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Performance Anxiety and Advocacy

As I advocate in the neuromuscular community, increasingly I have opportunities to speak to others about neuromuscular disease. Some time ago, I led a training session called Addressing Stage Fright. Ironically, while preparing, I realized that I had been experiencing moderate symptoms of performance anxiety, both in regard to leading this session and during my advocacy efforts.

Performance anxiety (also referred to as stage fright) is a heightened level of stress and arousal that occurs before and/or during a situation involving performing some activity in front of other people, such as public speaking.

Stress can be defined as any interaction between a person and the environment that causes changes in that person, including physiological, cognitive, emotional, and/or behavioral changes. Arousal can be defined as the reaction of the body, mind, and emotions to stress and can lead to changes in behavior.

People with moderate performance anxiety experience symptoms of stress and arousal at a level that can limit their ability to perform to their highest level and causes some distress. Individuals with this level of stage fright are likely to benefit from learning techniques for managing stage fright. Severe stage fright involves heightened levels of stress and arousal at a level that keeps an individual from performing entirely. Individuals with this level of stage fright would likely need professional assistance to alleviate stage fright.

Performance anxiety leads to maladaptive changes in functioning in several areas. Cognitive changes include dysfunctional thinking such as negativity and perfectionism, decreased problem solving, and forgetting past positive performances.

An individual’s body reacts physiologically before and during the actual performance. Often called the "fight or flight response," the physiological response can include increased perspiration, shallow breathing, increased muscle tension, increased heart rate, trembling, and stomach distress.

People may also experience changes in behavior, most often in behaviors of avoidance or escape. Some of these might include avoiding performance opportunities, procrastination, being late for a rehearsal or performance, physical complaints, and using poor preparation as an excuse. Emotional changes may also occur, including experiencing feelings of anger, fear, worry, guilt, shame, sadness, and/or irritability.

Physiological, cognitive, behavioral, and affective changes interact. For example, your cognitive appraisal that you are unable to successfully perform may increase physical symptoms, cause an emotional reaction, such as fear, and cause a behavioral reaction, such as skipping rehearsal. Avoiding rehearsal causes an emotional response, such as guilt, and so on.

Performers and speakers should not try to avoid stress and arousal completely. Too little arousal can lead to a lack of energy, motivation, and excitement, leading to poor performance. Instead, it is important to find the level of arousal that helps one to perform at the highest level.

A number of techniques have been found to be useful for managing stage fright. Different techniques work for different individuals, and matching the techniques to your own experience of stress will enhance effectiveness. A few simple strategies you can try include:

-Be over-prepared, and know your material so well that when it comes time to perform, you can forget about "performing" and enter into the experience.
-Use your preparation time to “desensitize” yourself to helping performing. For example, arrange to practice in front of a very small, non-threatening audience (i.e., one of your children), then a slightly larger audience (i.e., your family), and build up over time so that you are practicing in situations that cause increasing level of arousal (leading to rehearsal, dress rehearsal, and finally performance). As you successfully deal with anxiety at increasing levels, stage fright will decrease.
-Avoid scheduling multiple stressful activities in the same period of time. Stress is cumulative: If you have several stressful activities going on, your ability to manage your stress will decrease.
-Reframe the stress reaction as positive, for example as excitement, providing energy and motivation for performance. Learn to change your appraisal of the situation. Consider your thought patterns, look for negative thought habits, and deliberately replace negative thoughts with more positive thoughts.
-Use imagery to replace stressful thoughts with a positive picture of yourself effectively performing. Practice this positive imagery several times a day for short periods of time.
-Deep breathing, with long, slow, deep breaths can decrease physical anxiety. Try to take longer to exhale than inhale.
-Moderate physical exercise can lower overall levels of stress and anxiety.

Through using some of these techniques, I have been able to manage my performance anxiety and effectively speak during advocacy situations. With a little practice, you will find the techniques that are most useful to you and increase your ability to speak up during advocacy opportunities.


Emmons, S., and Thomas, A. (2008). Understanding performance anxiety. Journal of Singing, 64:4.

Hamedy, J. (2010). Performance Anxiety. Retrieved on 11/17/15 from

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Content copyright © 2015 by Jori Reijonen, Ph.D.. All rights reserved.
This content was written by Jori Reijonen, Ph.D.. If you wish to use this content in any manner, you need written permission. Contact Jori Reijonen, Ph.D. for details.


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