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You are good for a laugh.

I think it's worth getting things into perspective.

There is one drug/poison that most people use on a regular basis - alcohol. Not only are its side-effects almost instantaneous, it also causes damage to several organs (including the brain) when used for too long at a quantity that cannot be dealt with by the main detoxifying organ in the body, the liver. The ability of the individual to cope with it depends on his genetic make-up. (Note the word 'detoxify' - alcohol really is poisonous, and it crosses the blood-brain barrier easily). And many people predisposed to anxiety use alcohol to 'cope' with their symptoms, which actually only makes it worse. (Many alcoholics suffer from Chronic Anxiety Disorder - CAD).

Compared to which, propranolol and other beta blockers have been taken life long on prescription by zillions of people, with no adverse effects like liver cirrhosis, various cancers, early dementia (all known effects of alcohol) and so on.

Personally, I don't drink alcohol, because I dislike its effects on my cognition, on my brain, my ability to think straight, my ability to perform tasks properly. I wouldn't touch any mind-altering drugs like cannabis either. I've never taken beta blockers, because I don't have to give public performances, but if I have to and they suffer because of my nerves, I'd take propranolol without a second thought. And if it works, I'd take it again for my next performance. I take it in the knowledge that many, many people are on beta-blockers for life for cardiovascular problems or to prevent recurrent migraines, in daily doses far exceeding the one dose I need to enable me to stay focused for the particular performance.

Those who believe that no matter how bad one's predisposition to nerves are, it can always be cured or solved by non-drug therapy (CBT/hypnotism/whatever) or meditative techniques obviously haven't spent much time with highly-strung, intensely nervous, perfectionist people with CAD tendencies.

Most people take antibiotics every time they get any infection, including even if it's not required. (Many even take it for coughs and colds, which don't respond to antibiotics.......). Each course lasts 5-7 days (three days for uncomplicated UTIs, two weeks for some infections, six to twelve months for TB) at full dose (two to four times a day, occasionally one/day for one or two antibiotics) and side-effects like thrush, nausea and diarrhoea are common. Someone who takes three courses of antibiotics a year will be swallowing around 60 pills a year. Someone who has to cope with giving 60 performances a year will be swallowing.....60 propranolol tablets a year. Someone taking propranolol for heart problems (or migraine prophylaxis etc) will be swallowing 1095 tablets a year, each dose likely much bigger than the one used for coping with performance anxiety.

The point of the discussion, is it not, is to contribute to solutions for the OP. So let's try and do that. Argumentative statements to the effect of someone obviously doesn't have experience with ..... (fill in the blanks) presume much more than they contribute. Most of us are posting anonomously for whatever the reason. Let's be kind and give the benefit of the doubt. In particular, lets avoid arguing over what someone obviously does or doesn't have experience with. There's simply no way to know.

+1 to mindfulness
+1 to alternatives

Well, certainly, solving an issue without the use of drugs is better than using them. However, I think the OP is in the kind of a bind where temporarily using beta-blockers might be useful to get past the immediate issue.

I have gone through a lot of this sort of stuff, and, in fact, it was a major reason I abandoned the idea of a career in music, decades ago. To me, it's an exceptionally complex issue, and because of that, it is really hard to discuss the specifics that pertain to an individual in a forum like this.

But generally, yes, I think that mindfulness work and meditation can make a big difference for us folks who have problems of this sort. I also think that some people dabble in this kind of thing, and when it doesn't produce dramatic results in a week or so, give up on it (and then they go on to say it is useless). It takes real work, not just dabbling. But I don't think the OP is in a position to be learning how to do that kind of stuff right now.

I only wrote that long post when several people started saying things along the lines of 'avoid medication at all costs' (seemingly), no matter how crucial it is that the problem needed to be resolved by the OP in terms of his future; and he's already told us of his many failed attempts to get it under control by non-medication methods. In my line of work, I've seen how holding all sorts of dogmatic viewpoints can lead to disaster - in the high mountains, in situations where it's no longer just 'mind over matter', people fighting a losing battle against their genetic make-up and unwilling/unable to concede that only medical intervention will help etc.

I know of some people who are perfectly calm and self-confident in everyday life, yet go to pieces when required to 'perform' (speak or sing or play an instrument) in public. They've gone down every route imaginable from self-help to counselling/CBT to meditation to 'online self-CBT' (yes, there are good websites for this) without success, but saved their careers and rose to the top with judicious use of beta-blockers when they require them for certain occasions. There is a letter in Clavier Companion (Jan-Feb 2013 issue) written by a person whose career as a church organist was saved thus, despite the fact that she regarded propranolol as akin to a 'performance-enhancing drug'.

In the end, it's up to the individual, and I'd never force anyone to do anything he or she doesn't want to (unless it was a matter of life or death), but I believe that at the very least, the OP should be given the facts without being made to feel that he'd be a 'failure' if he decided to avail himself of medical help to save his future.

Personally, I agree. I appreciate all the suggestions and am glad that these are things you've all had success with. However, I think every person responds to stress differently, and while I've never met someone who said they didn't ever get nervous, this sort of debilitating anxiety is simply not something that everyone experiences. I started realizing this when I complimented a fellow student who is a wonderful performer for always sounding very confident on stage. To my great surprise, she responded that no, she was actually not confident, in fact very not confident! I thought, how can this be? She had no major mistakes, no blankouts, no restarts, no hesitation, no wild tempo fluctuations—all things I would personally associate with anxiety and doubt based on my own personal experience. Then I realized that all those things were just that, defining my own experience based on how my mind and body have reacted in the past. Clearly her personal definition of stress is different and tied to her own experiences with how her mind and body react under pressure. Thus how we could both claim to be not confident, yet have that manifested in such radically different ways. And so, since the way it is manifested between us is completely different, it then logically follows that what might work for her to deal with her lack of confidence might not apply to mine.

Personally, I do not generally seem to respond well to mind-over-matter techniques and have a fair bit of experience with some of these alternative-medicine practices as I had a friend who went off the deep end with it. He also became very pushy about wanting to "heal" me every time I saw him, and partially because I was trying to have an open mind and partially because I'm too polite to say no or walk out, I went through many, many of these "sessions" with him. Gradually it turned into the only thing we would do when we would get together. His claims about these alternative practices grew more and more fantastical—he began talking about how he could heal open wounds by just thinking about it and cure chronic back problems by just placing his hand on someone's back and "willing" the bones back into place. Finally, one time after sitting silent and motionless on a table in my birthday suit with my feet in a bucket of salt water as he waved his hands in the air around my body "manipulating my energy field" for three hours straight, I decided enough was enough. Unfortunately when I told him this wasn't for me, but I still wanted to be friends, he got angry and stopped speaking to me. So anyways, I know that sort of thing isn't what any of you are indicating, but that's just where I'm coming from (and I thought some of you might get a kick out of it). Also, just recalling how pushy and ready to make-or-break a friendship this person was with alternative medicine, I think it is important for both sides to remember to have an open mind and realize it will work for some but not for others.

That being said, just talking about it and directly, openly confronting the issue (something I've tried to hide or struggle with in private) seems to have helped in the slightest. I am playing in a master class tomorrow afternoon so we'll see if it's enough to make a difference. My gut tells me though that apart from the possibility of a medication "quick fix," this is going to be something that requires some serious medical, mental and/or psychological attention over a long period, and this is just the first step.

I do not know how common or how serious the side effects of beta blockers can be, but I'm wary of being overly concerned about the side effects unless they can be severe(in the doses usually prescribed for performance anxiety) and are a problem for some significant percent of those taking them. All medications, even the most common like aspirin or Tylenol, can have side effects but most people of a certain age and beyond are taking some medications on a permanent basis and do not have serious side effects.

I am in the same boat as you, though I do attribute a small part of it to issues with my eyesight, (which has helped curb just a little of the self-denigration, but not had a huge effect on the nerves in general). I was curious if you experience the same problem in your accompanying? Since I only play publicly as an accompanist, I'd say that the times I am able to overcome the nerves to the greatest degree are when I am able to focus the most deeply on what my soloist is doing (and God love 'em, I have to admit the very best is if they happen to falter in any way, as a whole new "gear" of my mind opens up and goes into overdrive in the moment of possible derailment). Have you experienced this? I am wondering if there's some way to translate that mentality to your solo work. Maybe, as odd as it might sound, to even imagine yourself as an observer or mentor to your playing self? Since you know your material extremely thoroughly, maybe you could start an inner dialog with yourself ("OK, you might want to lighten up on the bass here...that melody is getting lost right now....keep steady tempo through this passage" ) not so much in a panic mode of "What do I play next??" as much as just listening to what you are playing and prompting yourself in the same way you might if you were mentoring someone during their lesson? I dunno, maybe that's a completely stupid idea. I do know that the third-person mentality helped me immensely in my counseling practicum, where I was also very nervous. I was able to "hear" the practice client as if I was in the room with my supervisor going over recordings.. "OK, what did that person just say?" and it made it much less stressful than trying to just spurt out some appropriate comment in the moment. ? I hope that even makes sense.


ETA Other accompanists out there, want to weigh in on the experience of assisting a faltering performer? There's something so viscerally "I am no longer here, I am only an instrument to help" (not musical instrument, but object) that completely eclipses my own "How am I doing" nerves. If there was some way to home in on that mindset as a soloist.....

Hello and your teacher or teachers are not supportive of you and that is most of your tension. I feel badly for you. I have been where you are. I never had performance jitters as my first teachers were so supportive of me and treated me as though I was a gift to them. When I played for church years later the minister had studied conducting and was impressed with himself and loved to correct me. I had major performance jitters for the first time ever. The jitters went away after he was out of my life. Your lack of a support system seems at the root of your performance jitters. You will be fine once rid of these teachers who are not good teachers and should find other vocation as you are a gift to them and they should HONOR YOU their gift. Sandra M...

I agree 100%. Teachers who say such things have never experienced performance anxiety and have not really taken the time to find out what it takes to help a student through it.

According to some surveys, over 95% of professional musicians experience some form of performance anxiety. It is a real problem that only the right kind of preparation will help. I am reposting from a similar thread in the Piano Forum below. Feel free to ask more questions and/or PM me. I have experienced performance anxiety first-hand and have been able to overcome it personally and have also helped my students overcome it.

It is a complex issue that takes little steps over a long period of time with lots of performances along the way to build upon.

Preparation is very important. Not only do you have to know your music well, but you have to know *yourself* well. Know the places where you are likely to make mistakes, and create a Plan B (Plan A is to play perfectly). Plan B is what you are going to do if you make a mistake in this spot. Then you practice playing Plan B every time it comes up in your practicing. You still try to play what is written of course, so if you play it perfectly then you don't resort to Plan B.

You will also want to practice starting from different key spots in the piece. I would pick areas where the music changes, after a cadence, things like that and practice starting from those areas at random. Also, practice starting from a spot right after places where you are likely to make a mistake. Sometimes Plan B will be just to skip to the next measure. These things will help you to play without stopping or having to go back to the beginning and start over.

Then there is the part of preparation that involves simulating a performance before the real thing. This should happen after you've gone through the above prep work, but no less than 1 week prior to the performance. Play for everyone and anyone who will hear you. You can also video record yourself (or audio, but video is much better I think) which can simulate a performance as well. Be sure to listen or watch it and try not to be overly critical of yourself, but make comments that are valid changes you'd like to make in your playing.

Lastly, but vastly important, is the inner dialogue. This is what goes on in your head as you perform. See if you can reflect on your past few performances and recall what was going through your mind while you were playing. My guess is that your thoughts were not focused completely on the music and what was coming up next immediately, but rather on the audience, issues you might have with the piano or the position/height of the bench, how your hands are shaking or butterflies in the stomach or other symptoms of anxiety, that mistake you made 2 measures ago and how upset you are that you made it - basically everything BUT what you should be thinking about.

Music is about communicating feeling/emotions through sound. If you are not focused on the music and what you want it to sound like in the moment (NOT the past, which you can't change by thinking about it) then you are no longer communicating with the audience, you are communicating with YOURSELF. This is what is called "inner dialogue", and it is what destroys even the most prepared performers.

During your practice performances, you are to try and shut this inner dialogue off. It will still come in, but as soon as you notice it, refocus your mind back to what's coming up next in the music. Perhaps your first time you'll be able to stay focused 10 or 20% of the time. Then the next time it will be a little bit better. It's very hard to ever get to 100%, so don't get wrapped up in perfectionism. Just do the best that you can with the time you have before each performance. After the performance, assess your progress. If you had one moment where you noticed your mind wandered and you were able to reign it back in, then that is a successful performance and you can build upon that for your next concert.

Remember, live performance is about the risk, and that is what makes it exciting for the audience. It's not about perfect at all. It's about communicating feeling, and you can certainly do that with wrong notes.

Thank you for your wonderful post as you are a teacher and understand with kindness. We have so many wonderful teachers who are are a credit to the teaching profession. Sandra M

excellent thread, and something i'm sure most of us (e.g. myself included) struggle with.

in those rare moments of transcendence when performing in front of others it feels as tho i'm a member of the audience, listening to the music, self-consciousness is gone. but how to achieve that state with regularity? i don't know.

as others have said, being mindful of the inner dialogue can help focus it (e.g. by counting, to train monkey mind on a single task). then there's the additional stimuli of having others' attention focused on you. emotions kick in and involuntary hand shaking starts to occur, further bifurcating attention away from the music itself. then it becomes a question of survival.

i'm not sure trying to conquer our fears is the right approach. in eastern philosophy surrender is a far more important concept; that overcoming is achieved thru a complete acceptance of the situation. lots of meditations cultivate this state of awareness.

lastly, re: beta blockers -- unless one is a christian scientist and avoids any and all medication, i don't know why one would not entertain its use to potentially build positive experiences. you wouldn't be alone, as evidenced by the following article...

http://www.nytimes.com/2004/10/17/arts/music/17tind.html?pagewanted=1&_r=0

Good article in the NYT.

As the article stated, propranolol is NOT a performance-enhancing drug in the way anabolic steroids and erythropoietin (EPO) etc are; it just puts performers on a level playing field with those who don't suffer badly from nerves. It just stops you messing up your own performance with involutary shaking etc, something you wouldn't do at any other time when playing, except in front of the audience.

People who don't suffer badly from performance nerves don't know what it's like when your fingers/hands/arms/feet start shaking violently and uncontrollably, your head starts swimming, and there's no way of getting yourself out of the deep hole. Whereas most other people just get an adrenaline rush to the head, which makes their performances more exciting, more hair-raising, a few more slips of finger maybe - but not total loss of control, not the feeling you're falling into an abyss with no way of avoiding it.

I've performed in public (for charity etc) several times, but entirely voluntarily, and for me, it's like a visceral thrill when I feel the adrenaline surging through me, almost a masochistic enjoyment of 'the chase'; I often play faster in the fast music, and slower in the slow ones, daring myself to more extremes of expression than I'd ever play if no one was listening. But I'm not playing for critics, or for a jury, and my future prospects certainly don't depend on how well I play. And my audiences are not knowledgeable musicians, so finger slips are rarely noticed, therefore I'm not bothered by them either. For me, taking a beta-blocker would be counter-productive, because I'd lose some of the (in some ways, perverse) enjoyment of 'walking on a tightrope'. I get a similar sort of thrill out of doing it as I do when sky-diving, or mountain climbing in adverse conditions. (Why take a beta-blocker if you want to jump out of a plane for fun?)

It's an entirely different matter if your future is at stake, you're under total scrutiny from teachers and being judged on the way you play at that time, and you have no choice.

When I was younger and doing piano exams, my playing often suffered through nerves. (To this day, I still remember making three false starts in a Haydn Sonata in my Grade 8 exam. Fortunately, the examiner was sympathetic...). If I was to do them again now, there's no question I'd take propranolol. But beta-blockers weren't a known option at the time.

As I'm not someone who is prone to anxiety (in fact, quite the contrary) in normal everyday life, I see no earthly reason to put myself through 'therapy' of any sort.

I used to suffer stress and anxiety over performing when I was a student. Always thought there must be something wrong with me because I never really gave any terrible performances so couldn't blame it on any particular experience. Even so no matter how many times I put myself up there it never got better. I would also get really annoyed at how other students would thrive on it and could never see what all the fuss was about. About ten years after I left university I went back to study for my postgrad in an attempt to get over it but I felt exactly the same every single time.

Although it was awful at the time I'm fine with it now. In fact I'm glad that I didn't try to make a career as a soloist as I think it's a pretty hard life. I feel that the whole experience has helped me as a teacher because I understand what many of my students go through with the same issue. And I still get to enjoy playing and performing every week. Only now I accompany choirs and other soloists,
Ay in ensembles and regularly provide background music for weddings and functions which is so much less stressful and frankly more lucrative.

What I'm saying is that it's okay to feel the way you do about this. There might not be any need to fix it. Sometimes it's just the way it is. Finish your course, I'm sure you will play just fine and pass with flying colours despite the anxiety. Then take some time to think about what you really want out of life and accept who you are.

Absolutely. Myself and another student of my teacher played in the master class yesterday. A friend of mine who knew I was having problems came and sat in the audience—little did I know she was actually observing my teacher the whole time. I initially thought performance itself went alright. I tried to be as calm and focused as I could, practiced breathing and visualizing playing the piece beforehand...but when I began the performance, I still had a racing pulse pounding in my ears, panicked thoughts and inevitably, one moment where I totally lost my resolve and had to skip a measure. That being said, it actually was not a complete disaster, and I thought it went better than the last time I performed it. When I talked to my friend afterwards though, she was upset. She said that while the other student was playing, my teacher was paying attention and noticeably engaged with the performance going on. But while I was playing, he seemed to not be paying attention or interested at all, and did not even look at me the entire time—the only time he seemed aware of what was going on was when there was an error or a sloppy note, and an eyebrow would raise. I was horrified. It was as if he was so ashamed of me in particular that he could not even bear to watch and be engaged in my performance.

I don't think it was very helpful of her to tell you that.

I still get really nervous accompanying, sometimes more so because there's the possibility that I could actually screw the soloist up, and ruin their moment in the spotlight. That being said, it very rarely happens that way around, and often I do have to think on my feet to compensate for a missed entrance or early entrance. There definitely is something about that moment where your mind goes into hyperdrive in a beneficial sense.

Just to suggest another interpretation--is it possible he did not look at you because he knows of your problem with nerves and thought it might be more helpful to you if he didn't?

I assume you mean that I were to make eye contact or see his face in the middle of the performance it might distract me or make me feel more pressured? I'm not sure I agree in any case, but due to the unusual setup for the masterclass, the audience was behind me, and I so could not see my teacher or anyone else while seated at the piano.

I'd like to also chime in - in favour of propranolol. I prescribe a beta blocker almost on a daily basis , and it's a very safe drug when prescribed properly.

I've prescribed it for people with panic disorders before and it seems to help break the cycle of the physical symptoms of anxiety amplifying the actual feeling of anxiety. Anxiety is a self perpetuating thing - the more you have issues with performance, that will continue to negatively feed into subsequent performances.
Propranolol at the doses taken for performance anxiety (10-20 mg occasionally for performance) is way less than a regular dose of 80-160 mg twice a day, so side effect profile is minimal.

Also, as people have said here, this medication just prevents the physical symptom of anxiety, (palpitation, tremors, etc), the skill and technique is all you, so there is nothing unethical about it.

While I do agree with others here that counselling and relaxation techniques, are important (things like CBT, very important depending on exactly what the indication is), but pharmacotherapy has it's role as long as it's prescribed safely by a physician. In conjunction with counselling, but it may help you get out of your head enough that you can gain perspective to get over that hump.