Stress Management, Well-being and Self-Care

A string quartet

Stress, Stage Fright and In Vivo Desensitization

by James Porter May 17, 2024

About a month ago, I was invited to hear the premier of a string quartet written by my college music professor Neely Bruce. Neely's music has a lot of influences from Beethoven to John Cage, so I wasn't the least bit surprised when one very lyrical sounding melodic movement was followed by another edgy sounding rhythmic movement where all 4 players pulled out chopsticks and started hitting their strings in dramatic staccato fashion. 

After the concert, over a celebratory dinner, I asked the musicians what it was like to play with chopsticks. They explained that there was a bowing technique that was relatively similar, so it wasn't such a big leap to play with the chopsticks. There was just something about their pleasant almost shy demeanor and their modesty about playing this very challenging piece of music that made me think they must deal with stage fright just as I had done, when performing music for Neely in college. 

“So what do you do about stage fright” I blurted out, intuitively knowing that they must have experienced it. Almost in unison three out of the four players answered: “beta blockers.” In my post college years of studying stress, I’ve learned a lot about beta blockers: These medications are specifically designed to block the fight or flight response. As a result, they have been used for decades to help people lower blood pressure. Now they are commonly used off label to help people deal with stage fright and fear of public speaking. 

Tipped off by this admission of three out of the four players in this string quartet, I went online to learn more. And sure enough, there are websites now that for about $49 for an online doctor's visit plus $20.00 for a prescription you can "kick shaky voice, racing heartbeat and sweaty palms." 

I have always been an advocate for all natural ways of dealing with stress. When you take medications for certain stress related medical conditions like insomnia, high blood pressure, or certain allergic reactions you are only masking the symptoms of stress and not addressing the source of the problem. 

And these medications ALL have side effects, some of which interact with the medications you may already be taking (for other stress-related health problems) and some of which are just so unpleasant they nullify the beneficial effects of the medication. (Anti-depressants – specifically SSRI’s - commonly cause weight gain and low libido.) The possible side effects of beta blockers include dizziness, headaches, cold hands and feet, nausea and diarrhea. And yet there are plenty of people on TikTok who swear by using beta blockers mostly for their fear of public speaking. 

I'm actually glad I didn't know anything about beta blockers when I decided to tackle my fear of public speaking with a technique known as in vivo desensitization. In vivo desensitization is an approach to reducing your performance anxiety (or any fear for that matter) step by step by getting you used to the feared circumstances under less daunting circumstances and hopefully, without reliance on medications. I began my own desensitization program by enrolling in a public speaking class at a local community college. We all practiced speaking in front of each other during the course of that 12-week class. I remember one exercise where we had to make eye contact with each person in the class until such point as that classmate raised their hand. It felt scary at the time but it was a key piece of my getting over that fear. 

The fight or flight response is a response that we all activate mostly in situations we perceive as threatening. It's ironic that more people are afraid of public speaking than they are of death. (It’s not that much different: 41% vs. 40%) I remember Carrie Fisher joking in her one-woman Broadway show called WISHFUL DRINKING: “That means more people would rather be the corpse at a funeral than the one delivering the eulogy.” 

The fight or flight response is activated by the release of stress chemicals like adrenaline and cortisol into your bloodstream. Beta blockers specifically block the effects of adrenaline so that the heart doesn't beat faster as it would in a normal stress response. This response as I've said and written so many times before was designed to help save us from real life or death situations and not meant to be activated in situations where we can't fight and we can't flee: Like when we're stuck in a traffic jam or in an argument with someone who cuts in front of us in line or when you are playing a challenging string quartet. 

As Robert Sapolsky so aptly wrote in his book WHY ZEBRAS DON’T GET ULCERS: The reason zebras don’t get ulcers is that zebras don't think about the lion when the lion’s not there. Unfortunately, we humans have the ability to think about perceived threats to our livelihood and well-being at all hours of the day and night. Thus, pharmaceutical companies are cashing in on our own propensity to think about the lion when the lion is not there. 

I've made it my mission to try to help people find nonpharmaceutical ways to deal with their stress related health problems. In my next installment of this blog I'm going to write about white coat hypertension which is a stress related health problem that just about all doctors know about but never breathe a word about to their patients.

James Porter
James Porter