Good experience with natural beta blockers, anyone?

January 23, 2019, 2:37 PM · I’m researching my options for a beta blocker to make my hands stop shaking during performances. Has anyone had a good experience with a natural beta blocker, such as a herb, or vitamin? Thank you!

Replies (92)

January 23, 2019, 2:41 PM · What's wrong with regular beta blockers? They're a very safe drug with minimal side effects, and I bet you her docotr would happily prescribe them for performance anxiety.
Edited: January 23, 2019, 3:34 PM · I don't know if 'natural beta blockers' exist, and there's a good chance they wouldn't be as effective.

I second what Erik said. They're one of the most harmless drugs out there, as long as your doctor gives you the OK to take them. Maybe try a low dose first if you're worried.

January 23, 2019, 3:37 PM · Is this a joke? Why is everyone trying to stop doing vibrato for performances?
(It's a bad joke, I know, but it's still a joke.)
But no, I've never tried beta blockers myself, but some pianists I know have taken them on occasion. But they were regular beta blockers.
Don't know anything about natural beta blockers, sorry.
January 23, 2019, 4:38 PM · I found a single study from 1990 stating that Transcendental Meditation practitioners had a lower beta-adrenergic receptor sensitivity, but you may find that yogic flying practice cuts into your violin practice.

It's not a bad idea to start a meditation practice in general, as mindfulness should help performance. Exposure to performance, starting with performances that feel low-stakes and ramping up is also helpful. You may find that you feel a lack of confidence in your bowing, and that devoting a small amount of time to son file exercises each day will give you confidence in this skill. Finally, take a small vitamin C pill, or a sugar pill an hour before performing - Either of these function as a natural beta blocker.

January 23, 2019, 4:39 PM · I don't know if beets qualify as a "natural beta blocker" but they are very effective at lowering blood pressure. Unfortunately, I found it difficult to tolerate them--in any form--on a daily basis.
Celery also lowers blood pressure as well, but celery juice tastes even worse than beet juice.
Edited: January 23, 2019, 4:45 PM · Regular beta blockers - they have worked great for me, every time since 40 years ago! I only need 5 mg (1/4 of a standard 20 mg pill). After the first time I used BB I lost all fear of subsequent solo performing - after 30 years of well-justified terrors.

And Nina, who needs a "right-hand vibrato" (or a left hand freeze)???

Performed Brahms horn trio once - all under the BB influence) - split the pill and the pieces of one pill worked for all 3 of us (pianists get hand problems like violinist do, and wind players get diaphragm problems).

I never heard of a "natural beta blocker." Name one! We are after adrenaline suppression here, not BP reduction.

January 23, 2019, 4:55 PM · I’ve been on bbs for a heart condition for several years. I notice a huge difference (positive) in my nervousness since I’ve been on them, but I still get nervous when playing in front of people.
Edited: January 23, 2019, 5:21 PM · I found a different solution for overcoming stage fright:

Closing my eyes and playing the bloody music.

January 23, 2019, 5:35 PM · Cotton Mather: My thoughts exactly.

Stay away from pills. Train your brain to cope with the pressure. It's a part of the job.

January 23, 2019, 6:23 PM · Maybe a little empathy? Tony, I hope you and Cotton don't ever use antibiotics either. Just train your white blood cells to cope with pneumonia, gangrene, etc. And if you get diabetes, just train your pancreas ...

Come on guys! There's a reason we have modern pharmacology! Because it improves our lives.

January 23, 2019, 6:30 PM · Well, yes, it is a good idea NOT to use antibiotics, because it strengthens your immune system to be exposed to such infections and repeated use of antibiotics breeds antibiotic-resistant superbugs. Obviously, there are extreme cases, but violin performance is not life or death, so it's a moot comparison.

Beta blockers, for one, keep you from facing your fears. Maybe you find success with pills; I would never be able to live with relying on a pill to perform. It's also playing with things we don't quite understand... beta blockers change the chemistry of your brain and cause all sorts of unpredictable side effects you may not even notice, but which will still affect you.

January 23, 2019, 7:05 PM · I'm pretty sick of people treating modern medicine as a 'last resort', or worse yet, something to be avoided. Beta blockers are completely harmless in correct dosages with doctor's approval. There is literally no reason not to use them.

This is like telling someone with a broken leg "don't use crutches, learn to face your fear, it's part of being human".

January 23, 2019, 7:11 PM · Good luck getting older, Cotton. There's nothing like age to make you appreciate better living through chemistry.

During a period of time when I wasn't playing the violin, I was prescribed beta blockers for medical reasons. I suggest people who haven't tried them not speculate on the effects.

Edited: January 23, 2019, 7:26 PM · A reminder for everyone that the title of this discussion is "Good experience with natural beta blockers, anyone?" If you can not answer the question, please do not hi-jack the thread for your own agenda. Respect.
Edited: January 23, 2019, 7:32 PM · There's arguably no such thing as a "natural beta blocker", OP seems to have been misled. I think those of us who are encouraging OP to use beta blockers are doing the right thing.
Edited: January 23, 2019, 8:05 PM · Actually, cotton, you still feel everything the same as you would when not on beta blockers. The only difference is that the physical side effect of extreme shaking is mitigated. I find that people who say things like "just get over it" are those who never experienced an extreme problem in the first place.

I suppose a nice compromise between our two viewpoints would be to try and use beta blockers to have a few good performances (to overcome the multitude of previous bad ones, and tonproce to ourselves that it's even possible), and then to try and reduce the amount each time with the eventual goal of using very little, or perhaps even none.

Nothing wrong with crutches for those that need them. I think you'd be surprised at how many top pros use beta blockers, and I don't think you or I are in any position to question the judgement of these much better players. But of course, most won't admit it publicly because of the stigma.

January 23, 2019, 8:53 PM · Thanks for the helpful feedback, guys! I'm most certainly not against a regular beta blocker. I was just curious if anyone has had a good experience with a natural alternative.
January 23, 2019, 8:54 PM · For those of you who have used regular prescription beta blockers - have you noticed any side effects?
January 23, 2019, 8:56 PM · It's worth emphasizing that performance anxiety is not chronic general anxiety. It's not normally helped by anti-anxiety drugs. Prescription beta blockers are useful for blocking the physical effects of an acute flood of adrenaline, which is what happens in performance.
Edited: January 23, 2019, 9:26 PM · I would highly recommend looking at this thread on this exact subject, as clarinetist Gregory Smith of the Chicago Symphony Orchestra has a wealth of experience to share:

I have a colleague in a full-time position in a professional orchestra who has literally tried every solution available to prevent excessive tremors in their "fight or flight" response in performance settings. Beta blockers don't confer any advantage for them, except to bring them to a level of function equal to that of their colleagues who don't have this issue. They make use of the medication in a controlled setting to allow them to enjoy a decades-long career they have invested their entire life into pursuing.

January 23, 2019, 10:45 PM · Cammi, when I take them (especially in a higher dose) I can feel drowsy for a few hours after. On the occasion I've taken too much, I have been a little 'out of it'. That's just my experience - there may be more potential side effects - best to talk to a doctor.
January 24, 2019, 12:29 AM · Studies have shown a long time ago that beta blockers prolong lifes which many other blood pressure mechanisms actually do not do in that extent at least. They are really harmless if used correctly. I would say that any natural herb medicine is more likely to be harmfull than beta blockers in exception fo some people with astma. I have asthma and use beta blockers for health reasons with no problems at all and so do many others.

The thing that I always wonder as a GP is that some people are willing to eat almost any herbal tablet without any thoughts to its safety as long as its is branded as ”natural” and the same people are suspocious of any medicine written to them by doctors as medicines are regulated and herbal medicines are not.

But personally I do not really like the idea of eating any medicine (or herbal concoction) for any other than for real health reasons. So beta blockers to calm nerves with violin playing feels like doping to me. In sports it would be doping.

But things are not black and white and betablockers are one of the safest medicine there is. Just remember that the dose has to be small and do not try to solve everything with a medicine, it wont work.

Edited: January 24, 2019, 12:40 AM · One of the potential dangers of beta blockers is kidney damage.
January 24, 2019, 12:41 AM · Do you have any pre-existing health conditions, Andrew?
January 24, 2019, 12:48 AM · Why don't we find an even more public forum for me to tell you my medical history?
January 24, 2019, 12:53 AM · If a person has kidney damage all the medicine usage has to be evaluated again and many normally safe medicines cannot be used. However the likelihood of beta blockers causing kidney damage is quite unheard of. Some beta blockers are even used by people with kidney damage, but then great care has to be used. It may be that a person has kidney damage without knowing it and starts using a medicine that is not good for kidney damage and then alas blames that medicine for the kidney damage.

But if any medicine is used without an experienced doctor for example buying online practically anything can occur as medicines do interact with each other. Also many medicine sold online are not really that medicine at all and can contain harmfull substancies. And it is good to not want to use any more medicine that is really necessary as most medicine have some side-effects.

Edited: January 24, 2019, 1:03 AM · "However the likelihood of beta blockers causing kidney damage is quite unheard of."

Well, it depends how you define "damage". I knew that word would be contentious.

If you have a heart-attack and go on beta-blockers, your initially monthly or quarterly blood-tests will check kidney function among other things (e.g. liver function if you are also on ACE inhibitors)

January 24, 2019, 2:16 AM · Changing your mindset is the best natural beta blocker ever!
Edited: January 24, 2019, 5:56 AM · I am sorry Cami if sounded unemphatic. I am not.

But your avatar looks like you are a young girl with at least 50 and years of performance on stage ahead of you.

So I will try to be a bit more helpful and speak from experiences I had.

First of all, you were not asking for a drug. That's wonderful. It's very unfortunate that some people have medical conditions that require such (or any) constant medication. That being said, stage performances are not an ailment or a disease, so treating them with medication is therefore - for a lack of a better word - stupid.

Many musicians smoke pot or sniff coke (sometimes both) prior to going on stage and I doubt anyone would condone this as good practice. It's, however, just as 'harmless' and far more fun than beta blockers.

Adrenaline is an excellent motivator and keeps you alert. What negative side effects it has - they fade away with time and proper mindset. But to help you do this you may want to find some Autogenic training routine, that sets you up.

For me - it's minutes of solitude. When I am distracted or unfocused, when I am nervous or nothing is going right. I just find a quiet dark place and let everything go. Some chocolate or a banana and honey may get you some tryptophan and tyrosine, which are precursors to dopamine.

Now dopamine is the stuff that builds up on synapses when you sniff some coke too, but drastically more. What you get from a banana is not a calming effect, but a "feel good" effect, that builds confidence.

Honey does bring a mild calming effect calming effect and - if you can take it - a cold face wash lowers the heart rate and perhaps also relieves the hand shaking.

Edited: January 24, 2019, 7:14 AM · All these calming strategies may be perfectly fine and helpful in the long run. They're not likely to get the OP through her next audition. I'm wondering, for example, how many trials the OP would need to conduct before she discovers how many grams (or pounds) each of honey, chocolate, and banana she needs to eat to achieve the same effect as 10 mg of propranalol. Not to mention what that will do to your bowels half-way through your cadenza.

Cammi, please don't let anyone tell you that using a beta blocker for your performance anxiety is the same thing as snorting cocaine or smoking pot. Did you know that propranalol (the leading beta blocker) is considered one of the most safe and effective medicines known, by the World Health Organization? It's been around since the 1960s.

And by the way, marijuana and cocaine are both "natural" drugs. So is heroin. Nobody is suggesting you use those!

Tony wrote, "It's very unfortunate that some people have medical conditions that require such (or any) constant medication." It's even more unfortunate when people have grievous medical conditions for which there are no safe pharmaceutical treatments, or when people refuse readily available drugs out of prejudice or superstition.

January 24, 2019, 9:22 AM · My heart stops beating for 5 seconds or more at a time if I don't take my beta blockers. It's not deadly, but it feels like you can't breath and is very uncomfortable.
Edited: January 24, 2019, 9:50 AM · I have not done beta-blockers, but adrenaline, when uncontrolled, can do bad stuff. A lot of the PTSD that veterans see comes from stress hormones unleashed in combat, which literally fries your brain so it cannot behave normally. No idea if this is the same response that is being fought onstage, but it is worth thinking about.
Edited: January 24, 2019, 10:01 AM · Marty Dalton - a serious medical condition requires serious medication. No doubt there.

Paul Deck - I believe her question was about natural supplements. What you suggested is almost an ode to pharmaceutical industry. Can you tell me how do you draw the line between b-blockers, cocaine and pot to give an educated advice to a young aspiring talent?

I still maintain, that drugs are there to treat medical conditions, and performance anxiety is not a medical condition. There are far less invasive ways to a healthy musical career (if such a thing even exists).

Edited: January 25, 2019, 7:11 PM · Hi Cammi - I'm a trained herbalist. Herbs have done for me what better living through chemistry has not been able to do (herbs have been a last resort for me on multiple occasions, and I keep going back to them because they work when used correctly!) Herbs have also not been able to do for me what better living through chemistry has only been able to do!

I'm also an amateur player who does not play for others nearly often enough, and I am fairly crippled with performance anxiety.

You should be discussing all of this with a highly qualified medical practitioner.

The homeopathic Arg Nit is considered very effective for performance anxiety (where one has mistakes that build upon mistakes). Homeopathic Gelsemium, to my knowledge, is another "remedy" which is considered best for performance anxiety that dissipates once one gets in the groove. Quite different remedies! (I am posting this here because it is available for the public on the internet with a few searches.)

Acupuncture is well known for helping one in working with generalized anxiety, and there have been a couple of very small studies which have had positive results/correlations between acupuncture's effectiveness in reducing performance anxiety.

NEVER mix herbs with medications, or take when pregnant or breastfeeding, or in general without the guidance of a highly qualified medical practitioner.

Herbs do not provide instant satisfaction/results the way drugs do, they need time to work the changes in the body.

For those who have dealt with performance anxiety: what was your cause of it? Was it fear of failure, fear of lack of capability, inability to access "flow", fear of judgment? What is your performance anxiety related to? I ask, as I suspect (based on a lot of other V.commers responses) that once the deeper issue is addressed and resolved, the performance anxiety dissipates because the brain is able to rewire itself. I'm sure working with a qualified therapist (EMDR therapy is great) to help address these issues would be a goldmine of beta-blocker free material. (Albeit more time consuming than taking herbs, or having the instant help of a beta blocker!)

And, there is no shame in taking a beta blocker if it is safe to do so.

January 24, 2019, 10:19 AM · I believe that if you are going to take beta blockers, you should obtain a prescription from a doctor. You will need a beta blocker that comes in a dosage that you can divide, since the dose used to relieve performance adrenaline effects is far smaller than the dose used to control blood pressure. Most physicians will write prescriptions for musicians for this purpose.

Musicians who take beta blockers for performance nerves vary significantly. There are people who use them multiple times per week because they play in major symphonies with performances several times a week. And there are people who use them very occasionally -- for instance, for major auditions or major solo performances.

I think the naturopathic sites that discuss "natural beta blockers" typically talking about reducing the effects of stress and anxiety on people who are chronically stressed or have generalized anxiety -- that's why you'll often see them mentioned as an alternative to SSRIs, for instance, and not the beta-blocker drugs used to lower blood pressure (or deal with acute effects of performance adrenaline). And they are generally not referring to blocking the actual receptors for adrenaline, but rather, getting the nutritional elements necessary to ensure that your brain handles neurotransmitters properly.

I think it's easy to be judgmental about the use of beta blockers by other people -- especially if you yourself are not dependent upon beta blockers in order to be able to earn a living. For a professional musician, if taking a pill for an audition makes the difference between being able to land a six-figure full-time job with decent benefits and job security, and patching together freeway philharmonic gigs to scrape out a living without health insurance, well, an interloper is frankly a judgment jerk with zero empathy if they tell that musician that they should just cope and suck up the financial instability.

People should do what they need to do to earn a living. No one lives an optimally healthy life, either. (If you do, congratulations, but expect to be flipped the bird if you are sanctimonious about it.) Rational adults can consider the trade-offs and decide what's best for them.

Using beta blockers on a daily basis is different than occasional use. Never take a beta blocker for the first time before a big performance, though; you won't know how it affects you and you have to get the dosage right, too. The effects are different for different people.

January 24, 2019, 10:42 AM · Pamela, I think the answer to your question about performance anxiety is complicated.

In thinking about this thread, I realize that I experience adrenaline surges before, during, and/or after performances. That includes not just violin performances (whether solo, chamber, or orchestra), but also the public speaking engagements that are a routine part of my job.

For some time, I have been puzzling over the fact that these adrenaline surges seem unrelated to my level of preparation or mental state. Indeed, I can feel nervous but not really get the big surge that causes one or both hands to shake, or I can feel mentally very calm but still get that surge. I suspect that in some cases this is actually simply adrenaline as energy -- but an excess of it, so that something that might be good turns into something with detrimental physical effects. I imagine I'm not alone in these kinds of reactions.

Edited: January 24, 2019, 11:08 AM · I've probably said it before, but I fail to see why there should be any correlation between possessing musical talent and enjoying standing on a stage alone in front of an audience. If your kid has talent, it seems like sadism to me to make them play solo to an audience if the kid doesn't like it. But that's the nature of music, unfortunately, unless you remain anonymous in an orchestra.
January 24, 2019, 11:48 AM · When my oldest son was 11 years old, he suffered from performance jitters and one of my chamber buddies recommended Bach Rescue Remedy Pastilles. They may or may not have had a placebo effect, but he claims that they helped. They are touted as an homeopathic solution for stress and anxiety.
January 24, 2019, 12:50 PM · We went through all this here just over 14 months ago.
Here is the reprise:
January 24, 2019, 1:06 PM · Homeopathic remedies do not, by definition, contain any active ingredient. The water molecules are supposed to "remember" the active ingredient, which is eventually diluted out to something on the order of a teaspoon in Lake Erie. A silly idea of 18th century German origin, no better than other quack cures of the time.

Homeopathy must be one of the longest-running scams. Just imagine how much money you can make by giving someone water with pretty much nothing in it. And the fact that these "remedies' are unregulated and unverified, thanks to people like Orin Hatch, whose state is an epicenter for bottled nothing, makes it worse. They even adulterate basic vitamins--I no longer trust any of that stuff.

January 24, 2019, 1:14 PM · 1. Those who advise to use willpower to "get over" an overactive adrenaline response -- I'm curious if you feel the same way about drugs to treat other medical issues (i.e. cancer, depression, anxiety, infection).

2. Beta blockers are used by professionals more than you can imagine, orchestral musicians, chamber music, and soloists.

3. Ultimately, this is a discussion between you and a doctor. I would not allow the advise here to sway you one way or the other.

Finally, good luck with your performance anxiety struggle. The struggle can be very real for many performers, and there are solutions.

Edited: January 25, 2019, 6:39 PM · Lydia - I agree with you! I have the same surges, but mine also are accompanied by a hyper-critical mental state with the violin - which is not present when teaching other material, or giving speeches, but is present at other times in my day-to-day life. It seems the adrenaline rush of any kind of performance simply amplifies this tendency.

A couple of professional musicians whom I was recently in conversation with said that the issue of performance anxiety is something that everyone has dealt with at one time or another, and it is an indicator as to lack of being able to get into "flow state" and to "let go" to play the music. I agree with them, but then the question arises as to how to best access flow and to truly let go? There's a lot of trust involved in that - in oneself, the audience, other musicians, etc. It makes sense that adrenaline kicks us into fight/flight/freeze: being vulnerable performing can be quite scary and dangerous. (As you said, when a comfortable job rests on one audition - how is that not going to affect someone?)

Krista - I love those Bach Pastilles! Thanks for the reminder about them.

Lydia, again, re: SSRI's vs adrenaline receptor blocking, that's the thing. MOST herbal information available on the internet (from all of the low-quality sites that come up when you type in "natural beta blockers") list run of the mill anxiety herbs which do work more in the vein of SSRI's (see: St. John's Wort, lemon balm, etc.). If one works with an individual, a complex herbal formula can be created to address acute moments of anxiety as well as long-term anxiety. Herbs have complex chemical makeups, and for the ancient Chinese there are varying causes of anxiety (including surges of, as in the case of performance anxiety) and options to work with. All this to say, there is more than what's offered on the internet AND I'm not saying that there is a solution to this "natural beta blocker" question. Beta blockers certainly prevent the body from getting to the place where energy needs to be redirected, but the cause of it is not being addressed at a deeper level. I'm not disagreeing with you, just offering another point of view.

Andrew - thanks for the link! I remember that thread, going to revisit it now.

January 24, 2019, 2:11 PM · Scott - I know some folks who think they are wonderful and have seen amazing changes in people, and I know others who agree with you. I've taken them in the past and had nothing happen, and other times they seemed to work some kind of magic. I mentioned homeopathics because they are by all accounts safe for pretty much anyone to take. If they work (placebo effect or not), great.
Edited: January 24, 2019, 2:17 PM · Although I express cynicism, I played piano in three or four sessions of a music festival every year throughout my teens. It terrified me, but I never thought of refusing to do it, whereas I refused to go to Sunday school and I refused orthodonty. Apart from that, I can't really recall my feelings about anything.
I can recall being more nervous in front of a tape recorder than in front of an audience, though!
Edited: January 24, 2019, 2:21 PM · The issue with herbs is that if the herb works, by definition it contains an active medicinal ingredient. And you are getting that ingredient mixed in with a bunch of other things, in all likelihood. And each plant will contain a different amount of that compound, which means that you cannot get a precisely measured and consistent dosage, and cannot really predict the effects.

I'd rather take a pill and know precisely what I'm getting. (And even then, when you get generics vs a branded pill, there are differences too. Which is why I always buy a specific brand when possible.)

January 24, 2019, 2:26 PM · Alcohol is said to be an effective (but controversial) remedy. And natural.

Quoting from

"One of the most effective inhibitors of tremors is alcohol. Just a little - not enough to make you even slightly tipsy!! Maybe something in the range of 1/8 glass of wine, or even less. (....) alcohol is an effective, clinically proven, non-prescription inhibitor of essential tremors ("performance jitters")."

January 24, 2019, 2:32 PM · One thing I want to throw in to the conversation here: please take note that all of the people that are vocally pro-beta blocker here are those that actually routinely perform.

And all of the vocal anti-beta blocker people are those that *don't* routinely perform.

Just wanted to throw that out there :)

January 24, 2019, 3:41 PM · I don't perform very much actually Erik, and one of the reasons I don't is because I get really freaking nervous. I want to try beta blockers, but like so many people I've had it pounded through my thick skull that somehow that it's some kind of cop-out, and all I need is more experience. We'll I'm in my 50s. Just how much experience do I need?? And so, this very thread has me doing something about it! I'm calling my doctor tomorrow to get an appointment.

So I guess you're right ... but in kind of a weird vacuous way. Or something.

Edited: January 25, 2019, 6:41 PM · Lydia, if you gravitate towards getting something from a pill, then by all means. The thing with herbs is that when given correctly, **undesirable** side effects from said herbs are ideally zero. So it's a matter of how you approach your own life.

If my work/livelihood were on the line, and I was unable to rectify performance anxiety via other means, you bet I'd be calling the doctor for beta blockers as well as approaching it from a holistic perspective.

January 24, 2019, 4:14 PM · Cammi, I hope reading through all the nonsense of this thread has given you an important and boring lesson about taking medical advice from violin message boards.
January 24, 2019, 4:18 PM · I did make one important discovery: One of the things that was really making a big difference in my impression of nervousness was having an upset stomach pre-performance, sometimes starting several hours before, or even the night before.

The upset stomach would make me nauseous, and it would start an entire chain of adrenaline effects. Now I take a chewable Alka-Seltzer, and that totally eliminates the problem. And that by itself has hugely reduced my pre-performance nerves.

Still get the shakes sometimes, though. My teacher has taught me how to mitigate that somewhat technically, but that involves compromises that are not, for instance, audition-acceptable.

January 24, 2019, 4:43 PM · Lydia, would you mind elaborating on the bit about mitigating the shakes technically? Are there specific physical processes that can be employed while playing that you've found useful towards that end? (I hope the question makes sense--can't quite think of another way to phrase it at the moment.)
Edited: January 24, 2019, 4:50 PM · Pamela, while I am somewhat an advocate of not using commercial medications, homeopathic medications and herbs, and even diet choices are not necessarily any more free from side-effects than commercial drugs.
January 24, 2019, 5:04 PM · Basically you want to try relaxing the muscles. So for right-hand shakes, split up the bowings -- use much more bow than you normally would. It's useful to practice the opening of your program with an alternative bowing -- or simply choose your default bowing to be for the bow-shakes if you figure they are inevitable. (But I can get bow-shakes mid-work, too; I'm generally comfortable changing my planned bowings if I need to.)

For left-hand shakes, stop any deliberate vibrato until the tremor stops. Some vibrato will probably happen anyway thanks to the tremor.

January 24, 2019, 5:16 PM · Cammi, I just remembered a more 'natural' alternative to beta blockers: there is this stuff that you spray in your mouth before a performance and it calms nerves, though not as much as beta blockers do. Sorry, I can't remember the name, but it definitely exists. If your nerves are not too extreme maybe you could give that a try?

Tony, and everyone else trivialising performance anxiety: may I suggest you don't give advice on a medical condition (yes, it is a medical condition) unless you have experienced it to this level.

January 24, 2019, 5:28 PM · Thanks. I figured it was something along those lines, though I see how these strategies might be questionable in an audition. Although intelligent bowing selection for shake-problem areas certainly seems like it could have a place in audition prep.

Given that excess adrenaline primes us neurologically to run from a tiger, rather than to play music, I have to wonder if the fight-or-flight response actually alters the pattern in which we recruit muscle groups for playing. Perhaps the answer is to practice on the treadmill :-).

Edited: January 24, 2019, 5:44 PM · Pamela wrote, "The thing with herbs is that when given correctly, side effects from said herbs are ideally zero." If you have found success with herbs without side-effects, that's fine. But that's one data point. If science has taught us anything, it's that anecdotal evidence may be grounds for a hypothesis, but not a conclusion. The road to a conclusion in pharmacology is long, difficult, and expensive.

The reason people think herbs have zero side effects is precisely because they have not been studied in nearly as much detail, so the incidence is "zero" only because it's not known. The side-effects of propranolol are rigorously documented from over 50 years of clinical use (link below). The other important thing to consider is desired effect vs. side-effect. Once again, with herbs often the desired effect is not known because it's not been studied, or because the concentration of the active substance is so variable that a study would be pointless. You could isolate and purify the active substance, but then you've got a drug, not an herb, and all the romance (from which its efficacy as a placebo is likely derived) is lost.

Please understand that I'm not anti-herbs, just pro-science.

Edited: January 25, 2019, 6:31 PM · This all boils down to what we, as individuals, are willing to tolerate based on the information we have culled from professionals and research from multiple sources.

Exiting this thread now.

January 24, 2019, 7:14 PM · "The thing with herbs is that when given correctly, side effects from said herbs are ideally zero."

Sorry Pamela, but this is not responsible information. The term "herbs" is so vague, and can cover so many kinds of plants and compounds that you can't guarantee this. In fact, this is the problem with so many supposedly "safe" products:

People hear "herb" or "all-natural" and think "safe." Nothing can be further from the truth. For example, beets are a "natural" product. But they have compounds which, over time, can lead to kidney stones in those genetically at risk for them.

It's wishful thinking, like the current thinking about cannabis: solves all, no side affects.

As for homeopathy: I don't have anything against the placebo effect, which can be powerful. There is evidence to suggest that dopamine levels in the brain can rise just from anticipation of something. But there's a moral quandary: Should be people pay money for nothing? I don't know the answer.

And of course, to reiterate: "herbs" are not regulated, and we have no guarantee of purity or content.

Book recommendation: "Why People Believe Weird Things" by Michael Shermer.

January 24, 2019, 8:30 PM · Juliana, a recommended performance preparation technique is to exercise briefly and vigorously (for instance, run quickly in place) in order to bump your heart rate up a lot, and then trying to play.
January 25, 2019, 2:49 AM · Erik Williams said: And all of the vocal anti-beta blocker people are those that *don't* routinely perform.

I played 110 commercial solo performances last year (25 weddings). I played several non commercial too. I also sing (in a band) and in our church choir. How many more performances do I need to classify as a routine performer?

And again.

Do not equate adrenalin response to an infection or a psyciatric condition. This sort of thinking got our society to where we are now.
1. By intorducing “special needs” to children we forgot, that some children are special because they are gifted and some are just dumb.
2. By advocating gender we justify invasive surgery to change sex.
3. By treating normal human adrenaline response as a disease we stuff our ass with chemistry.

This is a bad approach. One should exhaust all other options before turning to prescription meds for performance.

Edited: January 25, 2019, 3:07 AM · Just fyi, you sound like kind of an insensitive douche, Tony.

I agree that one should exhaust their other options before using meds, but I also know that most of the people that have turned to meds already *did* exhaust their other options. That's *why* they turned to them.

January 25, 2019, 5:35 AM · I apologize for sounding (and perhaps being) an insensitive douche.

I will try to be more tactful in my responses.
I detest 'douchness' (is that a word?), even - and especially - if it's me being a douche.

January 25, 2019, 7:12 AM · +1 Erik.
Edited: January 25, 2019, 9:18 AM · Tony -- logical fallacy by conflation.

I've never taken them. I know some very fine players who need them, and I've got no problem with that. These allegations of being on "autopilot" and such are things I've never seen -- I note no change in sensitivity and artistry from these players.

Perlman has admitted to taking them, is he on autopilot? I think not.

#1 Fear - Being on stage
#2 Fear - Death

A lot of people are dealing with their # 1 fear here. They would rather be in the casket than giving the eulogy.

January 25, 2019, 10:07 AM · "1. By intorducing “special needs” to children we forgot, that some children are special because they are gifted and some are just dumb."

Kids on the autism spectrum or have ADHD are wired differently and have different brain chemistry.
They're not just "dumb."

January 25, 2019, 12:29 PM · What a lot of misunderstandings. Its obvious that many posters did not read a significant portion of the posts above.

A few summaries/points:
1. Beta blockers do NOT work on performance anxiety itself (which is a psychological state) but on its outcome - palpitations, sweat. They do this by blocking the physical manifestations of 'fight or flight'.

2. 'Natural' remedies are either hokum or they are the basis on which pharmacological agents are developed. For example native Americans in pain chewed on willow bark. Scientists isolated Asprin as the active agent - which you can buy. You can, of course, chew willow bark instead - but it won't be any better for you because it is natural. You could also eat deadly nightshade berries to get atropine, scopolamine and phenobarbital. But you might be more likely to survive if you used the purified and quantified products.
I don't know of a natural source of the usual beta-blocker, Propranolol - but there are lots of unverified claims to spend your money on - and not know the actual agent or effect.

3. I see the argument above that we may as well take advantage of modern pharmacology. Well, each drug - indeed, everything you eat or do - has a potential positive or negative effect. Propranalol is very safe if you do not have any pre-existing conditions BUT realize that no drug has been tested in every combination possible, either with other drugs or even dietary or behavioural cofactors. Everytime you add one more YOU are the experiment.

I struggled awfully with performance anxiety to the point where I would look down at my violin and wonder who's arms and hands they were - I had no control. I've had the gamut of physical outcomes too - but for me (and I stress for me) I see it as self-defeating to be limited to performing only when I took a pill. Over the years (last 10 to be exact) I have developed strategies to avoid the performance anxiety, or at least its extremes - and in the process the physical reactions have tempered. They still occur but the knowledge that I can control them has allowed me to perform - now with pleasure - when before I was virtually paralyzed.

Edited: January 25, 2019, 1:11 PM · Performance anxiety is very real, and it sucks, and I'm sorry you're having to deal with it. I remember you saying (?) that you played other instruments? Do you have performance anxiety issues with those instruments as well?

I personally wouldn't use an herbal product in the US. They aren't really properly regulated; basically as long as they don't poison you, nobody really checks what's in them. There was an independent firm that tested over the counter herbal supplements and found that they did not contain consistent amounts of the advertised herbs, and some contained none at all (one was just a common houseplant, if I remember correctly).

In the US, drugs are subject to intense scrutiny as far as dosages. When you buy 30 milligram pills, that's what you get. Prescription beta blockers will likely be more reliable as far as results.

There's also nothing preventing you from looking at both psychological remedies for the long term, and drugs of whatever type for the short term.
- Lydia (I think?) has mentioned - it's a great resource.
-The book "Stage Fright" by Kato Havas is good as well.
-Go through your performances the week before every night, envisioning yourself playing perfectly.
-Expose yourself to incrementally more stressful playing situations. Start with playing a concert for your cat, move to your parents, siblings, SOs, etc. Then invite your best friend to hear you play. Then have a party with 10 musician friends where you all play something short. Then go play at a nursing home. get the drift.

January 25, 2019, 3:47 PM · I agree with Elise that you've got to be careful about drug interactions. In the US, Propranolol is only available by prescription, so presumably you're talking to your doctor about other drugs you're taking (and whether you've got liver cancer or whether you're actually allergic to Propranolol). If you get all your medications from the same pharmacist, they check for potential drug interactions also, but of course that will not include OTC meds.

As for Propranolol, some products that may interact with this drug include: alpha blockers (e.g., prazosin), aluminum hydroxide, anticholinergics (e.g., atropine, scopolamine), chlorpromazine, drugs affecting liver enzymes that remove propranolol from your body (such as cimetidine, St. John's wort, certain SSRI antidepressants including fluoxetine/paroxetine/fluvoxamine, HIV protease inhibitors including ritonavir, rifamycins including rifabutin), other drugs to treat high blood pressure (e.g., clonidine, hydralazine, methyldopa), epinephrine, fingolimod, haloperidol, other heart medications (e.g., digoxin, disopyramide, propafenone, quinidine), mefloquine, rizatriptan, theophylline, thioridazine, thyroid hormones (e.g., levothyroxine), and warfarin.

January 25, 2019, 6:29 PM · Tom, I certainly understand not wanting to dispense medical advice over the internet, but surely you can share the mechanism underlying "courage"-mediated beta-antagonism?
January 25, 2019, 7:31 PM · Tom, performance anxiety isn't simply 'nerves.' Please stop telling people to get over it. If she could have done that, OP would have not needed to post here.

January 25, 2019, 7:53 PM · I'll preface this by saying that I've never taken beta blockers for a performance, or been on a beta blocker prescription during a period of time when I was playing the violin, so I do not have any personal experience of taking them for performance anxiety.

I can tell you that I have been my nervous performer my entire life, starting from when I began playing the violin as a child, and continuing to the present day. I've tried pretty much everything. I do the various "best practices" for this kind of thing.

I have a performance routine, including having learned what I can and can't eat (and when I should eat it, and what's likely to be best).

I have read extensively, including the aforementioned Kato Havas (and studied with someone taught by her, and the stage-fright mitigation techniques involved, including the alteration in playing technique).

I have done a Bulletproof Musician workshop. I've read the techniques. I do the practice approaches, the mental tricks, etc. (I recommend his stuff highly, by the way.)

I have performed a lot in solo situations -- in weekly group lesson for years of childhood, in frequent recitals, and now in adulthood, on a regular cadence in a variety of venues. I was in a Suzuki performing group as a child, too, and did a ton of performing in all kinds of situation, both solo and group. Plus I've done a large number of quartet and orchestral performances.

And you know what? My hands still shake. It never gets any better. What all that work has done is turn me into a seasoned performer -- one who knows how to cope when stuff goes wrong. It lets me walk into performances with good mental focus, and to be pretty good about keeping that focus (it's easy to dwell on your mistakes and get distracted). But it doesn't do a d*mned thing for the shakes.

I'm guessing that OP, who is a pro, has already done the usual "be less nervous" stuff.

January 25, 2019, 8:48 PM · Tom I dare say you are not the only qualified professional here :) But there is a big difference to giving specific medical advice and giving general medical or pharmacological information. The former is fraught with conflicts, even danger but the latter is generous and helpful - and no more than one can glean from the internet.

For example, here are the listed side effects on the Mayo clinic:

January 26, 2019, 12:13 AM · Tom, I didn't guide anyone here to self medicate. Please quote me where exactly I did that. Further, as a medical professional, you ought to know better than to minimize psychological issues and you ought to know better than to tell someone to 'change their mindset.' Performance anxiety is very real, and it's not a mindset. It's an abnormal response to stress that interferes with normal activities. And it's manageable.
Edited: January 26, 2019, 11:30 AM · Nobody has suggested that the OP obtain beta-blockers from a back-alley drug dealer. The term "self-medication" is wholly inappropriate when these medications are readily prescribed for performance anxiety by physicians. Really, none of the posts here have gone beyond the scope of the sort of "ask your doctor if Propranolol is right for you" verbiage that is common in TV commercials.

Tom, I did appreciate your sincere response to my previous comment. However, it didn't answer the question I posed (albeit in a tongue-in-cheek manner), and in fact affirmed my suspicion that you're conflating preventing an unwanted adrenaline surge from occurring with being able to play *through* that surge. The latter is what beta-blockers address, as you know. I'm not sure "courage" is synonymous with the former, either.

January 26, 2019, 1:54 AM · In my own experience, facing a fear and overcoming it can be really empowering.
It's no surprise that you may not be able to do it with stage fright directly if you have had that for many, many years. You have essentially taught yourself to respond to a performance situation in that manner, it's ingrained. But you could challenge yourself with something else!

Laugh all you want, but I used to be very shy and uncomfortable talking to people I met for the first time - just crippling fear. Then I got a sales job, which consisted of only that and also getting people to agree with me on this or that product.

I was able to adapt and that positive experience has carried into all aspects of my life, music performance being one of them. Of course your early childhood experiences also shape how your "psyche develops" - if you have been brought up to fear failure (like I was playing team sports, i.e. letting the team down) climbing that mountain might seem impossible.

January 26, 2019, 2:09 AM · J I, I'm not laughing. I think there's a spectrum of performance anxiety between mental "mental nervousness" and crippling physical symptoms that people experience, and I am interested to learn from those who have successfully overcome any of the above. I must admit, however, that I'm *particularly* interested in developing the ability to play music in the presence of physically crippling/and or nauseating levels of adrenaline. Is this an experience you share?
Edited: January 26, 2019, 4:50 PM · Edited because I discovered I *can* be more concise. Cammi asked about experiences with beta blockers and side effects. In my experience, Propranolol significantly attenuates the shakes, and seems to help reverse the feedback loop that develops after a critical mass of shaky performances, where the fear of the shakes brings on the shakes. It doesn't seem to prevent mental jitters for me, though I should add that the mental component has not always been correlated with the onset of physical symptoms.

It is hard to tell if this is psychosomatic, but I think I have experienced some side effects--cold hands (bad for violin), and an annoying general feeling of ennui after use. For these, and safety reasons, I do not always use them, and try to use the lowest effective dose when I do. Be careful and talk to your doc if you get them prescribed. :-)

Edited: January 26, 2019, 2:36 AM · Juliana,

I have never felt nauseous, the adrenaline spike wasn't that high but:

With social interactions, my hands would sweat a lot and shake a bit, voice stammer and I couldn't think clearly. The mental fatigue was worse than physical symptoms, after all you are mainly talking and not doing any complex movements.

Playing music felt like my hands had been frostbit and I had ice running through my veins - I had the music pretty organized in my head but my hands just wouldn't obey like they did during practice. Same experience during sports initially (soccer and hockey) but after coming back from difficult injuries I could play very well. It was routine for me to choke on game-winning or tournament-winning plays: suddenly I would have no energy, no strength, very sluggish. And my heart rate would skyrocket.
I think I gained some distance and frankly didn't care anymore for either sport.

January 26, 2019, 2:44 AM · J I, your frost-bite analogy is interesting. A cellist friend once compared the sensation of shaking in performance to shivering from cold, and acknowledged that he had partially addressed it by wearing extra-warm clothing in stressful performace situations.
Edited: January 26, 2019, 4:58 AM · Cammi, chamomile tea is not a beta blocker ("Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects."--, but I have had good experiences using it to help cope with performance anxiety.
Edited: January 26, 2019, 5:53 AM · Elise, in my experience beta blockers have reduced the mental parts of performance anxiety just as much as the physical symptoms. However, it is admittedly more of an indirect result. I believe a lot of the anxiety comes from anticipating the physical symptoms and how they will impact your performance. When this risk is removed, the anticipation/anxiety doesn't occur. Gradually your body learns not to associate performances with nervousness.

Tom, you may (claim to) be a doctor, but that's a very misguided view of performance anxiety. Most of the time one can't just "think it away" (much like any other psychological disorder). OP was asking for our experience with beta blockers; we are not claiming to be doctors & we are certainly not responsible for her choices.

Edited: January 26, 2019, 11:07 AM · I can appreciate Tom's reluctance to get anywhere near a comment that might have any chance of being construed as a recommendation. The language of TV ads is carefully screened by lawyers.

Since Tom is a doctor I would ask whether he is aware of any surgeons who take beta blockers before performing sensitive procedures (e.g., to minimize tremor during ocular microsurgery).

January 26, 2019, 11:07 AM · Coming back to the issue of drug interactions, one of the dangers of herbal medicines is that when folks' doctors ask "what else are you taking," they forget to include the herbal medicines. Nowadays the forms you fill out at a doctor's office or hospital will explicitly say to include OTCs and herbals, so hopefully that will decrease the likelihood of negative interactions.
January 26, 2019, 12:22 PM · "Elise, in my experience beta blockers have reduced the mental parts of performance anxiety just as much as the physical symptoms."

Elise, I second this. I believe that there is likely a related placebo effect after the pill is taken, even if it hasn't kicked in yet. You've taken an action--now your brain believes that a beneficial effect will happen.
You feel "protected," and confident just because you know your arm might shake less.

It's hard to tease out where the mental and physical effects separate.

Edited: January 26, 2019, 12:38 PM · The "mental effect" is not necessarily entirely a placebo effect. Human physiology is complicated and it's hard to isolate one system from another. So even though a drug might not work directly on the CNS, there can be CNS effects as a consequence of secondary chemistries within the body. That's all conjecture of course (which, depending on your perspective, may be indistinguishable from BS).

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