I’ve read compelling arguments both for and against the use of beta-blockers in the performing arts and can understand why many in the field have strong feelings both ways about their use (here’s a great article from the NY Times, another one here, yet another here, and one more here).

For the record, I’m not necessarily against the use of beta-blockers.

I just don’t think that most musicians need them. And worry that, like the ADHD medication Adderall, can be overused and lead to a kind of dependence that can be difficult to break.

And in fact, if your goal is to play your absolute best, beta-blockers may hold you back.

How could that be? Before we go there, let’s back up a bit.

What Are Beta Blockers?

Beta blockers such as Inderal are beta-adrenergic antagonists, or a class of drugs that block the body’s normal physiological response to stress. Think of the last time you nearly got into an accident on the freeway, went on a first date, or had an important audition. What do you remember feeling, physically? Pounding heart? Feeling like you can’t breathe? Muscles becoming tight and shaky? Perhaps even cold and clammy hands?

These reactions are all part of the sympathetic nervous system response, often referred to as the “fight or flight” response. Essentially, any time you are faced with a stressful, new, or challenging situation, an alarm goes off in your body and all of the systems related to strength and energy turn on, and all other non-essential systems (immune system, digestive system, reproductive system, growth processes, etc.) temporarily shut down. This is a great survival response that will serve you well if you ever need to fight off or run away from an angry bear, but will make nailing your audition more challenging if you don’t know how to properly channel all of this extra strength and energy.

This is where beta blockers come in – they will block the physiological symptoms and minimize the pounding heart, the tremors, the cold sweats, etc..

“Well that sounds freakin’ awesome!” you say. “How could that possibly be a bad thing?”

Here are a few things to keep in mind.

#1: The three components of performance anxiety

You may recall from this article that performance anxiety (or stage fright) consists of not just one, but three elements.

1) Physical effects

2) Mental effects

3) Emotional effects

While beta blockers effectively target the physical effects, the mental and emotional effects (such as focus and concentration issues, self-doubt, self-criticism, over-analysis, memory slips, and feelings of panic) are not directly addressed by the beta blockers. Though we tend to be preoccupied with the physical effects of anxiety, there are studies which suggest that the mental and emotional components of performance anxiety are more to blame for poor performances than the physical elements.

Stated another way, research suggests that one’s mental/emotional state ultimately has a bigger impact on performance quality than one’s physical state – yet beta blockers only target the physical aspects of anxiety — just 1/3rd of the equation.

Despite what you hear from people who swear by them, and even what you read in the popular press, the jury is still out on how much of an impact they have on meaningful aspects of performance. Most of the evidence supporting their use is anecdotal, as many of the controlled studies investigating beta-blockers and music performance quality fail to provide conclusive evidence supporting more widespread use.

#2: Calmer isn’t necessarily better

Here is something else to keep in mind.

Beta blockers may help you feel calmer and more physically comfortable while performing, but being calmer and comfortable do not necessarily help you play your best.

Each of us has a unique range of anxiety in which we perform our best. Some will play best when anxiety is fairly low. Others, believe it or not, will play their best when anxiety is moderate or even high. Several studies have found optimal ranges of anxiety to be surprisingly well balanced across low, moderate, and high levels. In other words, some of us will play our best even when we are pretty anxious – whether we like feeling that way or not.

#3: Peak performance requires a tremendous amount of energy

Beta blockers also rid you of a dynamic source of energy. Peak performance – those rare moments when everything just “clicks” and your performance is truly inspired – requires intense concentration, focus, and energy. When you are playing by yourself in the practice room, the energy that fuels peak performance is not available to you. It is only when you get on stage and the adrenaline kicks in that you have access to this energy.

Imagine for a moment that you have two cars in your garage – a Ferrari and a minivan. If you want to go grocery shopping, you’d probably take the minivan right? But if you wanted to go for a drive on the Autobahn or do some autocross racing, how many of you would say “Well, the Ferrari goes too fast and accelerates too quickly, so I’m going to take the minivan.” Not a chance, right? The problem is not the Ferrari’s power and speed, but not enough experience or practice driving that fast and utilizing all the resources at your disposal. Do you remember the very first time you drove a car – when going 55mph on the highway seemed insanely fast? I remember when I first started driving and my parents’ station wagon felt out-of-control until I got the hang of it.

Here’s another example.

Think of the difference between studio recordings and live performance. Studio recordings tend to be clean, controlled, and of a very high technical quality level. Live performances are often technically inferior, but much more exciting, dynamic, and inspiring. You tend to feel a live performance more than a studio recording, right? There is a reason why many prefer live performances, whether it be classical, jazz, or rock concert. When the artist is willing to go for it and not just play it safe, the performances can be inspiring and electric.

How exciting is a football game where every play is either a short pass or run up the middle? There is a reason why fans are thrilled by the Hail Mary pass, the double reverse, the one-handed leaping catch in the corner of the end zone, or going for it on 4th-and-goal. People aren’t moved by safe. Safe is not inspiring. People get excited when they see and hear you push the envelope. Yes, sometimes you will make a mistake and fall on your face, but more often, you will succeed and dazzle, inspire, and move the listener on a more meaningful emotional level.

Why Do Some People Swear by Beta Blockers?

There are several possibilities.

  1. Placebo effect. There is an old rule of thumb, suggesting that about 1/3rd of the people who try any given treatment (assuming they believe it will work) will respond favorably whether it “actually” works or not. So on average, you might expect 1 out of every 3 people who try beta blockers to find that it works for them.
  2. Reduces distractions. For those who have difficulty focusing past the physical effects, beta blockers can be a way of reducing the number of distractions to deal with during performances, which could then indirectly translate into better performances.
  3. Don’t know what else to do. For individuals who are debilitated by their nerves, and for whom anything is better than nothing, beta blockers may feel like a godsend. However, over time, they might begin to feel that they are not reaching their peak. They may definitely be playing better, even at a very high level, but perhaps not to the outer edges of the limits of their ability.

If Beta Blockers Are Not The Answer, What Is?

Performance anxiety is complex. There is no easy quick fix or magic pill that will change how you perform and respond to pressure overnight. However, there are many strategies and skills you can learn and integrate into your practice and performance habits, which when mastered and used in concert with one another, will help you take your performing to a whole new level. Not only will you find yourself performing at a higher level, but you will likely feel differently about performing, to the point that you may even begin looking forward to and welcoming the adrenaline rush.

Find that hard to believe? Well, it’s just like learning a new set of repertoire. Give it some time and practice.

There is no single cure-all, but one helpful skill is a strategy called Centering, developed by sport psychologist Robert Nideffer in the 70’s, adapted by Dr. Don Greene, and used by performing artists, Olympic athletes, business executives, SWAT teams, medical professionals, and individuals in many other high-pressure fields to quiet the mind, increase concentration and focus, and give you increased control over the physical effects of performance anxiety.

It is a specific sequence of psychological elements and physiological skills that, when you get the hang of it, will help you get into “the zone” with increasing regularity. When I got the hang of centering, I found that I could show up for a concert (and once, even an international competition) less prepared than I should have been, but still feel very much in control and play far better than I had any right to play given my level of preparation.

Can everyone learn to play their best under pressure and overcome performance anxiety? I’d like to think so. We just have to find what combination of skills, strategies, and tactics work best for each of us. But one thing’s for certain. Despite all of the controversy, beta blockers aren’t going to disappear anytime soon.

About Noa Kageyama, Ph.D.

Performance psychologist and Juilliard alumnus & faculty member Noa Kageyama teaches musicians how to beat performance anxiety and play their best under pressure through live classes, coachings, and an online home-study course. Based in NYC, he is married to a terrific pianist, has two hilarious kids, and is a wee bit obsessed with technology and all things Apple.

After Countless Hours of Practice, Why Are Performances Still so Hit or Miss?

It’s not a talent issue. And that rush of adrenaline and emotional roller coaster you experience before performances is totally normal too.

Performing at the upper ranges of your ability under pressure is a unique skill – one that requires specific mental skills and a few tweaks in your approach to practicing. Elite athletes have been learning these techniques for decades; if nerves and self-doubt have been recurring obstacles in your performances, I’d like to help you do the same.

Click below to discover the 7 skills that are characteristic of top performers. Learn how you can develop these into strengths of your own. And begin to see tangible improvements in your playing that transfer to the stage.

NOTE: Version 3.0 is coming soon! A whole new format, completely redone from the ground up, with new research-based strategies on practice and performance preparation, 25 step-by-step practice challenges, unlockable bonus content, and more. There will be a price increase when version 3.0 arrives, but if you enroll in the “Lifetime” edition before then, you’ll get all the latest updates for free.