday life—such as avoiding social situations at school, at work, or with friends and family—it’s time to seek professional help. Talk to a health care provider about your mental health.

Are there clinical trials studying social anxiety disorder?

NIMH supports a wide range of research, including clinical trials that look at new ways to prevent, detect, or treat diseases and conditions—including social anxiety disorder. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to a health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit NIMH's clinical trials webpage .

Finding Help

Behavioral health treatment services locator.

This online resource, provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), helps you locate mental health treatment facilities and programs. Find a facility in your state by searching SAMHSA’s online Behavioral Health Treatment Services Locator  . For additional resources, visit NIMH's Help for Mental Illnesses webpage .

Talking to a Health Care Provider About Your Mental Health

Communicating well with a health care provider can improve your care and help you both make good choices about your health. Find tips to help prepare for and get the most out of your visit at Taking Control of Your Mental Health: Tips for Talking With Your Health Care Provider . For additional resources, including questions to ask a provider, visit the Agency for Healthcare Research and Quality website  .

If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). You also can text the Crisis Text Line (HELLO to 741741) or use the Lifeline Chat on the National Suicide Prevention Lifeline website   .

The information in this publication is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

For More Information

MedlinePlus  (National Library of Medicine) ( en español  )

ClinicalTrials.gov  ( en español  )

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES  National Institutes of Health NIH Publication No. 22-MH-8083 Revised 2022

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To Overcome Your Fear of Public Speaking, Stop Thinking About Yourself

• Sarah Gershman

Tips for before and during your presentation.

Even the most confident speakers find ways to distance themselves from their audience. It’s how our brains are programmed, so how can we overcome it? Human generosity. The key to calming the amygdala and disarming our panic button is to turn the focus away from ourselves — away from whether we will mess up or whether the audience will like us — and toward helping the audience. Showing kindness and generosity to others has been shown to activate the vagus nerve, which has the power to calm the fight-or-flight response. When we are kind to others, we tend to feel calmer and less stressed. The same principle applies in speaking. When we approach speaking with a spirit of generosity, we counteract the sensation of being under attack and we feel less nervous.

Most of us — even those at the top — struggle with public-speaking anxiety. When I ask my clients what makes them nervous, invariably they respond with the same answers:

• Sarah Gershman is an executive speech coach and CEO of Green Room Speakers. She is a professor at the McDonough School of Business at Georgetown University, where she teaches public speaking to leaders from around the globe.

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Overcome your public speaking anxiety with these 10 tips

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What’s public speaking anxiety?

10 symptoms of public speaking anxiety, 10 common public speaking stressors, how to overcome public speaking anxiety: 10 tips, diagnosing and treating public speaking anxiety, speak with confidence.

Your opinion and expertise matter, so it can be frustrating when public speaking nerves leave you speechless. Maybe your heart races and you trip over your words, or you spend most of your presentation hoping no one asks questions. Fear not. Public speaking anxiety is a common experience that impacts even the most confident people — and it’s manageable.

The intense nerves associated with public speaking aren’t reserved for being on stage in front of a large audience. Discomfort might occur during small team presentations , a sales pitch with a client, or group brainstorming sessions . The stress may be so potent that you avoid important opportunities to showcase your expertise and advance your career. 

But identifying triggers and understanding your physiological response will help you overcome your anxiety. With practice and support, you’ll fearlessly share your important thoughts and opinions with others. 

Public speaking anxiety, or glossophobia, is the most common subset of social anxiety, affecting about 3–5% of the general population and 80% of people with social phobias . Those with glossophobia feel anxiety symptoms , like a racing heartbeat and stressful thoughts, when sharing ideas or asking questions in front of others. And those who experience public speaking anxiety often feel more general performance anxiety during activities like striking up a conversation with a stranger or eating in public.

But why does public speaking cause anxiety? According to an article by the Harvard Business Review, our ancestors perceived being watched as a predatory threat , so our brains evolved to have a fight-or-flight response . This is the body’s physiological response to danger, activating the nervous system to encourage us to return to safety.

While public speaking doesn’t present real physical dangers, social anxiety can trigger your stress response . Worrying about people judging you, making a mistake , or messing up an important professional opportunity are visceral fears that send messages to the brain to seek protection. 

In some cases, an acute fear can be motivating . Worrying about underperforming during a client presentation or making the right first impression at a face-to-face networking event could compel you to practice and perfect your speech. 

But a chronic and debilitating fear of public speaking can disrupt your career. You may become avoidant and miss important opportunities to show off your expertise, establish your personal brand , and achieve professional development goals . 

Publi c speaking anxiety is so all-encompassing you may not be conscientious of all the ways this type of stress affects the body. Acute anxiety symptoms are widespread and vary between people , but here are 10 common signs to be aware of:

Increased heart rate

Lack of concentration 

Avoidant behaviors like social isolation

Shortness of breath

Panic attacks

Intrusive thoughts

Shaky hands and legs

While you might associate public speaking anxiety with delivering a Ted Talk or corporate event presentation, plenty of everyday situations can trigger your fear of performing. Here are 10 common stressors of public speaking anxiety: 

Meeting new colleagues or coworkers

Job interviews

Sharing ideas in a brainstorming session

Giving a small presentation

Training new coworkers

Debriefing your team or managers on an ongoing project

Offering your opinion during a virtual meeting

Delivering an elevator pitch

Participating in a board meeting

Offering someone constructive criticism

Like any other challenge, thoughtful practice, care, and patience will help you approach public speaking confidently. Here are 10 tips for public speaking anxiety sufferers looking to improve.

1. Don’t expect perfection

Perfection is an unrealistic expectation that distracts from your good work and amplifies your anxiety. Instead of aiming for perfection , celebrate your improvements and seek out continuous learning opportunities . Every chance to speak in front of others is a chance to learn and grow — even if it means a few awkward pauses or stumbling over your words occasionally. 

2. Be yourself

While keeping your body language and humor professional, be your most authentic self and stick with what feels comfortable. Imitating others’ speaking styles could make you overthink each gesture or appear unnatural and insincere. And the more you step into your authenticity at work , the more comfortable you’ll feel being yourself in every area of your life. 

3. Remember your purpose

Whether delivering a presentation or making a sale, you’re speaking in public for a reason. Think about why you’re there — be it to share your experience or teach others — and focus on this core purpose. Doing so might get you out of your head and into the situation at hand so you can concentrate less on your anxiety symptoms and more on accomplishing your task.

4. Prepare and practice

The best way to feel comfortable speaking in front of others is to practice. Speech anxiety often focuses on the unknown, like audience questions or complex presentation materials. But subject-matter-familiarity quiets some of these questions and offers answers. 

You can jot down and prepare for questions you expect or memorize your materials so they feel less overwhelming. And p racticing your delivery and body language can take away the shock of talking to a group because you have less to worry about. 

5. Let your coworkers know

Consider informing coworkers and managers about your stage fright so they know to support you. They might make adjustments like offering you additional notice regarding presentations they’d like you to make or taking your questions last in a meeting so you have more time to calm your nerves. And you can also ask team members for feedback and encouragement on your public speaking skills . 

6. Visualize success

Use visualization , positive self-talk , and other manifestation methods to picture yourself confidently speaking in public. These positive projections can become a self-fulfilling prophecy as you do what’s necessary to make your vision a reality. You could also try anxiety journaling to shake negative automatic thoughts and track your positive thinking progress. 

7. Make eye contact

If you fear public speaking, you may instinctively avoid eye contact because it feels intimate or intimidating. But chances are everyone wants to encourage you, and you can feed off the room’s energy by looking your audience in the eye. If you see heads nodding and people paying attention, you may gain the confidence boost you need to continue nerves-free. 

8. Pose for success

Standing i n power poses (body postures expressing strength and assertiveness ) signals to audience members that you’re confident and comfortable. And embracing these postures can make you feel that way, too. For in-person speaking, try keeping your feet hip-distance and your shoulders back. And if you’re on a virtual call and have the option to stand, you can still carry yourself confidently to boost your own self-esteem. If you must sit, you can still hold your head high and posture straight. 

9. Create a plan

Feel in charge of your public speaking journey by creating an improvement plan. Start by outlining small objectives, like starting two conversations with colleagues each week or contributing an idea at a team meeting. Then, define larger goals further down your improvement timeline, like leading a brainstorming session or training a new coworker. You could also work with a career coach t o build the right plan for you and track your success.

10. Take a class

Structured learning might be the best way to reduce your public speaking anxiety and gain practice. Try asking your employer whether they subsidize professional development opportunities like a public speaking course or mentorship programs . Or invest in yourself by signing up for an after-hours class with a friend so you can hold each other accountable . 

According to the Diagnostic and Statistical Manual of Mental Disorders, public speaking anxiety is classified as a social anxiety disorder that causes symptoms like intense distress and panic attacks. While it’s common to feel nervous in social situations, a mental health professional might diagnose someone with public speaking anxiety if that person experiences symptoms that affect their day-to-day health, like missing out on job opportunities or having to leave a meeting due to nerves.

While social anxiety may feel overwhelming, the good news is that it’s treatable. The first step is finding a diagnosis. Treatment generally begins by identifying the root cause and any related medical conditions to ensure a larger issue isn’t causing your symptoms . Then, you’ll work with your mental health professional to determine the best treatment plan. Common remedies include psychotherapy, medication, or both. In some circumstances, you may also seek the help of a support group or work with a life coach to build an action plan . 

What you have to say matters, and you deserve to feel confident and comfortable when expressing yourself. While public speaking anxiety might quiet your voice, it doesn’t have to define your professional future. 

Now that you have some public speaking tips for anxiety, it’s time to start working toward easing your symptoms. Depending on the severity of your nerves, consider consulting with a mental health professional, career coach, or support group. From there, you can build an appropriate plan and begin speaking — one small speech at a time — with newfound confidence.

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Elizabeth Perry, ACC

Elizabeth Perry is a Coach Community Manager at BetterUp. She uses strategic engagement strategies to cultivate a learning community across a global network of Coaches through in-person and virtual experiences, technology-enabled platforms, and strategic coaching industry partnerships. With over 3 years of coaching experience and a certification in transformative leadership and life coaching from Sofia University, Elizabeth leverages transpersonal psychology expertise to help coaches and clients gain awareness of their behavioral and thought patterns, discover their purpose and passions, and elevate their potential. She is a lifelong student of psychology, personal growth, and human potential as well as an ICF-certified ACC transpersonal life and leadership Coach.

How to talk to your boss about mental health, let’s sit down and chat

Self-advocacy: improve your life by speaking up, speaking up for yourself is important — 11 steps to get it right, the 11 tips that will improve your public speaking skills, 8 tips to improve your public speaking skills, the importance of good speech: 5 tips to be more articulate, 7 strategies for how to stop yourself from spiraling, character references: 4 tips for a successful recommendation letter, 60 questions to ask to get to know someone, be brave even if you aren't yet (9 ways to conquer your fears), fear of public speaking overcome it with these 7 tips, how to not be nervous for a presentation — 13 tips that work (really), wondering what you're good at here are 10 ways to figure it out, 50 affirmations for anxiety to find inner peace, how the spotlight effect influences your experience of the world, power poses: how to feel more confident with body language, stay connected with betterup, get our newsletter, event invites, plus product insights and research..

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• Social anxiety disorder (social phobia)

It's normal to feel nervous in some social situations. For example, going on a date or giving a presentation may cause that feeling of butterflies in your stomach. But in social anxiety disorder, also called social phobia, everyday interactions cause significant anxiety, self-consciousness and embarrassment because you fear being scrutinized or judged negatively by others.

In social anxiety disorder, fear and anxiety lead to avoidance that can disrupt your life. Severe stress can affect your relationships, daily routines, work, school or other activities.

Social anxiety disorder can be a chronic mental health condition, but learning coping skills in psychotherapy and taking medications can help you gain confidence and improve your ability to interact with others.

Social anxiety disorder care at Mayo Clinic

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Feelings of shyness or discomfort in certain situations aren't necessarily signs of social anxiety disorder, particularly in children. Comfort levels in social situations vary, depending on personality traits and life experiences. Some people are naturally reserved and others are more outgoing.

In contrast to everyday nervousness, social anxiety disorder includes fear, anxiety and avoidance that interfere with relationships, daily routines, work, school or other activities. Social anxiety disorder typically begins in the early to mid-teens, though it can sometimes start in younger children or in adults.

Emotional and behavioral symptoms

Signs and symptoms of social anxiety disorder can include constant:

• Fear of situations in which you may be judged negatively
• Worry about embarrassing or humiliating yourself
• Intense fear of interacting or talking with strangers
• Fear that others will notice that you look anxious
• Fear of physical symptoms that may cause you embarrassment, such as blushing, sweating, trembling or having a shaky voice
• Avoidance of doing things or speaking to people out of fear of embarrassment
• Avoidance of situations where you might be the center of attention
• Anxiety in anticipation of a feared activity or event
• Intense fear or anxiety during social situations
• Analysis of your performance and identification of flaws in your interactions after a social situation
• Expectation of the worst possible consequences from a negative experience during a social situation

For children, anxiety about interacting with adults or peers may be shown by crying, having temper tantrums, clinging to parents or refusing to speak in social situations.

Performance type of social anxiety disorder is when you experience intense fear and anxiety during speaking or performing in public but not in other types of more general social situations.

Physical symptoms

Physical signs and symptoms can sometimes accompany social anxiety disorder and may include:

• Fast heartbeat
• Upset stomach or nausea
• Trouble catching your breath
• Dizziness or lightheadedness
• Feeling that your mind has gone blank
• Muscle tension

Avoiding common social situations

Common, everyday experiences may be hard to endure when you have social anxiety disorder, including:

• Interacting with unfamiliar people or strangers
• Attending parties or social gatherings
• Going to work or school
• Starting conversations
• Making eye contact
• Entering a room in which people are already seated
• Returning items to a store
• Eating in front of others
• Using a public restroom

Social anxiety disorder symptoms can change over time. They may flare up if you're facing a lot of changes, stress or demands in your life. Although avoiding situations that produce anxiety may make you feel better in the short term, your anxiety is likely to continue over the long term if you don't get treatment.

When to see a doctor

See your doctor or a mental health professional if you fear and avoid normal social situations because they cause embarrassment, worry or panic.

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Like many other mental health conditions, social anxiety disorder likely arises from a complex interaction of biological and environmental factors. Possible causes include:

• Inherited traits. Anxiety disorders tend to run in families. However, it isn't entirely clear how much of this may be due to genetics and how much is due to learned behavior.
• Brain structure. A structure in the brain called the amygdala (uh-MIG-duh-luh) may play a role in controlling the fear response. People who have an overactive amygdala may have a heightened fear response, causing increased anxiety in social situations.
• Environment. Social anxiety disorder may be a learned behavior — some people may develop significant anxiety after an unpleasant or embarrassing social situation. Also, there may be an association between social anxiety disorder and parents who either model anxious behavior in social situations or are more controlling or overprotective of their children.

Risk factors

Several factors can increase the risk of developing social anxiety disorder, including:

• Family history. You're more likely to develop social anxiety disorder if your biological parents or siblings have the condition.
• Negative experiences. Children who experience teasing, bullying, rejection, ridicule or humiliation may be more prone to social anxiety disorder. In addition, other negative events in life, such as family conflict, trauma or abuse, may be associated with this disorder.
• Temperament. Children who are shy, timid, withdrawn or restrained when facing new situations or people may be at greater risk.
• New social or work demands. Social anxiety disorder symptoms typically start in the teenage years, but meeting new people, giving a speech in public or making an important work presentation may trigger symptoms for the first time.
• Having an appearance or condition that draws attention. For example, facial disfigurement, stuttering or tremors due to Parkinson's disease can increase feelings of self-consciousness and may trigger social anxiety disorder in some people.

Complications

Left untreated, social anxiety disorder can control your life. Anxieties can interfere with work, school, relationships or enjoyment of life. This disorder can cause:

• Low self-esteem
• Trouble being assertive
• Negative self-talk
• Hypersensitivity to criticism
• Poor social skills
• Isolation and difficult social relationships
• Low academic and employment achievement
• Substance abuse, such as drinking too much alcohol
• Suicide or suicide attempts

Other anxiety disorders and certain other mental health disorders, particularly major depressive disorder and substance abuse problems, often occur with social anxiety disorder.

There's no way to predict what will cause someone to develop an anxiety disorder, but you can take steps to reduce the impact of symptoms if you're anxious:

• Get help early. Anxiety, like many other mental health conditions, can be harder to treat if you wait.
• Keep a journal. Keeping track of your personal life can help you and your mental health professional identify what's causing you stress and what seems to help you feel better.
• Set priorities in your life. You can reduce anxiety by carefully managing your time and energy. Make sure that you spend time doing things you enjoy.
• Avoid unhealthy substance use. Alcohol and drug use and even caffeine or nicotine use can cause or worsen anxiety. If you're addicted to any of these substances, quitting can make you anxious. If you can't quit on your own, see your health care provider or find a treatment program or support group to help you.

Social anxiety disorder (social phobia) care at Mayo Clinic

• Social anxiety disorder (social phobia). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed May 21, 2021.
• Gabbard GO, ed. Social anxiety disorder (social phobia). In: Gabbard's Treatments of Psychiatric Disorders. 5th ed. American Psychiatric Association; 2014. http://psychiatryonline.org/doi/book/10.1176/appi.books.9781585625048. Accessed May 21, 2021.
• Schneier FR. Social anxiety disorder in adults: Epidemiology, clinical manifestations, and diagnosis. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Stein MB, et al. Approach to treating social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Hofmann SG. Psychotherapy for social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Stein MB. Pharmacotherapy for social anxiety disorder in adults. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Physical, cognitive, and spiritual interventions. https://www.uptodate.com/contents/search. Accessed April 8, 2021.
• Social anxiety disorder: More than just shyness. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness/index.shtml. Accessed April 8, 2021.
• Natural medicines in the clinical management of anxiety. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed April 8, 2021.
• Sawchuk CN (expert opinion). Mayo Clinic. April 29, 2021.
• AskMayoExpert. Anxiety disorders. Mayo Clinic; 2020. Accessed April 8, 2021.
• Brown A. Allscripts EPSi. Mayo Clinic. Sept. 11, 2020.
• Valerian. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed April 12, 2021.
• Sarris J, et al., eds. Anxiety. In: Clinical Naturopathy. 3rd ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed April 12, 2021.

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Therapy options for people with SAD and public speaking anxiety

Your heart begins to pound, your palms grow moist and clammy as you take a nervous peek through the curtains out at the audience, all the while the seconds tick closer to your moment under the spotlight. A deep breath, a clearing of the throat as you think, “How did I end up here and why am I doing this?”

And you’re up. Showtime!

Even celebrities and the most seasoned public speakers can be overcome with a sudden and unexpected case of the jitters when performing or speaking before a crowd. Be it stage, office or classroom, the anxiety that comes with public speaking is a universally shared experience, though for those struggling with social anxiety disorders (SAD), public speaking is an especially daunting, even traumatic, proposition. Wracked by intense self-scrutiny and a nagging notion that people are quietly picking them apart, SAD sufferers often aggressively play down and dismiss their abilities as public speakers 1, 2 , creating a type of self-fulfilling prophecy 3 wherein the sufferer actively avoids scenarios involving public speaking, worsening an already acute sense of isolation and contributing to a general social awkwardness 4 .

Indeed, an SAD sufferer’s harsh and often incorrect self-evaluation can ultimately result in a kind of self-sabotage when public speaking is required 5 , resulting in another kind of negative feedback loop and closing off the development of the sufferers’ innate speechmaking potential 6 .

While the body has its own undeniable way of manifesting emotions tied to fear – the sweating, the trembling, the stomach doing somersaults, all understood as the body’s way of processing information more effectively in unfamiliar or stressful situations 7 – it is the emotion-regulating amygdala, deep in the center of the brain, which plays a more defining role in how an individual deals with moments of intense stress.

Studies into the mental processes of those grappling with SAD have indicated that when communication between the amygdala and the ‘higher’ cortical brain – that vast region where thought and action are formed – is compromised the adaptive relationship between the two portions is weakened, allowing emotions to run unregulated 8 . Likewise, when an individual is anticipating having to give a speech, the activity in the emotion-generating amygdala is prolonged and a greater loss of emotional control and a heightened overall sense of ‘threat’ is reported in SAD participants over non-SAD participants 9 .

According to Dr. Alexander Bystritsky , if individuals are interested in controlling prominent symptoms associated with public speaking with medication, they should consult a psychiatrist. For example, the consumption of beta blockers (e.g. Propranolol), one hour before performance can block sympathetic nervous system responses, such as heart palpitation, sweating, etc., while minor tranquilizers (e.g. Xanax) work by reducing tension and by producing calming effects.

As far as psychotherapies are concerned, with Cognitive Behavioral Therapy (CBT), the restructuring of negative thought processes in order to improve SAD sufferers’ reactions to stressful situations 10 has shown tremendous promise. One recent study indicates that exposure not only reduces negative self biases among those suffering with public speaking anxiety but often trains the speaker to learn to shift focus from the self to the audience, allowing a more fluid presentation as well as increased confidence and self efficacy 6 . Similarly, a different study shows that while pre-speech anxiety levels in those with SAD were higher than those without, once participants in either group were actually engaged in public speaking, the anxiety leveled off, providing a treatment strategy for the SAD group centering on controlling pre-speech nervousness through CBT treatment and exposure 11 .

Another recent study compared the efficacy of two brief cognitive-behavioral interventions, traditional CBT and Acceptance-Based Behavior Treatment (ABBT). It was found that both interventions were effective. While CBT was effective in reducing subjective feelings of anxiety, subjects who had received ABBT seemed to demonstrate a newfound confidence and ease with speechmaking, scoring higher on observer-rated evaluations during presentations. Apparently, with traditional CBT, the focus on rewiring thought patterns in preparation for a public speaking engagement can take up valuable prep time and memory that would otherwise be put toward the substance of the speech itself. In contrast, ABBT may free more cognitive resources since it stresses acceptance of one’s thoughts and feelings 12 .

Indeed, the relatively recent appearance of “third” wave therapies, which integrate mindfulness practice, has proven to be a useful tool in combating fears and anxieties. Mindfulness stresses the idea of becoming aware and accepting both positive and negative thoughts and emotions, rather than trying to change them. In addition, labeling these thoughts and emotions seems to activate areas of the brain that regulate negative emotions, bringing such feelings out into the light and lessening their hold. Recommended tips for reducing speech anxiety involve labeling emotions before each practice, increasing the number of practice sessions, and not letting too much time pass between practices 13 .

1. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. Heimberg, M. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69 – 93). New York, NY: Guilford Press.

2. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35 , 741 – 756. http://dx.doi.org/10.1016/S0005-7967(97)00022-3

3. Curtis, R. C., & Miller, K. (1986). Believing another likes or dislikes you: Behaviors making the beliefs come true. Journal of Personality and Social Psychology , 51 (2),284.

4. Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy , 35 (8), 741-756.

5. Rowa, K., Paulitzki, J. R., Ierullo, M. D., Chiang, B., Antony, M. M., McCabe, R. E., & Moscovitch, D. A. (2015). A False Sense of Security: Safety behaviors erode objective speech performance in individuals with social anxiety disorder. Behavior Therapy , 46 (3), 304-314. doi:10.1016/j.beth.2014.11.004

6. Cheng, J., Niles, A. N., & Craske, M. G. (2017). Exposure reduces negative bias in self-rated performance in public speaking fearful participants. Journal Of Behavior Therapy & Experimental Psychiatry , 54, 101-107. doi:10.1016/j.jbtep.2016.07.006

7. Durlik, C., Brown, G., & Tsakiris, M. (2014). Enhanced interoceptive awareness during anticipation of public speaking is associated with fear of negative evaluation. Cognition & Emotion , 28 (3), 530-540. doi:10.1080/02699931.2013.832654

8. Cremers, H. R., Veer, I. M., Spinhoven, P., Rombouts, S. B., Yarkoni, T., Wager, T. D., & Roelofs, K. (2015). Altered cortical-amygdala coupling in social anxiety disorder during the anticipation of giving a public speech. Psychological Medicine, 45 (7), 1521-1529. doi:10.1017/S0033291714002657

9. Davies, C. D., Young, K., Torre, J. B., Burklund, L. J., Goldin, P. R., Brown, L. A., & … Craske, M. G. (2017). Altered time course of amygdala activation during speech anticipation in social anxiety disorder. Journal Of Affective Disorders, 209 , 23-29. doi:10.1016/j.jad.2016.11.014

10. Goldin, P. R., Ziv, M., Jazaieri, H., Hahn, K., Heimberg, R., & Gross, J. J. (2013). Impact of Cognitive-Behavioral Therapy for social anxiety disorder on the neural dynamics of cognitive reappraisal of negative self-beliefs. JAMA Psychiatry , 70 (10), 1048–1056. http://doi.org/10.1001/jamapsychiatry.2013.234

11. Morrison, A. S., Brozovich, F. A., Lee, I. A., Jazaieri, H., Goldin, P. R., Heimberg, R. G., & Gross, J. J. (2016). Anxiety trajectories in response to a speech task in social anxiety disorder: Evidence from a randomized controlled trial of CBT. Journal Of Anxiety Disorders, 38 , 21-30. doi:10.1016/j.janxdis.2015.12.006

12. Glassman, L. H., Forman, E. M., Herbert, J. D., Bradley, L. E., Foster, E. E., Izzetoglu, M., & Ruocco, A. C. (2016). The Effects of a brief Acceptance-Based Behavioral Treatment versus traditional Cognitive-Behavioral Treatment for public speaking anxiety. Behavior Modification, 40 (5), 748-776. doi:10.1177/0145445516629939

13. Niles, A. N. (2015). How to conquer your fears and anxiety by labeling your emotions. Anxiety.org Retrieved from https://www.anxiety.org/fear-public-speaking-labeling-emotions-tips

Cinzia Cott ù  Di Roccaforte earned a Doctoral Degree in Clinical Psychology from Alliant International University Los Angeles in 2019. She received a Bachelor of Arts in psychology from UCLA in 2011 and her Master of Arts in clinical psychology with emphasis in Marriage & Family Therapy from Pepperdine University in 2014. Dr. Roccaforte has been working with  Dr. Alexander Bystritsky  at the UCLA Anxiety Disorders Program. Dr. Roccaforte and Dr. Bystritsky also collaborated writing articles for Anxiety.org.

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Resolve Public Speaking Anxiety

Channel anxiety into high performance. a solution is here..

• Fear of being noticeably nervous
• Obsessed about recurring panic
• Toxic Perfectionism
• Terror at the thought of doing a monologue
• Defensive thinking & behavior
• Detachment from thoughts & feelings
• Rationalizing a career change to avoid public speaking

“The Berent Method integrates technique with core work. Technique is the paradox of learning to become adrenaline friendly. Core work resolves the emotions of embarrassment, shame, and humiliation. The objective of treatment is to master the psycho-physiology of performance.”

Treatment available worldwide via telephone or skype also in our great neck office, listen to kendra world-renowned physician describes her “cure” for public speaking anxiety disorder, listen to tom sr. executive of a multi-billion dollar company, describe how he changed his life by resolving his deep rooted public speaking anxiety., interviews with patients who have resolved public speaking anxiety the most "evidence-based" clinical success since 1978, new podcast:, public speaking anxiety & fear of being noticeably nervous: mind surgery for high performers.

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Glossophobia or speech anxiety is the fear of public speaking or of speaking in general. The word glossophobia comes from the Greek glossa, meaning tongue, and phobos, fear or dread. Public speaking anxiety becomes a “disorder” when avoidance (phobia) occurs and when the mental and/or physical pain of the anxiety is substantial.

Almost everyone has heard that fear of public speaking is higher on the anxiety hierarchy than death for most people, but it’s hard to understand the reason for this.

Consider why: Carol was a homemaker and mother of two. She was an ovarian cancer survivor who once said “ I’d rather be back in chemotherapy than speak in from of a group. With the cancer there was no judgment. ”

Treatment with thousands of patients with public speaking anxiety at Berent Associates has demonstrated that the specific fear of judgment about being noticeably nervous is the singular most common cause that drives the fear. Examples of fear of being noticeably nervous include erythrophobia (fear of blushing), hyperhidrosis (sweating), voice stammering, and selective mutism .

The fear of being noticeably nervous is a big part of the untold story. One of the reasons this piece of the story is not well known is that many public anxiety sufferers are perfectionists. The last thing a perfectionist will do is admit they are not perfect. While the perfectionism is often a major positive variable for career success, it’s also been the energy that drives the anxiety. In “ Obsessive Compulsive Personality Disorder as Etiology for Performance Anxiety, ” Jonathan Beren t describes how perfectionism drives performance and social anxiety.

Being noticeably nervous activates unresolved emotional pathology in one’s “reservoir.” This recycling energy is the force that drives physical symptoms. Most glossophobia sufferers can relate to the fight-or-flight response being overly reactive in a group challenge scenario. What they don’t realize is that their internal critical script drives the adrenaline, which drives the anxiety.

Many sufferers have at one time been good public speakers only to suffer a panic attack seemingly out of nowhere. Once this trauma occurs, hypervigilance and obsessive worry about upcoming challenges dominate, and can wreak havoc on their overall mood and career or academic performance.

Effective treatment requires an architecture of F.A.T.E. (See Figure 1).

Anything less than this architecture trivializes public speaking anxiety disorder.

“It’s wonderful to strive for peak performance. It’s absurd to be paralyzed by fear of not being perfect.”

Performance anxiety within a public speaking context is based on worries about being noticeably nervous and losing control due to panic. Physical symptoms such as increased pulse,  blushing ,  breaking out into a sweat , nausea, and eye contact difficulty are common. A myriad of deeper negative thoughts run rampant such as, “people will see who I really am”; “I will humiliate myself”; or “people will not get to see my true ability”. These are characterized by varying degrees of obsessive thinking. When public speaking anxiety and panic turn into avoidance, a  social phobia  is present. The more avoidance takes place, the more there is the risk of an  avoidant personality disorder  developing.

Start the process: Resolve Your Performance Anxiety

If you understand your public speaking challenge as an anxiety problem rather than just a skills issue, and are truly motivated to change, this is the program for you. Your performance anxiety is resolvable when you learn to control “the physiology of performance”, and understand “autonomic hypersensitivity” concurrent to emotional and cognitive restructuring.

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Jonathan berent l.c.s.w. presents public speaking anxiety workshop to the national association of social workers, psycho-physiological therapy for public speaking anxiety & fear of being noticeably nervous.

Public speaking anxiety is the #1 phobia which is often driven by the fear of being noticeably nervous. Debilitating symptoms include panic attacks, fear of blushing (Erythrophobia), fear of sweating (hyper-hidrosis, voice freeze (selective mutism), and dissociation. These symptoms are driven by obsessive worry and perfectionism. This strategy can be utilized for social workers who experience this challenge. It also can be taught to their clients.

In this introductory workshop for social workers participants will learn the basic treatment architecture for public speaking performance anxiety.

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More Helpful Articles on Public Speaking Anxiety

A social anxiety perspective of the coronavirus, researching the research on cognitive behavioral therapy and social anxiety, jonathan berent announces first of its kind library of clinical interviews on public speaking and fear of being noticeably nervous, ask jonathan questions.

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Other Symptoms

Slurred speech from anxiety: causes and treatments, fact checked.

Micah Abraham, BSc

Last updated October 10, 2020

Many anxiety symptoms can make a person feel like there is something wrong with their brain. Our brains are arguably the most important part of our bodies, and deep down many people with anxiety have a fear that their brain may fail them. They worry that something is wrong with their brain, like a tumor or multiple sclerosis, and that worry causes them even more anxiety.

Slurred speech is an example of an anxiety symptom that can be incredibly frightening. But it's common with those suffering from anxiety attacks, and in most cases it says nothing about the health of your brain.

Causes of Anxiety Slurred Speech

Slurred speech, also known as dysarthria, is when a person’s words become jumbled together and may be difficult to understand. This is caused by the muscles that are used to create speech not functioning properly or to their best ability.

Slurred speech without alcohol is linked to a variety of diagnoses that are cause for concern, including:

• Multiple Sclerosis
• Brain Tumors
• Lyme Disease
• Head Injury
• Cerebral Palsy

If you think there's any chance that you may suffer from these or any related conditions, see a doctor. You should never leave your brain's health up to chance, because your brain is simply too important to take those types of risks.

However, it should be noted that in most cases where slurred speech is caused by the diagnoses above, the slurred speech is long lasting. It may fade in and out over the course of a lifespan, but rarely a few hours or less. It's possible, which is why this isn't a risk you should take to chance, but it's uncommon.

For some people, anxiety can cause slurred speech, as well as issues that resemble slurred speech. All of the following are potential links between stress/anxiety and slurring of words:

• Overactive Thoughts One of the key reasons that some people slur their words is because anxiety makes it hard to focus. Stress can affect recall and mental accuracy, and extreme anxiety can cause you to be so far "in your head" that it is extremely difficult to get words out. In a way, anxiety makes your brain work too hard, and when it does some of the other things your brain needs to do don't work as well - like speaking.
• Muscle Tension Anxiety also causes significant muscle tension. Muscle tension can make it harder to move mouth muscles, which of course is the main cause of slurred speech in most other conditions.
• Over-Awareness An interesting problem with anxiety is the way it makes you over-aware of what would otherwise be subconscious/automatic behaviors. It's seen in other areas of life as well - for example, anxiety can make it harder for some people to walk because they're more aware of the movements in their legs. It can affect the mouth and speech as well. Speech is an automatic movement, and during intense anxiety your mouth movements may be controlled by you rather than your subconscious mind, making them much harder to do.
• Anxiety Medications Slurred speech is the side effect of many different anxiety medications. Most often it's because these medications also act as muscle relaxants and make it harder to move the muscles in your mouth and face.
• Tiredness, Caffeine, and More Several fairly normal issues can also affect speech. For example, those that are very tired may be more prone to slurred speech because their brain is not functioning as well as normal. Tiredness (as well as a lack of caffeine for those with caffeine addiction and other issues that may affect alertness) slows the brain down to the point where muscles may work less effectively.

These are just some of the reasons that anxiety may be responsible for slurred speech. It should also be noted that some slurred speech once in a while is normal even in those without anxiety. But when you have anxiety, it's easy to feel as though your problems speaking mean "something more" than what someone without anxiety would think.

Slurred Speech From Anxiety Isn't Dangerous

While it's important to talk with your doctor about the cause of your slurred speech, slurred speech caused by anxiety is not dangerous. It's not a sign that you have something else coming, or that your brain will somehow be inefficient for handling life tasks in the future.

There isn't a specific treatment for slurred speech because slurred speech is simply a response to anxiety. One thing you should do, however, is avoid forcing the words out. If your speech is slurring, forcing yourself to speak is going to add more stress. The more you try to force out words that aren't coming out naturally, the more you'll find that the words become more troubling as your brain becomes more stressed as a result.

The best course of action is to learn how to cope with anxiety and learn to properly manage it.

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

Where can I go to learn more about Jacobson’s relaxation technique and other similar methods? – Anonymous patient

You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process. – Timothy J. Legg, PhD, CRNP

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Parent's Academy › Parenting Tips › Coping Skills › How Anxiety Affects Speech in Children

How Anxiety Affects Speech in Children

Anne-elisabeth germain.

B.A in Speech Language Pathology , Queens , New York

Jan 20, 2022 An anxiety disorder in children? What could they possibly be worried about? They’re just children after all!

For many, the idea of a child having anxiety seems almost impossible. And yet, studies tell us it is one of the most common forms of mental disorder among kids.

According to the Center for Disease Control ( CDC ), 7% of children (from 3- to 17-years-old) are diagnosed with a type of anxiety disorder. It’s true that a child may not be able to express their feelings like an adult, but it does not mean that they don’t experience worry and fear. This blog explores how anxiety may affect a child and some of the treatments used to combat it.

In This Article

Definition of anxiety.

• Common Signs and Symptoms of Childhood Anxiety  
• Causes of Anxiety Among Children 

How Can Anxiety Affect a Child’s Speech?

• Books to learn more about childhood anxiety 

According to the American Psychological Association, anxiety is an emotion characterized by feelings of tension, worried thoughts, and often physical changes such as increased blood pressure. Although feelings of anxiety can be quite normal and are needed for survival, when these feelings become unmanageable or interfere with one’s daily routine, it is a disorder.

And though there are different types of anxiety, children mostly experience the following: generalized anxiety disorder, social anxiety, separation anxiety , selective mutism, or phobias.

Common Signs and Symptoms of Childhood Anxiety  

• Insomnia  
• Excessive clinginess towards parents 
• Difficulty concentrating in school 
• Constant worry/irrational fears
• Overeating or not eating enough 
• Irritability
• Body-focused repetitive behaviors
• Obsessive-compulsive disorder
• Feeling tense or fidgety
• Nail-biting/skin-picking 
• Speech difficulties 
• Regressive behavior 

Did you know anxiety could affect a child as early as 1-year-old?

Research tells us that it is common for toddlers to experience separation anxiety when starting school or meeting strangers. As well, the severity and persistence of their fear can lead to bigger problems such as an actual anxiety disorder.

Causes of Anxiety in Children 

From environmental to genetic factors, there are various reasons as to why a child could have this disorder. While children can develop anxiety as a result of stressful events (trauma or neglect), it is also possible for them to learn it from their parents. And sometimes, it’s simply genetic.

Because abnormal forms of stress affect one’s breathing patterns, it is possible for a child with anxiety to develop a fear of speaking. For instance, a child may have a quiet or shaky voice. Selective mutism is another way in which anxiety may interfere with a child’s speech. Though not a speech disorder in itself, selective mutism means a child is unable to talk in some settings (classroom or around strangers), but can easily speak at home.

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Diagnosis and Treatments 

A formal diagnosis of an anxiety disorder requires your child to be evaluated by a team of health professionals. This team may include, but are not limited to a child’s pediatrician (to rule out other conditions), a psychologist, or a trained therapist. Once a child receives a proper diagnosis, there may be various forms of treatments. 

Cognitive-behavioral therapy or CBT: a method used to aid a child to learn how to acknowledge and change their negative thoughts.

Exposure therapy (another form of CBT):   is a technique used to reduce a child’s fear by gradually exposing them to what they are afraid of.  

Medication: In more severe cases, older children may be recommended medication to ease their anxiety.

Additionally, parents can implement different tools to overcome anxiety disorders in kids. Remember to pay attention and acknowledge your child’s feelings. But also, do not enable or reinforce their fear; doing so can hinder them further.

Indeed, anxiety does not discriminate based on race or age.

Just like adults can have an anxiety disorder, children can also have one. But one thing is for sure, anxiety is not a death sentence. It is absolutely possible for a child to overcome it. ☺ 

Books to learn more about childhood anxiety 

• Sometimes I’m Anxious, Volume 1 – ( A Child’s Guide to Overcoming Anxiety ) by Poppy O’Neill
• The Opposite of Worry: The Playful Parenting Approach to Childhood Anxieties and Fears by Lawrence J. Cohen
• What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner

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Should You Avoid That Difficult Conversation?

Consider the pros and cons of having a tough talk..

Posted August 10, 2024 | Reviewed by Gary Drevitch

• What Is Anxiety?
• Take our Generalized Anxiety Disorder Test
• Find a therapist to overcome anxiety
• Avoiding things that make us anxious can bring relief in the short-term but ultimately fuels stronger anxiety
• Evading difficult conversations can lead to miscommunication, relationship breakdown, and compromised values
• Acceptance and Commitment Therapy (ACT) posits alternatives to experiential avoidance.

On the list of things I enjoy, anxiety would probably be near the bottom. Right next to root canals and letters from the IRS. Yet, I have learned that just like root canals and letters from the IRS, avoiding anxiety only makes things worse.

It's only natural for people to want to turn away from pain. Yet what works in the external world (running away from a tiger) often is less effective in our minds. Painting ourselves into a corner to get away from anxiety usually creates more anxiety while blocking us from the things that truly matter.

Popular culture often encourages us to steer clear of things that spark troubling emotions, but there is a cost.

In Acceptance and Commitment Therapy , efforts to avoid anxiety and other mental experiences are called "experiential avoidance." Research suggests a correlation between this and the level of stress we perceive (Bardeen et al., 2013) in a situation. In other words, the more we try not to feel something difficult, often the more distressed we become.

Similarly, the cost of hiding is evident in missing out on things that matter to us. Not talking to someone to avoid feeling awkward might pay off in the short run but leave us lonely in the long term.

The Trouble With Evading Difficult Conversations

When it comes to difficult conversations, the intuition might be to skip them. Yet, by not speaking up, problems often compound each other, damaging vital relationships. Without clear communication, people tend to draw assumptions, and due to the human bias toward negativity, those conclusions might not be accurate or helpful.

For example, say Ashley is hurt that Erica did not invite her to a party. Ashley might assume Erica doesn't value their friendship as highly as her other friends. Over time, resentment is likely to grow. Still, if Ashley talks to Erica, she may find that Erica thought Ashley had other plans that night or that the invitation text message that Erica sent failed to send.

Similarly, we can't change what we don't know. If someone struggles with a grievance against another person, the other person may blissfully offend without even being aware.

Even when the tough conversation does not result in preserving the relationship, these conversations may deepen our understanding of a situation, leading to closure. It takes courage to speak up and often displays values like self-respect, desire for connection, and care for others.

If you are questioning whether or not to have a difficult conversation, it's worthwhile to consider the pros and cons of having the conversation and, maybe more importantly, of not having it. They may be strikingly different. While only you can determine whether or not to move toward the discussion, it's worthwhile to consider.

To find a therapist, visit the Psychology Today Therapy Directory .

Bardeen, J. R., Fergus, T. A., & Orcutt, H. K. (2013). Experiential avoidance as a moderator of the relationship between anxiety sensitivity and perceived stress. Behavior therapy , 44 (3), 459-469.

Jennifer Gerlach, LCSW, is a psychotherapist based in Southern Illinois who specializes in psychosis, mood disorders, and young adult mental health.

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Recognizing Anxiety Attack Symptoms

Anxiety attack vs. panic attack.

• Calming Techniques

Anxiety attack symptoms typically include shortness of breath, heart palpitations, uncontrollable thoughts, and feelings of panic. They occur with an episode of extreme and excessive worry, discomfort, or fear, lasting anywhere from a few seconds to 15 minutes or longer.

An anxiety attack can be frightening, despite the absence of an actual dangerous or life-threatening situation. When you have an anxiety attack, self-care methods like deep breathing may help you feel calm. If you regularly experience anxiety attacks, your healthcare provider can recommend treatment, including medications or therapy.

Illustration by Theresa Chiechi for Verywell Health

What Does an Anxiety Attack Feel Like?

Anxiety attack symptoms can vary from person to person, and situation to situation. People describe a wide range of experiences and symptoms.

Symptoms of an anxiety attack can include:

• Lightheadedness
• Trembling, shaking, or tremors
• Irritability
• Numbness and tingling in hands and feet
• Shortness of breath
• Heart palpitations
• Feelings of fear

Anxiety attacks symptoms in females can be more severe than they are in males, and females may be more sensitive to situations that that they perceive as threatening. Females are also around twice as likely as males to have panic disorder.

Unlike an anxiety attack, the term "panic attack" is recognized in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

An anxiety attack can be mild, moderate, or severe and can encompass any of the symptoms of anxiety. In contrast, the symptoms of a panic attack are intense and severe. They tend to come on suddenly and don't always have a cause or trigger.

During a panic attack, you are likely to experience severe physical symptoms, extreme fear, and an impending sense of doom.

There is no hard-and-fast rule about what differentiates an anxiety attack vs. a panic attack . However, you might think of an anxiety attack as broader in nature.

There is no singular cause of anxiety attacks. Anxiety attacks are a symptom of many mental health conditions. They can also be caused by specific stressful life situations or individual triggers.

Any number of situations could trigger an anxiety attack. For many people, an already stressful life situation may boil over into an anxiety attack. These situations could include:

• Unemployment
• Work-related stress
• Caregiving duties
• Grief or loss of a loved one
• Financial stress
• Performances or presentations
• Driving in heavy traffic
• Global pandemic

Remember that anxiety, as an emotion, is a totally normal part of life. Major life changes can be anxiety-inducing, but a healthy level of anxiety can keep you alert and focused. However, if your day-to-day worries lead to an anxiety attack with acute symptoms, this can be incredibly distressing.

A 2017 study found that people who experience panic attacks are hypersensitive to unpredictable stimuli. Therefore, unpredictable, shocking situations might trigger anxiety attacks for some people. These sudden situations might include being spooked at a haunted house, being bitten by a cat, or missing a step on the stairs.

Mental Health Conditions

Anxiety attacks can also be a symptom of certain broader mental health diagnoses. In particular, anxiety and panic attacks are a feature of many anxiety-related disorders , including:

• Panic disorder
• Social anxiety disorder
• Post-traumatic stress disorder ( PTSD )
• Generalized anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Specific phobias , such as agoraphobia

Anxiety disorders are the most common mental disorders in the United States. People diagnosed with a  generalized anxiety disorder  (GAD) experience excessive anxiety and worry most days for at least six consecutive months.

Medical Conditions

Certain medical conditions can contribute to anxiety. For example:

• Thyroid disorders
• Heart arrhythmia
• Conditions of the adrenal gland

How to Calm an Anxiety Attack

You might feel out of control while having an anxiety attack, but there are ways to take back control. Through self-care, you can reduce your stress, lessen the severity of anxiety attacks, and even prevent future anxiety attacks.

During an anxiety attack, you can try specific coping strategies to reduce the severity of the attack or stop it altogether. One way to do this is with the 3-3-3 rule:

• Look at your surroundings and identify three objects.
• Listen to the sounds in your environment and identify three of them.
• Finally, move three body parts.

This sequence of activities can take your mind off the anxiety and help you calm down.

Some other strategies that can be helpful include:

• Deep breathing
• Positive visualization

Some self-care strategies that can help prevent anxiety attacks include:

• Regular aerobic exercise
• Getting adequate sleep
• Practicing meditation and mindfulness
• Progressive relaxation
• Social support
• Eating a Mediterranean diet

When to See a Healthcare Provider

If you are experiencing anxiety attacks that are interfering with your daily life, or leading you to avoid previously enjoyed activities, please talk to your healthcare provider.

You can contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  at  1-800-662-4357  for information on support and treatment facilities in your area.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911 .

It is important to seek treatment for anxiety attacks. Not only can ongoing anxiety attacks lead to avoidance of previously enjoyed activities or situations, but research also indicates that anxiety attacks lead to an increased risk of suicide attempts.

Thankfully, there are many effective and accessible anxiety treatments. While most of these treatments are designed for anxiety disorders, they will also be relevant and useful to people who experience anxiety attacks. This is because, for some people, anxiety attacks are a symptom of an overall anxiety disorder.

Medication is a central treatment for anxiety disorders and can help reduce symptoms for many people. Generally, your primary care healthcare provider or psychiatrist will prescribe medication for anxiety.

These medications can include:

• Anti-anxiety drugs : Benzodiazepines can be useful for the acute treatment of anxiety.
• Antidepressants : Serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants to treat anxiety.
• Beta blockers : These are off-label medications used to treat the physical symptoms of acute anxiety, such as rapid heartbeat and tremors. This can make them a good treatment for people who experience anxiety attacks during social performance.

Anxiety attacks are also treatable through psychotherapy. Talk to your healthcare provider about referring you to a psychiatrist or therapist for your anxiety. Two types of therapy, in particular, are effective at reducing the symptoms and frequency of panic or anxiety attacks.

• Cognitive behavioral therapy (CBT) has been widely studied and shown to effectively treat anxiety disorders. Through CBT , a therapist teaches you to become aware of your distorted thoughts and behaviors and helps you change them in more emotionally adaptive ways.
• Exposure therapy may also be effective at treating anxiety attacks, especially those related to specific phobias. In exposure therapy , which may also be done through virtual reality, you are gradually exposed to a frightening stimulus. Through exposure, you are taught adaptive techniques and adjust to the stimuli, which eventually becomes less frightening.

Anxiety attacks are episodes of extreme alarm that can cause symptoms of shortness of breath, a racing heart, and feelings of panic. An anxiety attack is not a diagnosis in and of itself, though experiencing these attacks can be part of another mental health diagnosis, including anxiety disorder.

It's important to seek medical help for anxiety attacks. Your healthcare provider can diagnose the cause and connect you with appropriate treatment, such as medication and psychotherapy. They also may suggest self-care measures and lifestyle changes that can help.

Keep in mind that some symptoms of anxiety are similar to those found with other serious medical conditions, such as heart attacks. Your healthcare provider can help diagnose or rule out these conditions, too.

John Hopkins Medicine. How to help someone with anxiety.

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American Academy of Family Physicians. Panic disorder and panic attacks .

Ayers JW, Leas EC, Johnson DC, et al. Internet searches for acute anxiety during the early stages of the covid-19 pandemic.   JAMA Intern Med . doi:10.1001/jamainternmed.2020.3305

Grillon C, O’Connell K, Lieberman L, et al. Distinct responses to predictable and unpredictable threat in anxiety pathologies: effect of panic attack . Biol Psychiatry Cogn Neurosci Neuroimaging . 2017;2(7):575-581. doi:10.1016/j.bpsc.2016.08.005

The American Anxiety and Depression Association of America.  Understanding anxiety .

National Institute of Mental Health. Anxiety disorders.

National Institute of Mental Health. Anxiety disorders .

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Toledo-Chávarri A, Ramos-García V, Torres-Castaño A, et al. Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis . BMC Fam Pract . 2020;21(1):237. doi:10.1186/s12875-020-01307-6. 

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By Sarah Bence, OTR/L Bence is an occupational therapist with a range of work experience in mental healthcare settings. She is living with celiac disease and endometriosis.