Performance Anxiety: 15 Symptoms, Causes, and Treatments

We typically think of performance anxiety as being associated with sports: an inability to sink the putt or take the kick in the final playoff.

However, stage fright can happen anywhere, from the boardroom to the bedroom (Biswal & Srivastava, 2022; Kochenour & Griffith, 2020).

Performance anxiety can surface before any situation we feel anxious about or during a demanding activity. While moderate levels of stress can enhance our performance, too much can derail it (Angelidis et al., 2019).

This article explores the fascinating subject of performance anxiety: its symptoms, causes, and potential treatments.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free. These science-based exercises will equip you and your clients with tools to better manage stress and find a healthier balance in your life.

What Is Performance Anxiety in Psychology?

“Performance anxiety refers to the anxiety that people experience in anticipation of and/or during important tasks, resulting in impaired performance” (Angelidis et al., 2019, p. 2).

Sometimes referred to as “stage fright,” performance anxiety can affect everyone from public speakers, musicians, and athletes to someone giving a speech at a wedding (Marks, 2021).

And it is common. According to research, 10% to 40% of students experience test anxiety, and it’s even higher within subgroups such as students with disabilities, women, and ethnic minorities (Angelidis et al., 2019).

Psychology tells us the following (Kremer et al., 2019):

• Whether anxiety helps or hinders performance is related to how we interpret it.
• Anxiety isn’t all or nothing; it affects us at different levels.
• We each have our personal zone of optimal arousal: “the range of physiological arousal within which an individual can perform at the peak of physical, mental, and skillful ability” (American Psychological Association, n.d.).

Therefore, balancing enough anxiety to energize performance versus too much that crushes it is challenging.

Performance anxiety at work

In the workplace, performance anxiety can surface when employees perceive themselves as being scrutinized — in the spotlight for doing something they believe they could fail at (Biswal & Srivastava, 2022).

For the employee, this could be public speaking or delivering a crucial report on time; their “worry system” is in overdrive, and their performance suffers (Angelidis et al., 2019; Laguaite, 2021).

Performance anxiety in music and sports

Sports psychologists have suggested that when faced with a competitive sporting situation, “an individual will make cognitive appraisals of the perceived imbalance of the situational demands, resources, consequences, and the ‘meaning’ of consequences” (Ford et al., 2017, p. 206).

If too great, anxiety that could have been performance boosting becomes damaging or even debilitating (Kremer et al., 2019).

Performance anxiety is also found in musicians. Researchers refer to it as “music performance anxiety” and estimate that it is experienced by between 15% and 20% of students and professionals (Juncos et al., 2017)

5 Symptoms of Performance Anxiety

Clients may present with a wide range of symptoms that suggest performance anxiety, including (Forsyth & Eifert, 2016; Laguaite, 2021; Ford et al., 2017; Marks, 2021):

• Emotional symptoms
  Clients with performance anxiety may experience a wide range of emotional symptoms, including fear, worry, apprehension, embarrassment, and self-doubt. They create significant distress and negatively affect an individual’s ability to focus on tasks.
• Cognitive symptoms
  Performance anxiety can lead to negative thought patterns, including excessive self-criticism, unrealistic expectations, and a heightened focus on failure. Such thinking contributes to the cycle of fear and reduces an individual’s self-confidence.
• Physical symptoms
  It can also manifest as various physical symptoms, such as increased heart rate, shortness of breath, trembling, sweating, dry mouth, gastrointestinal issues, and muscle tension. All of these can further worsen the emotional and cognitive symptoms.
• Behavioral symptoms
  In response to the emotional, cognitive, and physical symptoms, clients may display behavioral changes, including avoiding situations that trigger anxiety, withdrawing from social interactions, and displaying impaired performance.
• Interpersonal consequences
  Performance anxiety can strain relationships with colleagues, friends, and family members. The affected individual may seem distant and uncooperative, leading to further social isolation and increased pressure.

While the list is not definitive, it highlights several aspects of a client’s response to their existing and anticipated environments that should be monitored and discussed.

3 Common Causes of Performance Anxiety

Sports psychology offers valuable insights into the causes of performance anxiety that are equally applicable across other settings.

Three of the most important include (Kremer et al., 2019; Angelidis et al., 2019):

• Fear of failure
  Humans are prone to “what if” thinking. We spend much of our time asking ourselves, “What if I fail? What if I let others down?” Our fear of failure leaves us uptight and focused on what could go wrong — and what we need to avoid — rather than on getting the job done.
• Unrealistic expectations
  We are prone to perfectionism. We set ourselves unrealistic expectations and then judge ourselves harshly when we don’t deliver. Such all-or-nothing thinking, where we are either successful or a failure, results in anxiety in competitive and challenging situations.
• Lack of confidence
  Our belief in our ability to be successful or achieve specific goals impacts our degree of anxiety. Too little, and we can become stuck, expecting failure and unwilling to try.

Performance anxiety can cause “choking” — the sudden deterioration of performance (in sports, the workplace, educational settings, and beyond) under conditions of perceived pressure. “The more effort you put into your performance when you’re extremely anxious, the worse it gets” (Kremer et al., 2019, p. 47).

3 Most Popular Treatment Options

While performance anxiety can feel all consuming, it is not inevitable.

Three of the most popular therapeutic treatments for anxiety include the following.

Acceptance and Commitment Therapy and managing performance anxiety

Acceptance and Commitment Therapy (ACT) offers a valuable therapeutic approach for breaking free from anxiety with mindful acceptance and regaining a sense of control in stressful situations (Forsyth & Eifert, 2016).

ACT accepts “unwanted private experiences as they are” rather than trying to avoid or fight against them (Juncos et al., 2017, p. 2).

In a 2017 study, music students that received a 12-session ACT treatment experienced a significant reduction in symptoms of performance anxiety and were less likely to avoid potentially triggering situations (Juncos et al., 2017).

Mindfulness and performance anxiety

While mindfulness typically forms part of ACT, it is also a treatment in its own right.

Mindfulness in the workplace is associated with leaders’ ability to cope with uncertainty and anxiety-inducing situations. Mindfulness training and interventions provide employers with an opportunity to promote psychological capital in employees and reduce the occurrence and impact of performance anxiety (Biswal & Srivastava, 2022).

Research into mindfulness in the workplace shows that employees “become more aware of their thoughts and feelings, are non-judgmental, and reduce stress levels” (Biswal & Srivastava, 2022, p. 6).

CBT for managing performance anxiety

Cognitive-Behavioral Therapy (CBT) is recognized as one of the most evidence-based treatments for psychological issues and has proven successful in managing performance anxiety in musicians, athletes, and beyond (Nagel, 2010; Gustafsson et al., 2016).

Exposing the performer to anxiety-inducing situations reduces the bodily sensations associated with anxiety and increases their capacity to tolerate symptoms (Gustafsson et al., 2016).

How to Reduce Performance Anxiety

There are several techniques for reducing anxiety. Many reflect on the reasons behind performance anxiety and how to reframe our fear of failure, unrealistic expectations, and lack of confidence.

One helpful activity is to revisit perceived expectations.

The performer benefits from considering what they expect of themselves by reflecting on the following questions (Kremer et al., 2019):

1. Do I expect to deliver a flawless performance every time I perform, regardless of the situation or context?
2. Am I considering giving up entirely if I don’t succeed in this specific performance or event?
3. Is it helpful to set my highest expectations consistently in every performance?
4. Do I believe that failure in my performance equates to failure as a person?
5. If I can’t be the best in my field, does that make all the time and effort I’ve invested in training and practice pointless?

Recognizing that their expectations are unrealistic and viewing themselves with more compassion can remove some of the pressure that leads to performance anxiety.

4 Therapy Techniques for Calming Anxiety

The following techniques can help manage anxiety and improve performance with regular practice.

Calming anxiety with CBT

CBT helps identify and challenge negative thoughts to calm performance anxiety (Nagel, 2010; Gustafsson et al., 2016).

1. Identify negative thoughts
   Before performances (such as a presentation), we may experience negative thinking such as “I’m going to fail,” “I’m not good enough,” or “Everyone will think I’m a fraud.”

Write the thoughts down and recognize how they contribute to your anxiety.

2. Challenge negative thoughts
   Challenge unhelpful thoughts by asking yourself, “Is this thought realistic?” or “What evidence do I have to support this thought?”

Come up with a more balanced or realistic thought to replace the negative one.

For example, “I’ve prepared well and done this before. I can handle it.”

3. Visualize a positive outcome
   Spend time visualizing a successful performance outcome.

Ask yourself, “How does it feel to be confident, calm, and deliver a great presentation?”

Working through the event in our minds helps counteract negative thinking and build confidence.

4. Take action
   Finally, take action toward your goal.

Prepare well, practice, and do what you can to ensure a successful performance.

Focus on the process rather than the outcome and remember that even if things don’t go perfectly, you can learn and grow from the experience.

Managing performance anxiety is a process that takes time and practice. Learning to challenge negative thinking, build confidence, and perform at our best is possible.

3 Best relaxation techniques

Learning to relax before and during a performance can help us feel calmer and more centered (Biswal & Srivastava, 2022).

• Anchor Breathing
  This seven-step breathing meditation is a short, straightforward intervention for encouraging calm and increasing relaxation.
• Square Breathing
  Ideal for use before a performance, square breathing can successfully engage the parasympathetic nervous system to reduce anxiety (Nestor, 2020).
• Grounding and Centering
  Grounding is a powerful tool for feeling more present and focused on the moment instead of dwelling on what might go wrong. This technique allows feelings of safety and inner strength to surface.

Coaching for Performance Anxiety: 11 Tips

Performance anxiety often occurs when we get up in front of people and perform. We worry about failing and making a fool of ourselves.

The following tips help avoid performance anxiety when presenting and can be applied to other situations (Marks, 2021; Anderson, 2017).

1. Be prepared and well practiced
   Try to visit the location and, if possible, perform a run-through and get feedback from a trusted colleague.
2. Use fear as a motivator
   Fear will make you take practicing seriously.
3. Practice mindful breathing
   Slow, deep breathing is a powerful tool for relaxation and regaining control.
4. Drink enough water
   When anxious, our mouths can become dry, leaving us struggling to speak.
5. Limit caffeine and sugar
   While it may be tempting to keep drinking coffee on the day of the performance, too much will only add to your anxiety.
6. Eat something
   Often when anxious, we ignore feelings of hunger. An empty stomach can make anxiety worse.
7. Self-talk
   Telling yourself “I can do this” helps develop a positive mindset for an outstanding performance.
8. Find a friendly face
   At the beginning of the talk or performance, find a friendly face and connect with it. Present to that person.
9. Remember, vulnerability can be powerful
   Usually, an audience understands nervousness because they imagine themselves performing. Don’t fear appearing nervous; embrace it.
10. Be yourself
    It is helpful to watch others’ performances for tips, but be natural. Be yourself.
11. Be ready with a backup plan
    If things go wrong, how will you handle it? If you forget your words, be prepared with some notes or a prompt.

3 Questionnaires and Scales for Assessing Anxiety

There are several measures available for assessing anxiety. Here are a few of the most popular.

• Anxiety Control Questionnaire
  The Anxiety Control Questionnaire is a 30-item questionnaire that measures “the degree to which participants agree with statements about their perceived control over internal anxiety-related emotions and external threats” (Juncos et al., 2017, p. 5).
• Sport Anxiety Scale
  The Sport Anxiety Scale is designed for athletes but can be modified for wider use. The 21 questions measure three factors: somatic anxiety, worry, and concentration disruption (Smith et al., 1990).
• Workplace Trait Anxiety
  The Workplace Trait Anxiety scale is a 20-item subscale of the State-Trait Anxiety Inventory for Adults, measuring state and trait workplace anxiety (Dieguez, 2022, p. 268).

3 Fascinating Books on the Topic

The following three books offer a range of insights into performance anxiety and creating the right mindset for being your best under pressure.

1. TED Talks: The Official TED Guide to Public Speaking – Chris Anderson

Most of us fear standing up before others and giving a presentation.

Chris Anderson, the creator of the TED Talks series, offers valuable insights into what makes a good presentation, how to prepare for it, and how it should be delivered.

Anderson’s (2017) book contains many helpful suggestions for crafting the ideal talk and creating an impact in front of others.

Find the book on Amazon.

2. Do Hard Things: Why We Get Resilience Wrong and the Surprising Science of Real Toughness – Steve Magness

We can learn a great deal from performance athletes and what it means to compete at an elite level.

In this book, performance expert Steve Magness helps the reader cultivate mental strength and fortitude.

Rather than promoting a mentality that hides any sign of weakness, Magness teaches us to work with our body and create the space needed to take thoughtful action.

Find the book on Amazon.

3. The Mindfulness and Acceptance Workbook for Anxiety: A Guide to Breaking Free From Anxiety, Phobias, and Worry Using Acceptance and Commitment Therapy – John Forsyth and Georg Eifert

John Forsyth and Georg Eifert’s (2016) book is a valuable addition to any therapist’s library. It contains evidence-based tools to help gain freedom from fear and anxiety by nurturing acceptance and self-compassion.

Use some of the techniques yourself or with clients to live more fully without the fear of anxiety.

Find the book on Amazon.

Best Resources From PositivePsychology.com

We have many resources available for therapists supporting their clients in managing and overcoming anxiety.

Our free resources include the following:

• Reverse the Rabbit Hole Worksheet
  Learn to combat the tendency toward negative thoughts and the anxiety associated with the question “what if?”
• Interoceptive Exposure
  By replicating the physiological symptoms associated with anxiety, we can learn to become more comfortable with and better able to manage feelings of panic.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:

• Leaving the Comfort Zone
  The fear zone is understandably uncomfortable and can leave us anxious. In this exercise, we identify the costs of staying in the comfort zone versus leaving and experiencing growth:
  • Step one – Reflect on experiences of leaving the comfort zone for the fear zone.
  • Step two – Next, consider the learning opportunities available from passing through the fear zone to the learning zone.
  • Step three – Understand how staying in the learning zone can lead to long-term growth.
• The Acceptance or Avoidance Route
  Acceptance and Commitment Therapy helps clients achieve more valued living through the acceptance of emotions.
  • Step one – Understand how avoidance-based coping can result in fear, preventing value-based living.
  • Step two – Next, recognize the value of acceptance-based coping for living according to your values.

If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, check out this collection of 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.

A Take-Home Message

Performance anxiety is uncomfortable and frustrating. Athletes, musicians, students, presenters, and anyone else placed in a pressured environment can feel they might fail to deliver their best performances.

The cause can be fear of failure, unrealistic expectations, or lack of confidence. The result is stage fright. We either freeze or cannot share our knowledge and skills and lack confidence in who we are.

Knowing that performance anxiety is familiar to most people can help, as can reflecting on whether our expectations are rational and realistic. We can also identify and attempt to replace irrational thoughts with kinder, more compassionate, less critical ones.

Counseling can help. A professional therapist can teach clients to visualize a positive outcome, identify what is within their control, and take the necessary actions to prepare.

Work through the symptoms and causes to understand your or your client’s performance anxiety and consider which strategies and tips may be most helpful in managing and bringing it under control.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free.