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What Does a Beta-Blocker Actually Do?

Kayleigh Miller

Written by
Published: September 9, 2014 at 8:00 PM [UTC]

So in the last few weeks, I've been busy (and stressed, too!), but I've been thinking about stage fright, sympathetic response of the nervous system, and why things happen to us when we're nervous. Most musicians will at some point run into beta blockers as an antidote to stage fright- whether a colleague uses them or even a teacher, by adulthood, we have encountered someone who uses them for something not related to its initial prescriptive purpose. (Musicians are certainly not the only folks who use these-actors, presenters, etc., have been known to use them as well).

Whether or not you take them, it's useful to know what the heck is going on if one does take them.

First of all, a beta blocker is typically prescribed for folks with heart issues, arrythmia, and who need to lower their standing heart rate. It tackles the beta-receptors of the smooth muscles of the heart, kidneys, and sympathetic nervous system to prevent norepinephrine and epinephrine (adrenaline) from attaching to beta receptors, which ultimately encourages blood flow (as opposed to restricting vessels) and reduces overall heart rate. If that language didn't make things clear, let me simplify. Beta Blockers reduce overall heart rate and prevent adrenaline from playing its role in sympathetic response, AKA fight or flight. That means it reduces the physiological symptoms of the sympathetic nervous system, which affects breathing, fine muscle control, tremors, etc.

While this may sound like a wonder-drug, there are a few things to consider:

  • There are side affects, like all mysterious chemical concoctions, and they're fairly standard: nausea, vomiting, headaches, as well as more complex effects if one already has heart problems. (And of course, there's a warning about sexual dysfunction, so don't forget about that.)
  • Beta blockers are banned in the Olympics, but not in auditions, competitions, or performances. What would it be like if they were banned in auditions and competitions? It's a question I've pondered, because I think performance under pressure differs so widely person to person. It would even the playing field, whether that's a good thing or bad thing.
  • Beta Blockers only target the symptoms of panic, but don't address any of the psychological/somatic issues. If your anxiety is based in a constant fear of being good enough, or prepared, or talented, then BB's will only help so much.
  • Some people (audition committees/teachers/etc.) feel that BB's limit expressivity, spontaneity, and in the moment performing creativity, which is something to consider. If you regularly take them for performances and auditions, it might be worth wondering if you always need them.
  • The sympathetic response (AKA fight or flight) does have some benefits when you are in a stressful situation. Your response time is quickened, your brain is particularly focused, heart rate/blood sugars increase to fuel the body, and muscles tense up to provide speed and power. The whole point of sympathetic response is to support the body under dangerous conditions, so the changes that occur are meant to support. I realize that performance is not life or death, but it is an interesting physiological response to notice.

I leave the decisions with you, but notice if beta blockers become a crutch. Do you need them for every performance opportunity? Do you find yourself using them for rehearsals as opposed to concerts or auditions? (And if you're not a BB user, that's great too.)

Want to know more about the nervous system? Read here! http://www.musicianshealthcollective.com/blog/2014/8/18/nervous-system-101/


From Jim Hastings
Posted on September 9, 2014 at 11:38 PM
"Beta Blockers only target the symptoms of panic, but don't address any of the psychological/somatic issues."

So true. This is why I feel so strongly on the subject. FWIW, I'm a non-user.

Now, I'm not suggesting that everyone else here can or will out-bully the nerves as fast as I did. Nor do I believe that everyone else will go on to ace recitals and auditions drug free, which I did. But I have to believe that the vast majority can.

As a kid, just starting out in recitals, I felt the nerves, as I'm sure nearly all of us did at first. This was many years before I'd even heard of beta-blockers. But one thing I clearly remember is that the heightened state of nerves didn't last. Probably within less than 2 minutes, I had burnt off enough adrenaline to feel like my regular self again. When the session was over, I thought, "Hey -- that wasn't so scary after all." So I looked forward to going back at it the next time.

"Beta Blockers reduce overall heart rate."

This is one thing I would find scary. I've known people who take beta-blockers for medical conditions. Some report side-effects like drowsiness, slowed circulation, or cold hands and feet. When I'm playing, any one of these things would be anathema -- far worse, in my book, than nerves. If beta-blockers are medically necessary -- or if the player simply can't manage the nerves any other way -- that's one thing. Otherwise, might not the cure be worse than the disease?

From John Cadd
Posted on September 13, 2014 at 7:54 AM
"(and if you are not a BB user That`s Great Too ) ????????
Implying that taking Drugs is great??????? Shocking ending to the article .
From Kayleigh Miller
Posted on September 13, 2014 at 5:44 PM
Discussing beta-blockers with performers is loaded with judgment about one's skills and psyche. I have no opinions as to whether one should or should not take beta-blockers, and I leave that decision with a performer. I am not saying that taking drugs is great, I am merely saying that if you don't take them and you don't feel like you need them, then you've made a good choice for your body and your needs. If you do take them because you find your nerves debilitating under performance and audition stress, I am not here to judge you, and I respect your decision.

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