V.com weekend vote: Have you tried using beta-blockers for performance nerves?

December 8, 2017, 5:48 PM · Stage fright can become a huge problem for a musician, especially if it keeps that person from performing.

brain nerves

What is the solution? Of course, good preparation can help one feel secure, and then there are other mind-relaxing practices such as yoga, deep breathing and meditation. But for some, these solutions don't help, and a sizable percentage of musicians have found help in using beta-blockers, that is, drugs such as Inderol, which reduce overall heart rate and temper that fight-or-flight response. People can get judgmental about "using drugs," but if you've ever been on stage, in the spotlight and then felt the full effect of a harrowing panic attack, you're likely more sympathetic.

For some people, beta blockers have simply helped on an occasional basis: getting through a tough audition or even just getting through a period of heightened stress. For some, it's simply something they use whenever they perform. Others have tried it and not liked the effect, and yet others have never used it at all.

Have you used beta blockers to help with performance nerves? Did you find it helpful? What other strategies have helped you either cope with or avoid performance nerves? Please share your thoughts in the comments section after voting.

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Replies

December 9, 2017 at 03:17 AM · When performing, even being well-prepared and using other relaxation forms (yoga, deep breathing, etc. did not help - deep seated panic stage-fright would take over. I did consider trying beta-blockers at a couple of times and places in my life, and maybe it would have helped me get past much of the stage fright earlier - much earlier. I have had stage-fright all my life - both as a theatre major and as a musician. But I kept thinking that, for me, it would be a crutch that I needed to address. I still have to confront it - even making certain types of phone calls can be difficult as the old stage-fright feelings surface. But in many other areas of my life, I am and have been confident, comfortable, - speaking in front of an audience, being in a classroom. Who knows: maybe at some important time I would consider beta-blockers (with at least one trial run) - ?

December 9, 2017 at 04:08 AM · To say that leaving beta-blockers at the door levels the playing field is short-sighted. Many of us use beta-blockers TO level the playing field. In my case, when I’m playing a solo recital without beta-blockers, my arm shakes. I take Inderol and it doesn’t shake. Period. I still get very nervous. I still have Adrenalin. I just don’t shake. The awareness of shakiness, during a performance without Inderol, destroys confidence; the performance becomes subpar. I do meditation, I have done therapy for performance anxiety. What works for me is all of this internal work plus Inderol.

December 9, 2017 at 04:42 AM · I remember a recent conversation about beta blockers here - this topic may bring some strong responses :)

I use them in particularly nerve-wracking situations because I'm lucky enough not to experience side effects, and they get rid of nerves, so it's overall a positive addition to the performance. Other things that have helped are eating bananas and salmon (separately!), visualising your performance going well each day in the leadup, and being 500% prepared.

December 9, 2017 at 05:54 AM · I've never had problems with performance nerves, so I don't see myself touching beta blockers for the foreseeable future.

December 9, 2017 at 06:18 AM · I was on two types of BBs for a heart condition, and while they helped slow the heart rate and reduce blood pressure, the side affects were so bad they had me in hospital many times as they gave me headaches, dizziness, insomnia, constipation, weird tingling in my arms and sweating. Of course, I didn’t know it was the B.B. doing this to me, and neither did the hospital.

Unless your doctor recommends them for a heart condition, do not take they to reduce anxiety. I know everyone will react differently, but why risk it. I used yoga, slow breathing and meditation, and they worked better than a BB.

My live turned around soon after I stopped taking them. I’m now a normal person again.

December 9, 2017 at 06:25 AM · Beta blockers saved my life. Before a pianist friend suggested them, I did vibrato with my bow in an extreme way every time I had to play. As a result, I was the teacher who never performed. This was humiliating. After I took beta blockers, and I’m talking about only 10 mg, all of my preparation for performances became viable. I could perform, and really enjoy myself. I love performing solos, I love performing chamber music. Beta blockers vastly and extraordinarily improved my musical life.

December 9, 2017 at 06:30 AM · You failed to include an important option: Do you take beta-blockers for another reason?

I've taken beta-blockers a very long time for hypertension. Does this medication affect my playing? I cannot say. I was already taking it when I resumed playing the violin. During the past few months, my physician had to change the prescription from atenolol to propranolol, because atenolol is currently unavailable.

I did improve my performance by eliminating another medication almost a year ago; the drug to which I refer proved to be responsible for my tremors, which were especially bad for my bowing technique.

December 9, 2017 at 07:41 AM · I had bad stage fright, was almost fainting every time entering the stage. So I tried b-b. Even a quarter of a pill gave me a terrible headache and I didn't feel like I was there. Performing went over "without" me. Not a very pleasant feeling.

What was the turning point for me: entering stage as a nervous wreck on a school performance and seeing my little daughter sitting there with her hand before her mouth. "Don't do this to her!" I thought, took a deep breath and everything fell off. It went fine.

This doesn't mean, that I do not get nervous any longer, but to a completely different degree and the experience helped a lot to find a different approach. I can recommend Kato Hava's book "Stagefright" and Dr. Michael Bohne's "Klopfen gegen Lampenfieber" (Tapping against stage fright, not sure about an English edition, there is a Spanish one). Homoeopathy: Gelsemium, Argentum, Ignatia. But ask a homoeopath which one suits you best. Homoeopathy definitely helps me.

December 9, 2017 at 07:54 AM · I have used 5-10mg propranolol for several years when in a performance situation, either playing the pipe organ, and more recently, having resumed violin after several years away.

A small dose like this does not get rid of nerves in my case, but it does control the unhelpful physical effects of nerves such as a racing heart rate, and on the violin, a shaking bow arm and frozen vibrato.

I wish I didn't have to use it. I wish I had the confidence and control that some of the others here clearly have, but if taking a tiny dose of a relatively innocuous drug helps me, I'll take it.

BTW, I am a retired Anesthesiologist and I know a bit about these drugs!

December 9, 2017 at 02:34 PM · Better living through synthetic organic chemistry!

December 9, 2017 at 04:01 PM · I was first struck by bow-arm performance shakes when I was 17 in the lowest-threat solo situation I had yet done - and I had no sense of nervousness when it struck. That shake situation continued for me for the next 27 years for all solo & string quartet events (orchestra was no problem even though I was CM). Then I heard about beta blockers, got an Inderal Rx from my MD and the next 40 years have been s-m-o-o-t-h -- until tremors hit my bow arm at 80 in whatever context I am playing - even practice behind closed doors.

Guess what! My MD prescribed propranolol for that too, but it is only moderately effective and hardly worth the after effects.

The best solution: tutti viola!

December 9, 2017 at 04:33 PM · I am wondering now, if doping is prohibited for participants in music competitions? Or every one, who performs in the finals for 100 000$ prize, takes drugs to perform better?

December 9, 2017 at 05:32 PM · Never tried them. Two main reasons:

1) I don't need them. As a kid, I got over the nerves pretty fast and enjoyed connecting with a live audience. As long as I had mastered the material and had the right conditions -- i.e., good health and warm hands -- I was good to go. I could play up to my level.

One thing I caught on to early was that opening with high-energy, aggressive music helped to burn off adrenaline. Then, after a few minutes, I could play something more lyrical. As I gained more experience in performing, I didn't have to rely on this plan of attack; but I still prefer it, because I like to grab the listeners' attention this way. If you have a problem with nerves, I don't recommend opening with Meditation from Thais -- it will definitely betray a case of nerves. Start instead, if you can, with something gutsy -- like Kreisler's Praeludium and Allegro.

2) The side-effects I've read about make me shudder -- e.g., slowed heart rate and slowed circulation. Warm hands and secure grip are crucial to me. Cold hands are anathema. I'm far more afraid of cold hands than I am of playing for people.

December 9, 2017 at 08:57 PM · In the discussion topic about beta blockers there was so much negativity that I didn't want to say I use them. But now I do want to admit. Because they saved me from quitting to play. I always have so much nerves. And it has nothing to do with preparation. It is just who I am, it is part of me. I get nervous all the time and for a lot of things. Normally I just accept it and do what I wanted to do. No problem. Accept with playing the violin. The trembling and shaking made me fail so many times in public. I did a program with a sport/music psychologisch, did the program from bullet proof musician. But it didnt stop the trembling and shaking. Two years ago I failed again in a musical and I was so desperate that I decided to quit with playing my violin. Why would I practice so hard when I cant play in public and it only makes me cry? That was the point my husband made me call my doctor and he presribed propranolol. Only 10 mg. Since then I am in violin heaven!I still am nervous but I can deal with that now the shaking is gone. The side effect? I do have a bit colder hands. But without the beta blocker my hands are really cold ànd sweaty and trembling. The only real side effects are that I cant do a heavy work out or a lot of alcohol the ours after I used them. I can live with that ;)

I take aspirine when I am in pain. I take the pill every day not to get pregnant. And a few times a year when I play a violin solo I take beta blocker. So what, no big deal. I think every day 2 to 3 ours in heavy traffic for work does a lot more harm to me. Im really happy with my beta blockers!

December 9, 2017 at 11:01 PM · To call using beta blockers "doping" is ludicrous.

December 10, 2017 at 12:08 AM · Some of the great violinists from yesteryear used tobacco.

Kreisler smoked early on. Heifetz even keep a few cigarettes in his jacket pocket after he quite smoking. Are beta blockers a better option or any worse?

December 10, 2017 at 02:22 AM · "Many of us use beta-blockers TO level the playing field...."

And some use them to FIND the playing field...

December 10, 2017 at 03:10 AM · I agree I wouldn't call it doping. And I've got a mind to try this stuff myself, because I kind of turn into Mr. Hyde as soon as I step onto stage -- don't even really know where I am, etc.

On the other hand, if you had a 14-year-old student who struggled with stage fright in the form of shaking bow and so on, would you say to the student's parents, "Please take your child to the doctor and ask about beta blockers for performance anxiety." And if not, why not? After all it'll be the physician's call.

December 10, 2017 at 08:45 AM · I agree with Laurie that calling the use of BBs doping is harsh.

But how would we regard using marijuana to calm nerves or cocaine to enhance peformace?

Soon (maybe already?) there will be drugs which improve performance, perhaps by sharpening focus.

Sport is grappling with this issue and it’s naive to think it cannot happen for music performance.

Will there need to be drug testing at auditions?

By the way, there is no level playing field: we differ in genetics and upbringing.

Terry

December 10, 2017 at 01:15 PM · Betablockers are perscription drugs to lower the heart rate. It is highly problematic to even consider them for performance anxiety. If performance anxiety is such a bad problem, then there is something else terribly wrong.

I once had the experience to perform with betablockers because of a prescription after an inflamed heart muscle. It was awkward. I thought about Pizza while performing and really wasn't fully there. It was pretty indifferent to me how the performance went. I was well prepared so it went well, but the Beta-blockers removed the emotional involvement for me.

Medically it is also problematic to take those pills without the monitoring and consultation of doctors. It can cause a healthy heart to go too slow when you rest.

I had to stop taking them because my heart rate fell regularly under 50. I can tell you that is not a healthy feeling when you sometimes struggle to stay conscious because your heart is artificially slowed down. I also got tingling in the fingers, because my blood pressure went down so much. And I was taking the smallest dose on the market. One quarter a pill.

beta Blockers are not an easy medication!

December 10, 2017 at 01:46 PM · What many people do wrong before a performance is, that they don't eat enough. Especially carbohydrates. Also sleep enough, workout and get some fresh air.

December 10, 2017 at 02:22 PM · Beta blockers are prohibited during competition in a number of sports; out of competition, they are prohibited only in archery and shooting.

And in shooting, they are prohibited, because they help to control tremor and fine hand movements- exactly, what you want them to do for you.

And yes, it's considered as a doping if competition requires fine motoric in a sport.

Of cause, competition in violin is not sport. There is no WADA. On the other hand, self-control, emotions, fine technique are parameters that matter, and can be affected by betta-blockers.

So, from my point of view, if your have a concert, you should help yourself to perform better with any available and working for you methods and aids. But when it is a competition, it is not honest, i think.

December 10, 2017 at 08:43 PM · I've never been in a concert. Still, using dope doesn't seem to be a good alternative. Meditation and muscle-relaxation techniques will have to do for me. If you have to take "something", take a Tylenol. It works in the same areas of the brain as anxieties/emotions and can lower your social anxieties.

From the Mayo clinic:

"Side effects and cautions

Side effects may occur in people taking beta blockers. However, many people who take beta blockers won't have any side effects.

Common side effects of beta blockers include:

Fatigue

Cold hands or feet

Weight gain

Less common side effects include:

Shortness of breath

Trouble sleeping

Depression

Beta blockers generally aren't used in people with asthma because of concerns that the medication may trigger severe asthma attacks. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. It's important to monitor your blood sugar regularly.

Beta blockers can also affect your cholesterol and triglyceride levels, causing a slight increase in triglycerides and a modest decrease in high-density lipoprotein, the "good" cholesterol. These changes often are temporary. You shouldn't abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems."

December 11, 2017 at 05:02 AM · Taking a beta blocker for a musical performance isn't "doping;" how ridiculous.

But to answer Paul's question about a hypothetical 14-year-old student with bad performance anxiety, no, I most certainly would not make any suggestions of a medical nature to the parents. That would be grossly overstepping my bounds.

I think young students need to have every opportunity to develop non-pharmaceutical ways of coping with performance anxiety--14 is too young to conclude that everything else has already been tried, and it is the rare 14-year-old indeed who has a performance or competition that is as high-stakes as a professional orchestra audition (the context for much of the discussion on the beta blocker thread).

December 11, 2017 at 05:11 AM · @Mary Ellen Goree

"Taking a beta blocker for a musical performance isn't "doping;" how ridiculous."

As in doping for sports- no. But it's still dope. Maybe not a narcotic but they aren't good for you. One day someone will realize a pill isn't the answer for everything.

December 11, 2017 at 06:42 AM · It isn't the answer for everything but it is the answer for some things. You would tell a diabetic to just "cope with it," don't be a weakling and resort to insulin shots! And if you are using beta blockers for performance anxiety, then you don't use a prescription meant for a heart condition. You talk to a doctor about the right prescription for using them for performance anxiety.

December 11, 2017 at 09:16 AM · I wonder why there is so much performance anxiety in classical music in the first place. It has been shown that this genre harbors by far the most. I have never heard of a pop musician using beta blockers. Though I have never used beta blockers myself, I noticed immediately, when I performed rock for the first time that I had zero nerves whatsoever, and continued to have none ever, whereas for some classical performances, I had nerves that were distracting and made performing no fun, and they were present from the first time I ever did a solo performance. I have analyzed why that may be, and I have come up with that maybe classical musicians are just too rigid in performance expectations. We have gotten to the point where we accept no blemishes, and the audiences behave in such a sterile manner. I feel like its 10 times worse when auditioning behind a screen. It feels like a cold vacuum. Maybe if we loosened up a bit and accepted a bit more humanity, people wouldn't be so nervous.

December 11, 2017 at 10:05 AM · I heard that bananas have some natural beta-blocker-like substance - maybe it was only a placebo but that worked on me! Also, accepting that performance nerves is normal, and that it's coming every time one performs as a matter of fact helped me also a lot - sometimes your performance gets more exciting/interesting when you're a little bit nervous

December 11, 2017 at 07:05 PM · I still feel that people confuse the recreational use of alcohol and drugs with the responsible, thought-through, doctor-supervised use of drugs for the treatment of very specific and real problems. If performing causes a person to regularly have all-out anxiety attacks, and it's all preventable with the small dose of something that simply brings the heart rate back to normal, then this is a decent, humane solution that does not deserve so much judgment heaped on it.

December 11, 2017 at 09:10 PM · Simon wrote, "If performance anxiety is such a bad problem, then there is something else terribly wrong."

There are always people who say if you have headaches, or insomnia, or depression, whatever, that it's your fault for not figuring out how to correct that with your diet or your lifestyle or whatever. The recriminations are curiously the most strident when the condition in question has a completely mysterious physiological origin. They're perfectly fine with taking insulin for diabetes merely because the cause of that particular illness happens to be known.

The folks making these kinds of "deal with it" appeals are usually those who have never suffered these maladies, but sometimes they include people who started eating Turmeric and their headaches went away, so they concluded that everyone else's headaches must be as easily neutralized.

Why do we even have modern pharmacology, if not to help us live more productive, more enjoyable, *healthier* lives? Sure, all medicines have side effects. If you try beta blockers for performance anxiety and the side effects are too much, then stop! But going through a performance with horrific anxiety has side effects too ... many of which are on Jim's list! After my most recent violin performance, a few evenings ago, I found myself in a state of very extreme agitation. I really don't need that. I've tried "taking deep breaths" ... that doesn't work for me.

Years ago I discovered Zaleplon (Sonata) for occasional insomnia. I typically use it when I travel, which is not very often, or sometimes when I have a cold. I guess I use it a couple times a month on average. My doctor recommended it (thankfully without first asking me whether I've tried warm milk and soft music), and he keeps refilling it for me when I run out, so ... enough said.

December 12, 2017 at 02:15 PM · @ Laurie - yeah, my little brother had a doctor-supervised medication, he's now living with half a brain in a nursing home.

@Paul - I hope your not suggesting those of us who are apposed to drug therapies are saying "deal with it". "healthy lifestyle", some of the most dead people I know led healthy lifestyles. And milk, I tried that- kept me up all night.

All I'm saying is people so often times want the instant fix to issues that might be otherwise taken care of, and more permanently, outside of the drug mart. A little more difficult perhaps, but the benefits last a heck of a lot longer and no where near as risky.

December 13, 2017 at 05:05 PM · Paul, you are throwing things together, that don't belong in one sentence. You twist my words and interpret something in it. I don't have to argue about that with you.

Performance anxiety is not an illness. If you can't deal with it, stop performing. People consider the easy way out way too fast and don't realize that it is a dead end to take medication instead of working on the psychological and physiological aspect of it.

In the end it is up to everyone personally to deal with it in their own way. But advising a heart medication to get control over your hands and mind as a musician, is like give a 100m sprinter the advice to take the car.

Performance anxiety is a part of our job. If it is too bad, so that the passion to perform is completely overshadowed by anxiety, then either there is a more general problem or it is a sign to maybe change things... like profession if necessary. There are enough good musicians out there. There is no need to sacrifice your health for music. And there are many (!) other ways which will lead you to overcome the anxiety.

Taking a prescription drug will damage your health. You can read the side effects on Wikipedia, or inform yourself about the drug in general. I repeat myself, but I want it to be clear as some people here still playing it down:

I have had some serious performance anxiety, I dealt with it over the time, it wasn't easy, but I know, how bad things can be and I know ways out of it. I considered taking Beta blockers against it when I was young, because some irresponsible musicians played them down and promoted the use of Beta-blockers in forums. I luckily didn't get the hands on them at that time. I took them when I had a recovery from a heart inflammation to slow my heart frequency and blood pressure. When I took them (smallest dose) I had terrible side effects, like too slow heart beat, no feeling in the hands when I wake up and serious dizziness until a point where I fear I will faint. Also I had pain in the chest, which wasn't related to the disease I had and it is a common side effect of beta blockers. This will not let you sleep and rest properly. On the other hand you feel tired and lazy all the time with Beta-Blockers.

So if you really tried everything over the years. Preparing yourself, getting good sleep, eating healthy, being healthy and if you can say ok to all those possible side effect and take into consideration, that you will form a tolerance against a drug, which can help slowing your heart rate if needed, then maybe talk to a good (!) doc and ask him, if in your health state taking Beta-Blockers is a good idea and also buy a device to monitor your heart frequency and blood pressure, so that you can check by yourself if especially the frequency is getting too low. Especially when you sleep and rest. It should not drop under 50. And don'T combine it with Cannabis or alcohol for god's sake. Take care.

December 13, 2017 at 05:47 PM · What is really interesting about this thread is that it seems if you have tried them, then you use them with a degree of regularity. The statistics of this relatively small sample size with an unknown number of professional vs. amateur vs. beginner show that whether or not you use beta blockers is based on whether you have tried them more than anything else. Just interesting food for thought.

December 14, 2017 at 05:26 AM · Jim, I'm sorry to hear about your brother. However I'm guessing the culprit was not enderol. It's true that caution and care should attend the use of any kind of serious medication. It's a particular problem in the US where regulation is so lax for pharmaceuticals, which can even legally be advertised in very obviously irresponsible ways..

December 14, 2017 at 05:54 AM · After an incident when my hands shook so badly I could barely play in a chamber music setting, I asked my doctor about propranolol. She recommended trying 5 mg before a performance. Before I had a chance to try it, she called and informed me that I would be takin 20 mg 2x per day, as labs had just shown an autoimmune thyroid problem that could potentially cause heart arrhythmia.

I have taken 60 mg per day for almost 10 years now, and have never again had the bow shakes like that first time. The experience gave me new insight into performance anxiety. For me, the underlying nerves from performing in public threw gasoline on a fire that had nothing to do with performance at all.

No amount of meditation, biofeedback, practice, or bananas would have made a bit of difference for me. Anyone who is critical or judgmental about the use of beta blockers should thank their lucky stars they have never been in a situation where they might have needed them. Racing heart and shaking hands are a horrible feeling. If that is how your body reacts to stress—either because of an underlying medical condition like mine or just because that's how you're wired—I don't see anything wrong with using beta blockers to calm the tachycardia and tremors. B-blockers are not tranquilizers in any way, shape, or form. They block the effects of adrenaline on certain aspects of the sympathetic nervous system. They will not make up for a lack of preparation, nor will they quiet any little voices in your head telling you that you are about to screw up.

December 14, 2017 at 12:23 PM · @Laurie - thank you. The point isn't the drug, the point is, one can't always count on doctor supervision of medications or their decisions to prescribe to be in your best interest. They're not calling it an opioid epidemic for nothing. I know that isn't the one we are talking about either, but the point is obviously proven.

And with that, I'm going for donuts, anybody want one?

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