Stage fright: causes and treatments

You’ve very likely experienced symptoms of stage fright—you know, those sweaty palms, racing heartbeat, and shaky knees that come before a big presentation or performance. 

If you’ve felt those pre-performance jitters, you’re certainly not alone. After all, 75% of the population has experienced at least one form of stage fright at some point during their lives (Rowland, 2019). But what exactly is stage fright, and what’s the best way to deal with it?

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Stage fright is a type of performance anxiety. It isn’t categorized as a phobia or mental disorder. However, an extreme fear of public speaking is considered a phobia (the fancy term is “glossophobia”).

Stage fright is considered a subtype of social anxiety. Still, people who get stage fright may not have other types of social phobia, like dreading social gatherings or fearing meeting new people. (Interestingly, though, some shy people can give confident performances on stage and find it liberating to take on a new personality as a performer temporarily) (Scott, 2015).

Stage fright can happen in different situations. It can occur when you’re speaking in public, making a presentation (for instance, for a school project or a job interview), acting, or delivering a musical performance (Rowland, 2019).

There are other types of performance anxiety as well, which occur in different situations: for instance, sexual performance anxiety and sports performance anxiety, sometimes called “choking” (Rowland, 2019; Pyke, 2020).

Stage fright is extremely common. Just about everyone gets it at one time or another. No less than 75% of the population has experienced the fear of public speaking (Rowland, 2019).

Fear of public speaking may be so prevalent because almost everyone is called on to talk in front of a group at some point in their life, whether they want to or not. Performers, like musicians and actors, perform out of choice. That doesn’t necessarily free them from stage fright, though. It’s estimated that 50-70% of musicians have experienced stage fright (Rowland, 2019).

The symptoms of stage fright can vary from person to person and depend on the episode's severity. They include (Raab, 2016; Shahrokhi, 2021):

• Racing heartbeat

• Rapid breathing

• Flushing

• Trembling hands, knees, lips, voice

• Nausea

• Sweaty palms

Stage fright can strike no matter one’s age, gender, years of experience, or level of technical mastery (Helding, 2016). Even very experienced, high-profile performers like Adele, Lady Gaga, Ian Holm, John Lydon (aka Johnny Rotten), Brian Wilson, Rihanna, George Harrison, Maya Angelou, Jason Alexander, Hugh Grant, and many, many others have gone on record as being subject to stage fright.

While we don’t know the exact cause of stage fright, there are some possible contributing factors. 

Psychological causes

Several different psychological factors, such as lack of self-confidence or low self-esteem, can come together to create stage fright (Nagel, 2018). An episode of stage fright can be particularly strong when others evaluate your performance, and people's judgments will affect you personally or professionally. It may also be more pronounced when you're performing in front of strangers.

Physiological causes

The symptoms of stage fright are due to activation of your sympathetic nervous system, which is responsible for the “fight-or-flight” response. In this type of physiological response, the body releases adrenaline into the system in preparation for quick action.

Adrenaline speeds up the contraction rate of muscle fibers in preparation for that flight or fight; this can lead to uncontrollable muscle twitches, as in trembling hands and shaky knees. Adrenaline also activates the sweat glands (for those sweaty palms) and slows down the digestive system—including the salivary glands, resulting in a dry mouth.

Fortunately, there are effective ways to deal with stage fright, both before and during your performance.

Before the performance

• Practice, practice, practice. The most effective way of dealing with stage fright is to be fully prepared. Memorize your speech, lines, or music thoroughly—you can practice in front of a mirror. If possible, perform in front of a group of supportive friends or family members before the performance date so you're used to being in front of an audience.

• Meditate. Meditation gets you in the habit of disengaging from your emotions and negative thoughts and focusing on the task at hand—for instance, counting breaths or repeating a mantra. Meditation can help you to feel a sense of peace, even in stressful situations.

• Do controlled breathing exercises. Controlled breathing can calm your nervous system and lower your heart rate.

• Create positive mental imagery. Do visualization sessions in which you imagine yourself performing confidently and well in front of your audience.

• Look your best. Dressing and grooming yourself well can help you to feel confident.

• Limit caffeine the day of your performance. The last thing you need is those caffeine jitters.

• Relax your body. Before appearing in front of your audience, do stretches, yoga, relaxation techniques like body scanning, or other calming physical practices.

During the performance

• Make Connect with your audience by finding people who seem sympathetic and looking at them often.

• Focus on what’s in your control. Concentrate on what you can control (the immediate process of your performance), not what’s out of your control (the audience’s reaction) (Allan, 2016).

• Smile. Whether you’re faking it or not, smiling encourages positive thoughts.

• Laugh. If you can do it genuinely, laughing relaxes both you and your audience. 

If you use the techniques listed above and stage fright is still getting the best of you, you may want to talk to a professional, such as a therapist or counselor, who’s trained in treating anxiety issues. In some cases, your healthcare provider may recommend medication. 

Propranolol, a type of medication known as a beta-blocker and often used for high blood pressure, is sometimes prescribed off-label for stage fright (Shahrokhi, 2021). (“Off-label” prescribing means the Food and Drug Administration has approved the drug to treat a condition different than the one you’re taking it for; it’s completely legal and common to do this).

Stage fright doesn’t need to stand in the way of a fulfilling life. Try the techniques above, and if you need help, reach out to your healthcare provider.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

July 23, 2021

Written by

Alison Dalton

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.