3 Reasons Why Beta Blockers Could Ultimately Hold You Back

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.

Ack! 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 perhaps a few other tweaks in your approach to practicing too. 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 learn more about Beyond Practicing – a home-study course where you’ll explore the 6 skills that are characteristic of top performers. And 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.


42 Responses

  1. I was fortunate to have a wise and sympathetic doctor when I was 19 and recovering from almost a complete breakdown in my ability to play. He prescribed beta-blockers in very small numbers and encouraged me to see them as a tool to help me break a cycle of self-fulfilling catastrophising. I can remember him saying, ‘These won’t help you if you come to depend on them, so I am not going to let you have enough for that to happen.’

    The drugs, as you say, only dealt with the physical symptoms, but the structured approach he had me take to using them was also significant in giving me a sense of control over the process of recovery. And it is much easier to generate some less destructive self-talk when you have a couple of performances under your belt in which you’ve not disgraced yourself.

    So, not a solution in itself, but they can have a use as part of a wider approach. Mind you, the thing that shocks me in retrospect is the state I’d got myself into without any of my teachers intervening. I’m so glad performance psychology has developed so much since then!

    1. Thanks for sharing, Liz! This is a nice way of illustrating how beta blockers could be used as a way to help people get their feet back under them a bit. Very helpful story, thanks again!

  2. A quibble here, and this is something that’s always bothered me about this argument. I get why musicians don’t want to use something external as a crutch to avoid dealing with a mental or psychological issue but … there are millions of people who have no choice but to use these things every day of our lives. Millions of people in this country have heart disease, and listening to the fearmongering that beta blockers will destroy your mind, turn you into a sedated blob, and make you into the world’s crappiest musician is very, very problematic for those of us who must take them, and in doses greater than any classical musician would ever take. I’m a classically trained pianist who plays all her own music. I also have Marfan Syndrome, inherited from my father who died of it. My mom has very high blood pressure. What that means is that every single member of my family is on beta blockers. We rolled genetic snake-eyes. Most orchestra violinists nibble on the edge of a pill — I take 100mg a DAY of this stuff. And I must do it or risk sudden cardiac death or the blowing out of my aorta. My dad died of that, my oldest brother has more plastic in his heart than he has in his wallet, and my mom and older brother have blood pressure that could stun a horse.

    And I feel that I have to keep all this a very close secret simply because it will give everyone an excuse to blow off my music, my work, my emotions, everything I’ve ever put into my piano, all because the prevailing opinion is that, as one of millions of Americans who have inherited heart disease, I am incapable of “succeeding and dazzling, inspiring, and moving the listener on a more meaningful emotional level.”

    The sad part is I can tell you right now beta blockers don’t really help anyway. It’s a placebo. It has never once helped me magically somersault over my own red-light syndrome or stage fear — not once. I know that people don’t want to get dependent on drugs to solve problems that have other solutions, but heart disease HAS no other solution but these drugs, and it really bothers me that the implication is that anyone with any medical need for them is automatically damaged goods and has no business making music because you’ve all convinced yourselves that metaprolol turns me into an unmusical jelly-brained zombie who has nothing of emotional value to say to anyone and is incapable of “moving” anyone. *argh*

    These are some of the most lifesaving and widely prescribed drugs ON THE PLANET. Please be aware of that so that you avoid concluding that those of us who need them to live are inherently crappy musicians and will never be any good, solely because some other people have decided to use OUR lifesaving medicine as a crutch for them to avoid dealing with their own issues in a more productive way.

    1. Hi Janis,

      Thanks for the perspective – a significant number of musicians do indeed take beta blockers for existing health concerns. And yes, it’s fortunate that this doesn’t turn them into lifeless zombies on stage.

    2. Good read, although it seems there may be more than two sides here, not just for or against.

      I especially liked the car reference..

      Thinking of performance in a car, could we not use the beta blockers like a tool to dial in our performance.

      If a person was to use the blockers to get over performance problems then slowly dial back the dose?

      I think then it becomes a question of how addictive are they? Because if the answer is they’re not then there is no reason to be against them.

  3. As a recently retired Emergency Physician and SWAT officer, performance anxiety really is a life & death issue. One alternative to beta blockers is over-the-counter ImmodiumAD. The effects vary considerably from person to person with somnolence as a potential side-effect, however it often is enough to blunt the fight or flight response that interferes with the focal concentration required to execute complex and delicate tasks. And for me, constipation just before a performance is NEVER an issue!

  4. I am a 60-year old trumpet player/singer who has severe anxiety in certain playing situations. The physical symptoms (pounding heart, shaking hands, sweating) at times caused my sound to shake and break up. One time it was so bad one time I returned the money I had been paid because I played so poorly. Then I developed atrial fibrillation and went on a very high dose of Sotalol (betapace), which is a very strong beta blocker. The next time I performed in church, I was mentally nervous, but no pounding, shaking or sweating and I gave one of the best performances of my life. I had NO IDEA why my body stayed so calm. After a couple such performances, I realized that it must be the Sotalol. I eventually had an ablation procedure that eliminated my afib and I went off the Sotalol. Now the “shakes” have returned. The relief I got from Sotalol was NOT a placebo effect because I had no expectation that it would help. The benefits were very real. It didn’t improve my playing at home. But it allowed me to be my normal self in high pressure situations. I plan to talk to my doc about Inderal or something like it.

  5. Echoing what Janis has to say: yes, these drugs, like ALL drugs, have their medical place. The choice to use a beta blocker for performance anxiety needs to be weighed very carefully, just as the choice to use any medication needs to be carefully considered. As someone with metastatic breast cancer, I can tell you that I am often offered many different, often addictive substances for dealing with pain. When I really need the drugs for pain, I do not get addicted to them; they are a temporary fix. If I were to have heart disease, of course I would use a beta blocker for its life-saving qualities. I do not believe that if I were to use a beta blocker for its original purpose, I would suffer some of the other side effects of feeling disconnected from my performance, but I might. The preventive nature of the beta blocker outweighs the risks of not taking the drug.

    Having said that, however, it brings to mind the time I did use a beta blocker to keep my nerves at bay for an audition. I simply did not play as well. I did indeed feel disconnected from the performance. I also remember going to a quartet performance where one of the violinists sounded better than she ever had. I went backstage to congratulate her after the performance to find her in tears. “I forgot to take my Inderol and I played so badly!” she was apologizing to her colleagues. The other members of her quartet kept saying, “What are you talking about?” When I later spoke with one of her colleagues, he said that he had no idea she felt so dependent on Inderol. I suggested that she listen to the recording. She had never been so present for a performance in my memory. Her intonation was beautiful, she was more engaged with her colleagues; it was her perception that had her freaked out.

    I still have friends who pop Inderol like it’s candy, convinced that if they don’t have it, they’re going to bomb their performances and never get hired again. It’s this frame of mind that scares me. I’ve found that the best way to get around stage fright is to feel over-prepared for everything. Sometimes that’s not easy, especially when you’re playing an orchestra gig with tough repertoire that you only get a couple of days to learn, but then the trick is to just do your best and learn to forgive. When we embrace the process rather than the outcome of perfection, life – and music – generally becomes more rewarding, I’ve found.

    1. Yes I totally agree with you about embracing the process, rather than trying to be perfect. Well said!

  6. Thanks for the positive approach to performance anxiety. As a violinist aspiring to be professional, I like to think that a bit of adrenalin is necessary to give the performance a bit of extra something special. I agree that beta blockers are absolutely essential for people undergoing extreme cases of stage fright, however I sincerely believe that people should try to use it only as a crutch, to help them get back on their feet. I personally think it may be damaging to become addicted to them.
    I’m currently doing my research project on Improvisation and Performance Anxiety, and I’m exploring the question of whether a type of “Improvisation Therapy” could be used as an antidote to Performance Anxiety. Such a debilitating condition seems extremely unfair for those who suffer from it, yet love playing music. I think that improvisation, as well as therapies like Alexander Technique and meditation could be helpful for musicians to regain a sense of enjoyment in their music-making.

    As classical musicians, I feel we are inherently blocked, as we are constantly reproducing notes which someone else has written. We do not express ourselves intimately in the same way that jazz musicians do. This puts immense pressure on being “Perfect”, and I believe that perfectionism is a dangerous factor which contributes to Performance Anxiety. We are constantly analyzing, criticizing and second-guessing ourselves. And the reality, we can never achieve the perfection we foster in our minds. My case for improvisation holds the view that it can help us regain our lost sense of creativity. A TED talk given by Ken Robinson was based on the topic that the Educational System Kills Creativity. I am of the opinion that the Music Education System does the same thing. Now, here’s a question. Are classical musicians involved in the creative process? I’m not so sure, as we are constantly trying to perfect what is on the page, where is the room for creativity? Through conversations with jazz musicians I have come to the realization that in jazz, players are encouraged to “find their own voice”. In classical, we are encouraged to sound like the Heifetzs’ or Menuhins’. There may be some sort of creative license in the way we express the dynamics or phrasing, but it is with very strict boundaries. Baroque music is an exception, as it was intrinsically bound up with improvisation. Stories I hear of orchestral musicians being jaded, because they have no musical autonomy, seem to be resultant of the disregard for creativity in the orchestral workplace. There is definitely something inherently wrong with the situation of a musician who’s own mind destroys their own art, which they have been arduously, and painstakingly studying over for years. I advocate for a re-introduction of improvisation back into schools and especially into the Conservatorium. We know that in the 17th and 18th century, improvisation was an intrinsic part of what made up a musician. Composers were performers, and performers composed. Famous improvisors like Mozart, Paganini, Bach are examples of the stark contrast between the values then and now.
    I propose that with the rediscovery of improvisation in classical music, we would reclaim our buried creativity, and develop our own individual voices and confidence in ourselves as valid musicians. Performance might become less of a thing which belongs to the elite, and more of a celebration of our humanity and its power to create and explore. What do you think?

  7. I completely disagree with this article.
    I am a Horn player, and have experienced solo recitals without beta-blockers, and with them.
    I agree that the mental and emotional aspects of performance are important to address, but beta-blockers can only help, not hinder the development of those processes as well.
    The general consensus among research has been that beta-blockers have improved(both qualitatively, and by more concrete standards) musical performance.
    Lastly, it is just as easy to play with energy and passion when your body is calm and under control. Conversely, musicians body with an uncontrolled sympathetic nervous response is like a Ferrari that takes a turn too fast and ends up in a ditch on the side of the autobahn. Not too great for your mental and emotional development is it. People end up totaling their ferrari in the process of trying to fix their problem holistically.
    My advice is to try beta-blockers and see if they help.

  8. “Well, the Ferrari goes too fast and accelerates too quickly, so I’m going to take the minivan.” Are you kidding? Not a chance, right? The problem is not the Ferrari’s power and speed, but your inexperience driving that fast and aggressively”

    Stupidest thing I’ve ever read

  9. I got addicted to beta blockers at music college. Eventually I was unable to perform without them. They did work but I was in a very small minority where they caused an adverse effect of severe depression. 3 days after I took one, I’d end up in bed for a week, unable to move. It took me a while to make the connection. By the end of college I ended up having a breakdown and have never touched them since. That was 15 years ago, I left music and never conquered my stage fright:(
    One day I will…

  10. its one thing for someone to write a blog post about a certain disorder, but its plain as day when it comes from someone who has no experience with the symptoms
    yes, there are underlying symptoms to social phobias
    but unless u experience physical manifestations totally beyond ur control when u simply need to stand up and give a speech, ur advice simply doesn’t hold its own weight
    im a confident person in every situation except public speaking
    when i have to speak in front of a crowd larger than 20, i lock up……..i cant help it
    yes, i can go see a shrink etc…….but ive started taking inderal for the physical symptoms and i feel “normal”
    i only take the drug every now and then, so its hardly a health concern…… it simply helps////so
    before writing a blog post simply to write a blog post and boost readership, check in a little with the people u are writing about so ur more informed in a real world sense

  11. I am angered by this blog post.

    This blogpost is at best irresponsible and at worst a cynical gambit for more business.

    Dr. Kageyama is a performance psychologist who “teaches musicians how to play their best under pressure through live classes, coachings, and an online course.” Therefore beta blockers are a direct threat to his business.

    With such a dramatic conflict of interest, a post about how beta blockers might be “holding you back” has zero credibility.

    Beta blockers have changed my life.

    For years I practiced and prepared diligently but I could only ever achieve about 30 percent of my actual ability during live performances. For me, performance anxiety caused clammy hands, terrible loss of muscle memory, and emotional distress. As a result I was deeply confused, depressed and anxious about the thing I loved more than anything, sharing music with people. Each compromised performance contributed to a growing experiential memory bank of tension and fear which affected every subsequent performance. A feedback loop of stage fright. This went on for years and I almost quit numerous times.

    My first time on beta blockers I saw zero improvement (and obviously no placebo effect!). But overtime, with the help of my physician, I perfected the dose and the timing (for me, 10mg of propranolol 90 mins before performance). I can not possibly overstate what this has done for me. I now play with confidence, joy and absolute clarity. My hours of practice are manifest in my performances. I am literally getting teary typing this because of the happiness this has brought me. Live music is fun again!

    But that’s not all.

    The most profound change has has been the resulting improvement of my overall mental health, confidence, and self esteem. This confidence has carried me through numerous instances when I had to perform without taking the beta blockers for any number of reasons. I still have heightened anxiety, but the beta blockers have helped me build new positive memories associated with performing which I can draw on to find my comfort zone. The feedback loop of stage fright has been stopped. As the new positive memories and experiences accrue, I expect to be able to ween myself off of the beta blockers eventually.

    Beta blockers are not a panacea. They are not for everyone. They can have side effects. But they can be a truly amazing help for some people. I am one of those people. And I thank god I wasn’t exposed to Dr. Kageyama’s poorly reasoned, even more poorly researched, and sadly biased blogpost before learning the truth on my own.

    Additional psychological homework such as centering, meditation and relaxation techniques are EXCELLENT and can only help. But if they don’t get you far enough, I encourage you to try beta blockers UNDER A DOCTOR’S SUPERVISION.

    If Dr. Kageyama were truly interested in helping anyone other than himself, then he would too.

    1. The older I get, the more I find myself agreeing with the usefulness of beta blockers for the segment of society — small, but present — that just physiologically reacts to adrenaline differently for some reason. I don’t know why, and I don’t think anyone does yet, but people like you are out there, and listening to them has made at least my own opinion on the use of beta blockers evolve over time. I ran into an article written by a virtuoso pedal harpist who talked about his experience, and how when he settled his BB dose, he realized that it was the first time in his life that anyone had heard how he could really play, and that he began to look forward to going on stage and sharing music with the audience. Isn’t that what we’re supposed to want to do? I found that incredibly touching, and it made me realize the senseless illogic behind the belief that one has to suffer to perform well and “connect” with an audience.

      I don’t want to pay to listen to someone who is fearful, and if their bodies react that way to their adrenaline, and they’ve tried everything in the universe to deal with it, then who the hell am I to demand that they suffer through misery and terror? How musical can one be when one is busy trying not to pass out?

      Sure, some people don’t react that way. Who cares? That’s them, good for them. I’d rather hear someone who feels comfortable and relaxed on stage. For people whose bodies and chemistry react more constructively to stress, to expect that other people who aren’t as fortunate can just turn themselves into that by working hard is like me telling someone who is short that they can make themselves tall if they just worked at it more. And frankly, that physical and mental type is fairly rare, and I want to hear from a larger slice of society when it comes to music. If you want to watch winners and losers, and people who “have what it takes” and people who don’t, then watch goddamned sports. Music is different.

      I don’t think Noa is making a cold financial calculation, though. I think (if I can be presumptuous here) he teaches teenagers who might be really prone to looking for quick solutions and as a result feels that the “drugs will not fix the problem” stance is needed. With teens, it may be. But anyhow … I just wanted to reply that listening to people like yourself has caused at least one person’s opinion to shift and grow softer on the use of BB.

  12. I’ve been debating between whether to take beta-blocker for my upcoming performance or not. I’ve personally been prescribed BB for my palpitations. I’ve been told, however, that I might risk being “dumbed down” during the actual performance, meaning, if I do encounter slips, I might not be sharp enough to recover from it.
    My thoughts after reading this article and certain comments are: I personally agree that being able to play well without unnecessarily relying on drugs (I’m not referring to those whose health depend on the drug) would be the best solution, and something we should try and aim at. We musicians are lucky not to be banned from certain drug-use during performance (think Olympics where beta blockers are banned).
    However, a question comes to mind. I’ve read many of Dr. Kageyama’s posts saying that sometimes our emotions are being controlled by our physical sensations (i.e. the study where subjects found a sit com funnier with a pen held between their lips versus those who don’t). If our bodies, after taking BB, are calmer, won’t that help us boost our confidence, and won’t that in a way improve our playing?
    Is it possible for us to work on our anxiety with the help of drugs, and when the anxiety level has gone down, slowly decrease our dosage/independence on it?

    1. Hi Tweet,

      For some, taking the tremors, heart rate, etc. off the table does indeed help facilitate more mental calm and focus and helps them perform better. But others continue worrying, and experience a great deal of cognitive anxiety regardless, and don’t seem to benefit quite so much. I’ve had a number of students or clients who were already using beta blockers when we met, and many did find it easier to continue using them to some degree while working on and incorporating new mental skills and approaches into their performances and preparation, and gradually weaning themselves off over time. Then there were some who continued to utilize beta blockers even after our work was finished too, and weren’t necessarily looking to reduce their use in the short term at least. Ultimately, I think it’s often a personal decision about timing, and when feels right to start making changes.

  13. I realize the focus of this article is about Beta Blockers on a normal, healthy person, but as you can see above some of us have heart rhythm issues. I truly wish the experts who wrote on performance anxiety and strategies would address issues for people with certain health concerns that affect performance.

    I have a tachycardia and ventricular premature complex.–I suspect I was born with it (my son and my mother have similar issues). My heart likes to race and I get extra heartbeats. It’s worse with lack of sleep, stimulants (I avoid caffeine and decongestants), stress, or exposure to allergens. The last one is the kicker. Certain perfumes/colognes cause me absolute terror–racing heart, sensations of the room spinning or the floor dropping out from under me, nausea, trouble breathing, and once in a long while, shaking. During a performance when this is happening I cannot just walk off stage and abandon the concert. I have to guess which performances I’m going to have a reaction and which ones I’m going to be lucky. If I take a beta blocker and it turns out I didn’t need it, my eyelids feel heavy. But if I take it and it turns out I needed it, I feel normal.

    It is not fair to have me be subjected to the reaction to perfumes/colognes and I try to ask people around me not to wear them, but it still happens. I cannot play my best in such a circumstance. I’ve played unaccompanied cello in a packed church of about 1200 and not had a problem and then sat in the back of a cello section (no solos) where I had the terrifying symptoms I mentioned above.

    This has been a long road. The first symptoms I was aware of were in my middle school or high school years. Freshman year of college a nurse gave me allergy medicine that sent my heart rate to 221. Afterward, I went to see a doctor who listened to my heart and said “Hmm. I thought I heard something funny. Oh, never mind.” It took 17 years after that before a doctor was listening to my heart and finally told me what was going on. I was put on Paxil, which took me from underweight to gaining 30-40 pounds nearly overnight and then later switched to Lexapro when it became available. I eventually quit taking those, not wanting to take something all the time, was was put on a beta-blocker that I only take when I need it. A proper diagnosis far earlier in my life would have been extremely helpful for my career, quality of life, and financial circumstances.

    Emotions certainly are affected by the physical. When I have an attack of racing heart, I’m often very tired and sometimes depressed. I feel like I’ve been assaulted. I really don’t need that. I perform every weekend. Without the perfume/cologne and heart issues, I wouldn’t need the beta-blocker. I’m done with guilt trips. With my own string quartet, I don’t take the beta-blocker because my colleagues know better, but playing elsewhere I can’t always trust people around me. There is the musician I sat next to who when I asked her to please wash off her perfume, said defensively “I only put it on this morning” and “If I don’t wear a perfume someone else will.” Because of people like that I am forced to take a beta-blocker.

    1. Thank you for sharing your story, Gary. It’s a vivid reminder that there are rarely, if ever, any one-size-fits-all solutions when it comes to complex, multifaceted issues like this.

  14. The placebo effect can work both ways. Those who feel they gave an ’empty’ performance may have been expecting to feel numb, and then made themselves feel numb.
    It’s not fair to call it a possible placebo effect when it works well, but not address that it may be a placebo effect when someone claims not to have felt the excitement of a performance.

    I often hear about how the nervous energy needs to be channeled into something positive, to do breathing exercises, positive visualization, and a whole bunch of other suggestions. Those who say this just don’t know how severe the physical effects can be. It’s not even a matter of being nervous; it’s the same kind of shaking that occurs when very excited.
    I can’t even hold a newspaper or magazine in the air for someone else to read without shaking. That’s how I’m wired, so any shaking in addition to that and I can’t play at all.

    I can’t really comment on mental or emotional nerves, but I do have extensive experience with physical nerves. And beta blockers and alcohol have both worked for me, but I usually just used a 10 mg pill.
    When I was young, I had a serious problem. I used drugs to get through those tough situations that mattered the most to me. And I’m very glad I did.
    (PS: I rarely use them now, but that’s because I don’t care as much how things go (which helps) and I play publicly so often that it’s almost routine to me now)

  15. The stuff in this article is probably true for many musicians, but I’ve always needed the beta blockers to perform. A few years ago I tried performing a concerto without them and I blanked out for almost an entire page before picking up again because I was so nervous. Also at an audition I took too low of a dosage on accident and I gave the worst performance of my prelude I had ever given. The results didn’t turn out well, but I’m over it now. I now feel that for me it would be unwise to come off them. Great article though!

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