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  • Writer's pictureRebecca Karu

Final Facts of Beta Blocker Use & The Mental Factors that Contribute to Performance Anxiety

I would like to start by wrapping up last week’s discussion about beta blockers. I think that Beta Blockers are a great resource for musicians and if you fit the bill to take them, then you should. Who fits the bill? A small group of people. Those people who have already tried other methods such as meditation, breath work, Alexander Technique, methods in sports psychology books. People who have tried these other methods and have not had any success with controlling their physical symptoms are perfect candidates for beta blocker use. The physical symptoms they may experience include uncontrollable shaking, nausea, and a racing heartbeat. To reiterate, beta blockers do NOT help any part of the mental side of performance anxiety. If you struggle with negative thoughts or feelings that you need to be perfect or that you’ll be a disappointment if you’re not perfect, then beta blockers are not for you. Those thoughts and feelings need to be dealt with either on a professional level or with a mindfulness technique and a medication such as beta blockers will have zero effect on those thoughts and feelings.

This tends to be a sensitive subject for many people and there is an even divide for those who agree and those who disagree with beta blocker use among performers. I will say that before people side either way, they need to look at the facts, and not just go by word of mouth. If you are still unsure, it is always best to consult a medical expert who treats performers. There are many journals, studies, and books available on this subject. Another suggestion would be to reserve judgement and not choose “pick a side”. The best way to look at this is with an open mind. Medication use may not be what you want or what you need, but it might be incredibly beneficial for someone else. Let it be. Let the people who benefit from them benefit from them. There’s no “leg up”, or performance enhancement factor that plays into the use of beta blockers, it just allows someone to help calm their nervous system so they can perform how they’ve prepared. Beta blockers do not make you play any better or worse, they simply allow you to showcase the work you’ve prepared.

The psychological aspects of performing I think are the most difficult to deal with. These can stem from any of you life’s experiences. They can be caused by pressure from teachers or parents, a perfectionist personality trait, lack of confidence, or a trauma. However, traumatic performing experiences can cause higher anxiety.

At one point in our growth and progression as performers, we’ve encountered a teacher who may have been a bit hard on us, or always expected more. We’ve had people who have dropped the hammer when we needed to get it together, but sometimes our paths have crossed with people who made it seem like no matter what we did or how hard we worked, we were always a disappointment. Unless we did something FABULOUS, they didn’t really bother. It made us want to work harder, but also may have instilled the fear that perhaps we might not be cut out for performing, leaving us feeling doubtful. There’s a difference between tough love and cutting someone down. Anyone who isn’t able to identify progress or belittles you each time you work with them, to the point where you question your worth or ability as a performer, is not worth your time. Find an educator who dedicates their time to you 100% and gives you the constructive criticism you need to grow. There are so many of them out there. Sometimes these are people who teach the more general classes that we take. It's worth learning how to accept criticism with a grain of salt. I know, easier said than done, especially when they are your superior and possibly have a very successful career. Always try to look for the helpful words beneath the hateful ones whenever possible.

Sometimes, pressure from family members may be a part of the issue. Maybe a parent, or both parents have previously had successful careers as performers and want the same for their child. Pressure from them to become successful and be the best can ultimately have a negative effect. They become worried about pleasing their parents, trying to be good enough in their eyes. They want to please their parents but forget about if they are really pleasing themselves.

Perfectionist Personality traits can make many aspects of life difficult to deal with but this is something that we can learn to manage. While many may consider themselves perfectionists, there is a difference between wanting to be perfect and being obsessed with perfection. Perfectionistic traits can be overwhelming and can be identified as having high personal standards, and obsessing over mistakes made whether it be in practice or performance. It can be detrimental to one's mental health because of how hard they can work, and the way they beat themselves up when perfection is not achieved. This can result in major self-doubt, and self-deprecation.

A lack of confidence can surely lead to performance anxiety. As someone who’s dealt with a lack of confidence, I can surely say this has led to much self-doubt for me as well as performance anxiety. I’ve worked hard throughout the past year to fix this issue. My teacher, David Jolley constantly reminds me of how well I’m doing and even encourages me to feed my ego, in a positive way. Learning how to deal with my performance anxiety, and being more kind to myself in the practice room has made a big difference in my ability as a performer. A lack of confidence is something that can very much be fixed with things such as good practice habits, meditation/visualization, yoga, reminders of good things you like in your playing, and much more!

There are so many factors that contribute to performance anxiety that it becomes a bit confusing. To sum it up a bit, there are different types of performance anxiety:

  • Stage fright (a less severe version of PA)

  • Trauma induced PA

  • Generalized anxiety that contributes to PA

  • Environmental factors that cause PA

There are also the factors that contribute to one of these types, especially the psychological side of PA:

  • Pressure from parents/family members

  • Unsupportive and tough teachers

  • Perfectionist personality traits

  • Lack of confidence

  • Performance trauma (as well as all trauma)

When combined together, these create the way we feel in performance scenarios, whether it be the physical or psychological symptoms we encounter. In the coming weeks, I will continue to talk on some of the best relief methods.


Please welcome both of my featured guests, Michael Burner and Jessica Lombardo. They are both here to share their experiences with performance anxiety.

Jessica Lombardo is from Long Island, NY and is currently working on her Masters degree at the Cincinnati Conservatory of Music (CCM). She previously received her Bachelor's Degree at the Mannes School of Music in NYC. She started horn at the age of 8 and continued through high school and college. She now is the Principal Horn at the Battle Creek Symphony in Michigan. Jessica will be featured in next week's blog as well.

Have you ever struggled with performance anxiety? If so, what were your most debilitating symptoms?

So this is kind of a more recent thing for me. I hadn’t really struggled a lot with performance anxiety in the past, but about 6 months ago in January I was playing Mahler 9 and I just totally had an anxiety attack on stage. I was very close to getting sick on stage. I felt like I was going to throw up. And that was the first time I ever experienced anything like that in my entire career. Ever since, I’ve basically had that feeling in my stomach before I perform. It’s mainly nausea and stomach issues that I’ve been experiencing with performance anxiety.

What methods of relief have you tried? What did you find worked for you and what did not?

I have been taking beta blockers for maybe like 3 or 4 years. And I found that the beta blockers have usually been helpful, especially for physical symptoms, like if you get shaky when you play, or if you feel like you can’t breathe when you play. Beta blockers have been helpful for the physical symptoms of being nervous. I can’t stress that enough. Because the Beta Blockers do not help the mental side of being nervous. Which is something that I have recently been struggling with because when I performed in January. I took beta blockers before the performance, but it still didn’t help the mental side of it.

How did you hear about the relief methods?

I had talked to my previous teacher Phil Meyers about Beta Blockers. He swears by them. He is like the Beta Blocker King. I know there’s a stigma behind it and he was like “Nope do it. Do it now. No shame”. He was really the one who advocated for beta blockers.

Do you believe that there’s a stigma that surrounds the use of Beta Blockers in a performance scenario?

My father is a psychologist and he is very pro mediation. He’s always been very pro therapy and pro medication. And I think the stigma around beta blockers is very similar to the stigma around antidepressants or anxiety medication. It's like people have to feel ashamed that they have to take a pill. Especially with performing, a lot of people feel like if you have to take a pill to perform, you shouldn’t be performing. It’s like that kind of attitude, and I think that’s so wrong. I think that if the only thing separating you and being a successful musician is taking a pill, you should do that. The stigma is around people feeling like you shouldn’t have to take a pill to play your instrument. Like I think that’s the bottom line. That’s the stigma. The thing about beta blockers is yes, you can become dependent on them for sure, but they’re basically harmless. I don’t think there’s anything wrong with taking one before a performance. It is definitely a slippery slope. Like I said it doesn’t solve the mental side of things so it's very easy to be like , “Oh I’m nervous let me just pop a beta blocker and I won’t be nervous anymore”. But that’s not really how it works. It takes away the physical symptoms of being nervous. It's a tool, but there is the mental side of it too.

Would you recommend this method?

I feel like for beta blockers I wouldn’t necessarily recommend them to everyone. I would recommend them to someone who gets really bad physical symptoms from performance anxiety. If you feel like you can perform, and you don't get shakey you don't get shortness of breath, if you feel like you can control those aspects of your playing, then I would say you don't need them. If you don't need them don't take them. But if you are someone who gets these physical symptoms, then I would definitely recommend beta blockers.


Michael Burner is from Arkansas, home of the first ever Walmart! He attended both the University of Arkansas and Mannes School of Music for trombone. He always liked music. He remembers seeing the Chicago Symphony when he was 8 years old. They played Mahler 5 and after seeing that he really wanted to play the trumpet. In 6th grade, he tried the trumpet and couldn’t even make a sound. His teacher suggested trying the trombone, and that’s what he stuck with. Now, Michael is a Trombonist for The United States Army Band, The Pershing's Own.

Have you ever struggled with performance anxiety? If so, what were your most debilitating symptoms?

Oh yeah. I think it's something that’s very common for all musicians. Right before I would do an audition or perform something I would just, my heart would suddenly go a thousand beats faster. It was just a surge of adrenaline, effort and all that. I played football. I learned very quickly that I couldn’t catch passes because my hands would be shaking too much and I would drop the ball. So I switched and I was a running back, just grab it and hold on and use that nervous energy and anxiety to plow through other people. With Trombone though I can think back, we had chair tryouts starting in 7th grade, but you did it in front of the entire band and people would challenge you for your chair. And I was like, “Oh my god.” This anxiety. Everyone was watching you. People who don’t like you are waiting for you to mess up, and when you do people laugh. It’s this awful, ball of anxiety moment, and that was something I associated with auditions for the longest time and so my way of dealing with it when I was young was to just practice something on repeat over and over and over a thousand times, ten thousand times. Whatever it took. And that was with me all the way through college and continued until I started taking professional auditions.

What methods of relief have you tried? What did you find worked for you?

The first big, professional audition I took was for the navy band here in Washington D.C. I made it to the finals for the audition. I had never tried Beta Blockers or any of that and I was just so anxious. My way of knowing if I was ready, especially for the final round, was to keep practicing even in the warm up room. I would play it over and over until I was subsided, it's here. “Okay, it’s gonna be okay. It’s gonna be okay.” And of course I went in, I fracked a note, my heart started beating through my chest again and it was all over from there. But that was something that led me to look for other ways to deal with anxiety and deal with being anxious and being successful. So the first thing that I did was talk to my teachers about it, or talk to professionals in New York. I studied with the guys from the Metropolitan Opera. All three of them had different things to say. One would say, “Take Beta Blockers, try it.” And one said, “No that’s a crutch. Why would you ever take that? I’ve never taken them.” And then the last one said, “You should practice deep breathing, meditative exercises.” So I tried a combination of the three. I put myself in stressful situations, I tried to play in more masterclasses, and things like that and trying beforehand to do deep breathing drills. Trying to slow down my heart rate before a big event. And that was mixed success because during a masterclass is not the same thing as a professional audition. And that’s because you put emphasis on the things that are really important, and that’s natural for any of us. And I took the idea of professional auditions like anything that was going to pay money as like, “oh this is a big deal I can’t mess this up. It's impossible to fail this task.” So I took it very seriously, versus a masterclass with a great player. Still a big deal, but it doesn’t really matter in the same regard. It's probably a poor attitude to take, but that’s how I viewed it. So then I started exploring taking beta blockers. This was in the Spring of 2017. I had already been in school for a while. I had been performing with some groups around town in New York, and I just thought, “Okay I'll take one and try it and see what it does''. I took a beta blocker before an off broadway production of Urinetown. And normally, because that book you’re playing Trombone, Bass Trombone, and Euphonium, for Euphonium it was, “Okay I hope I practiced the valves enough. I feel okay about it”. And for the first time ever my heart wasn’t beating through my chest and I didn’t have the usual surge of panic and thrill, anticipation and anxiety before I played. And that was the moment of, “Huh. Well that’s pretty cool”. So the first time I put it into an audition situation, I felt clear. I felt like I didn’t have to worry about the shaking hands or the nervous energy coursing through my body. That's something that I will still take before big moments because I don't want my body to get in the way of what I have already practiced and spent hours and hours and hours doing in my studio before I go to an event. And that’s where people, colleagues that I've had at Mannes or other people I know have asked me ,”do you take beta blockers?” And my answer to them usually is, “I’ve made it to the finals for a few positions with beta blockers, and I’ve done it without beta blockers. I just take them because it gets the nervous energy intention out of the equation which for me is worth it”.

Were the Breathing Techniques you tried helpful?

I didn’t find it as much helpful, but it's still something that I do now, even in stressful situations of any kind. When the COVID situation was happening and I was in Basic Combat training I felt like, “Oh no, I’m stuck here in possibly the worst place on earth. My Fiancé, now my wife is in New York City. We were just told New York City is on fire and everyones dying. Oh my god what is happening.” And that’s where it was very useful in clearing anxiety. So that does help. I don't think it helped me performance wise as far as playing, as much as I wanted it to. But it is still a useful trick and I would advise people to try that before they get on medication for something. But it's something that helps self regulate.

Do you believe that there’s a stigma that surrounds the use of Beta Blockers in a performance scenario?

I’ve had a number of teachers who we’re a 50/50 split. Some of them were very open with how and why they took Beta Blockers. One of my teachers was adamantly against beta blockers. He made the connection between them and performance enhancement drugs for an athlete. He sort of shamed them, “if you can’t handle doing this for an audition, how are you going to handle doing the job? You take pills, is that really fair to everyone else? Is that an equal playing field?” And there’s a number of other people who will say the same thing. Other people I've met have that stigma of, “Why do you have to take something?” It’s sort of an old school, “you have to just deal with it”. As far as comparing it to performance enhancement drugs in sports, I think it's a really cruel narrative. It just seems like people aren’t willing to do whatever it takes or try whatever avenues there are out there to be successful. And maybe they’re the lucky ones who don't get nervous easily. Maybe they just compartmentalize better than I do. I feel like I’ve tried every avenue before that, or a number of avenues to reduce, and play through the pain, and play through the adrenaline rushes. I’ve botched some performances.I wasn’t willing to do that anymore. So I encourage my friends, and my students once they reach a legal age to try it out. It's not something that is harmful for your body. Most doctors will give you a prescription for it that can be refilled and if you don't want them, you throw them away. So I encourage people to try it if they have performance anxiety or anxiety driven things.

Have these methods you’ve used impacted your Performance Anxiety?

Definitely. I’m in a place now where I’m very secure in my job. I received a unanimous vote in the final round so I know my colleagues wanted me, and I got automatic tenure. So I have a very secure position, and that means a lot. When you’re a freelancer in New York, we tie so much of our self worth to playing, and so much of, we have to be perfect at all times. There are people always watching us or judging us, because if you play poorly you’ll never get a call from those people again. That’s the narrative we’ve created that we have to deal with. And it's so true. It's far far harder I think. There are people I know who have been in New York for decades and I don’t know how they do it in the freelance scene because it's so competitive. It's so varying on what you’re going to do in a given week and you always have to be on. And that’s something that I don’t think I would have been able to do for very much longer if I hadn’t won my position. I wasn’t cut out for the freelance world. I don’t know that mentally I would be able to keep up with it in that way because of the varying ability you have to have on any given day you have to change styles and match with people at the drop of a hat, versus having something that’s secure. That's definitely something I had to consider.

If you could offer a piece of advice about Performance Anxiety or one of the methods you mentioned, what would it be?

I think that anyone who’s a musician can probably attest to this: we are so critical of ourselves. I think as musicians we don't mean to be because we pour so much good and niceness, art and emotion into what we do. But we tend to be too negative, and too hard on ourselves in a lot of ways, especially in performance. Someone will come up to us afterwards and say great job and we're like,” Oh I missed this note and that note, and this section sucks and I think I need a new mouthpiece. Ugh god the conductor”. But we can be nicer to ourselves because there’s so much negative that we put on ourselves because everything is, “You’re out of tune. You played that wrong. You aren’t getting the right style. Your intonation still isn’t great. Your technique is sloppy.” It's always a negative sort of thing. And that doesn’t seem like much but it weighs down on ourselves after a while. Weston Spout was really good about saying, “Every time you play, think about one thing that you really liked about it.” Build yourself up because there’s only so much one can take. That's something I think is important, especially those trying to get better. That's where I think one little thing, like being kind to yourself; what’s one thing you like about yourself when you play. And it can’t be like, “I have the most beautiful trombone in the world. It's gold plated”, no no, It can’t be something like that. It has to be you; it has to be you’re making. One good thing like, “Yeah my intonation is great. Man, my articulation sounded really clean on that passage”, or “I have a beautiful sound and no one can beat me with my most beautiful sound”. And once you have that thing that you like, then you can go about everything else like, “that wasn’t the best, but it can be. I can change that.” In regards to everything else, beta blockers, K tonguing and air stream, listen to everything and try everything once.


That's all for now! Have any questions, comments or want advice? Feel free to email, or follow me on instagram @mindoverpractice. Stay tuned for more next week. Have a productive week of positive practicing!

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