Beta Blockers. While not one of the first methods of relief I’d suggest for treatment of Performance Anxiety, it is something that should be discussed because of the stigma that surrounds it. Beta Blockers is by far the most controversial method of relief for performers. Performers of all kinds have argued about the use of Beta Blockers for years, some supporting the thoughts behind the stigma, saying it is the equivalent to an athlete’s use of performance enhancing drugs, and others who are in favor of their use, believing it is a safe way to help members of the performing arts community. So what gives? Are Beta Blockers okay for performance use?
The honest truth is that Beta Blockers, a.k.a Beta-adrenergic Blocking Agents are not a medication prescribed for anxiety, but rather a heart medication meant to treat high blood pressure, A-Fib, chest pain, and heart failure. They are also used to treat symptoms of severe tachycardia in chronic illness conditions such as Postural Orthostatic Tachycardia Syndrome (POTS). However, the way this medication works can be described through an example of someone in a performance scenario who suffers from Performance Anxiety:
Joe is preparing for his Principal Clarinet audition with the Houston Symphony. He has properly prepared for said audition by practicing efficiently and performing mock auditions for his colleagues. However, Joe begins shaking whenever he gets into performance scenarios. These shakes are activated when the adrenaline, also known as the hormone called epinephrine, is released along with cortisol throughout the body in response to the activation and arousal of the autonomic nervous system. Because of the adrenaline release, the body is now adapting and trying to deal with the threat at hand. Muscles become tense and ready to act at any moment, causing the body to shake or tremor. Joe took a Beta Blocker to block the stress hormones we know as Epinephrine (Adrenaline) and Norepinephrine (Noradrenaline) from the Beta Receptors of the Sympathetic Nervous System. The blockage of the receptors helps his body calm down and slows his heart rate. Joe is no longer shaking and is in a good physical state to perform.
Because of the effects Beta Blockers have on the body, they do work and are well-suited to use for high stress situations, such as auditions. Keep in mind, just like any other medication Beta Blockers come with their own list of side effects. Some of these side effects include:
Dry mouth
Stomach Upset
Bradycardia (heart rate under 60 bpm)
Fatigue
Dizziness
Weight Gain
Sometimes the cons outweigh the pros and it’s not worth taking a Beta Blocker. If you experience any of the side effects, this is something to be considered. They are not meant for everyone and they do not work for everyone. Beta Blockers may have negative effects on those who have conditions such as Diabetes, Low Blood Pressure, or Asthma. Regardless of whether or not you have an underlying medical condition, you MUST speak with a doctor before using Beta Blockers. Beta Blockers are not an over-the-counter medication and the use of them needs to be determined by a medical physician, not your own intuition. A prescription is needed to obtain the medication for YOUR personal use.
Do NOT share your prescription with other people. Do NOT offer it to your friends to colleagues to “try”, and do NOT take medication that is not yours. Many people are wary of Beta Blocker use because of how “casual” some people make it. While not directly the same as ADHD medication Adderall, people can develop a similar dependency on them. Much like Adderall, they are often sold privately, from person to person. If you believe that Beta Blockers may help you as a performing artist who struggles with Performance Anxiety, calling your doctor to make an appointment to have a consultation is a much easier and SAFER alternative and requires little to no effort.
Beta Blockers for Performance use has been proven to be highly effective in those whose Performance Anxiety is so significant and cannot be managed any other way. Typically I’d recommend Beta Blockers to someone after they’ve worked through other types of anxiety-relief methods and have not achieved any physical relief. While Beta Blockers are extremely effective for the physical symptoms, they don’t help the mental or emotional symptoms that tag along. Mental and emotional symptoms need to be managed by other methods such as meditation, visualization, Alexander Technique, breathing techniques/yoga, or talk therapy with a licensed therapist. I will address these in more detail in future posts.
Some of the physical symptoms of Performance Anxiety include tremors/shakes, sweating, nausea, dry mouth, racing heart rate. How you perform is not included among the physical symptoms. A very common misconception that fuels the stigma surrounding Beta Blockers is that they are “equivalent” to the use of performance enhancement drugs in sports and Beta Blockers give performers an unfair advantage when taken prior to an audition. These ideas are entirely untrue. The use of performance enhancing drugs in sports, also referred to as doping, considerably increases athletic performance. Types of steroids and hormones are typically used and can severely affect the biological functions of the human body. Excessive use of these drugs can lead to permanent and irreversible side effects. The body changes caused by PEDs is what gives athletes a “leg up” in their performance. Beta Blockers do not change the body’s biological function and the effects are not irreversible. Beta Blockers do not “enhance” one’s performance. They do not make someone play better. Beta Blockers take away the effects that performance anxiety has on the body so that the performer can play the way they prepared. The underlying preparation that one has put in is what makes the performer perform better, not the Beta Blockers. There is still a strong possibility that you will not perform well on Beta Blockers if you haven’t adequately prepared. The Beta Blockers do not make you perform better, you make you perform better.
While much more can be said on the topic, let’s save that for next week. In the meantime, please welcome two people who have had very good and relevant experiences with Beta Blockers, Grant Abelson and Alex Shuhan.
Grant Abelson is a Masters student at the Mannes School of Music whose concentration is French Horn. He is from White Plains, New York and formally studied at UCONN for his Bachelor's Degree. He has been playing horn since he was 9 years old, and is now here, many years later to talk to us about his experiences with Beta Blockers.
Have you ever struggled with performance anxiety? If so, what were your most debilitating symptoms?
Yes and my most debilitating symptom was a shaking in my abdomen, or as spasm if you will.
What methods of relief have you tried? What did you find worked for you and what did not?
I’ve tried meditation, Alexander technique and eventually settled on beta blockers which helped the most. I can’t remember the type of meditation I used to do but it was effective in helping me in my general life, but in regards to performance it didn’t really have an effect. Alexander technique the same. It helped with learning how to center my body and all of that, but it didn’t change the amount of adrenaline that my brain was putting out while performing. I heard about beta blockers through the grapevine of it being kind of a bad drug in the music world. But I spoke to other people who had actually tried it and they could not give more positive reviews about it. And I spoke to my general physician about my symptoms and before I even mentioned beta blockers that’s what she recommended.
Do you believe that there’s a stigma that surrounds the use of Beta Blockers in a performance scenario?
Yes there is a stigma because people don’t get the proper prescriptions from their doctors as they should. Because it’s a backstage drug, people surround it with a stigma like there is steroids in sports. But if everyone went to their physicians like they’re supposed to and got a prescription and we’re explained how it worked through their doctor, I don’t think there would be a stigma. So no I don’t side with the stigma at all.
How have the methods you've mentioned impacted your Performance Anxiety?
So what I found effective with beta blockers...I don’t want to say I have performance anxiety because I don’t feel nervous going on. It’s just in the heat of the moment my brain gets really excited and starts exceeding adrenaline and that’s what makes my abdomen shake. So it’s not like I feel nervous, or I get cold feet. What beta blockers do is nothing but stop the shaking. It doesn’t allow me to do anything I wouldn’t already be able to do in the practice room; it's just letting me do what my body naturally does.
Would you recommend this method?
I would recommend all of these methods for people, coupling meditation with Alexander technique because if you can get a natural way to work, I would say that’s the best route to go. But if neither of those methods work, I would try to explore the prescription route.
If you could offer a piece of advice about Performance Anxiety or one of the methods you mentioned, what would it be?
The people who are thinking about going on beta blockers, do not be ashamed of it at all. I wouldn’t say you need to hide it because we need to end the stigma around beta blockers because it helps so many people.
A New Jersey native, Alex Shuhan grew up in Cranford and lived there for 22 years. He graduated from Eastman with his Bachelor's Degree in both Music Performance and Music Education and later earned his Masters in Performance from Southern Methodist. He was a member of Dallas Brass for 8 years, and was a founding member of Rhythm & Brass. He began teaching at Ithaca College in 1998.
Have you ever struggled with performance anxiety?
The truth of the matter is, I went a good 30 some odd years in my performance life without having any issues like that. I played hundreds and hundreds, if not thousands of performances over the years between Dallas Brass and Rhythm and Brass when we were doing full time travel. I was on the road over 200 days a year. For me it's not that I felt like I needed to be afraid, but the fact is I spent so much time performing and working with the same group of people for so long that It was just comfortable to play. The vast majority of my performance experience was in the context of those two groups.
A couple of years prior, there were a few times when I played that I had sort of little inklings of uncomfortableness. The challenges involved in any kind of workplace environment had risen to a point where my stress levels were out of control for me.
What methods of relief have you tried? What did you find worked for you and what did not?
Most of my life anything I knew about Beta Blockers was surrounded by negativity, certainly. When I was in school in the early 1980’s at Eastman, I don’t know what the exact history of Beta Blockers are, or when they started being used by the musician community, but I certainly remember that that was stuff at that time people were starting to discuss. There were kids at school who we’re using them and we’d all talk about how you couldn’t possibly play musically and blah blah blah, as if we had any idea what we were talking about. It was never an issue for me so I never thought twice about it.
Whatever it is that happened to me, whatever threshold I crossed I knew I had to find a way to get it under control. So I made an appointment with my family physician. I went in because you have to have a consultation before you're prescribed these things. He identified that I seemed like I was under a lot of stress at the institution I teach at based on the fact that I wasn’t talking much about music or performance like I usually did. So I think whatever fears that I developed, a lot of them hinged on stuff that goes on at the college rather than other places. You’re under a microscope so much of the time. I had so much stuff going on that it was seeping into all of my being, so when the Doc said that to me, I was like, “Oh, well yeah I guess you might be right”. So he gave me the stuff and told me to try it.
How have the methods you've mentioned impacted your Performance Anxiety?
When I get into performance situations I start to shake, and that has never happened to me when I’ve taken Propanolol. Not a single time. That doesn’t mean I’ve always played well, but I have never had the experience of not being able to be in control. There’s no amount of breath control or breathing exercises, nothing stops the shakes.
I have gotten to a point where I have not used it for every single performance I have ever done. I’ve played some things that I wish have gone better. But none of the things I’ve played, or have wished for better performances can I blame on anything but that we play the horn, or perhaps I should have prepared more. It certainly wasn’t because I was out of control, nervous and unable to play. That was not the case at all. There have been a handful of other times in other key performances where I’m like, "I don’t need to do this for that", and I’ve been right all of those times. I haven’t played something where I’ve regretted, “awe shit I should’ve taken that stuff”. I’ve gotten to a point where I feel like I know fairly well how it's going to feel and what the stress level is going to be.
Do you believe that there’s a stigma that surrounds the use of Beta Blockers in a performance scenario?
For people who choose not to take them, you can very easily just decide for yourself. If you’re not someone that experiences the feeling of not being able to be in control and you feel like you’re always able to be in control, then it's really easy to spin that as, “You’re not prepared”, or,” you’re just not working hard enough. You’re being lazy about the way you’re trying to handle this problem. You’re taking the easy road”. I think it's really easy to spin that kind of dialogue so that you can choose to not participate in taking them. In the same way that in sports; all the performance enhancement drugs obviously give someone an unfair advantage if you’re not taking them. I think there’s a not proper correlation that’s made between those two things. The fact of the matter is when you’re having that rush of Adrenaline that you get that you can’t control, you’re not choosing that at all. It’s a response to your stimuli and what the Beta Blocker does is it sort of says, “that’s not going to stop me from doing my best.” It’s not helping me do better than I would otherwise, it’s just not going to get in the way of me doing the best I can do right now. Plus, If you have that shit racing through you and you can’t control yourself, then you clearly can’t perform at the level that you perform the rest of the time when you’re not having that issue.
Would you recommend this method?
Roger Kaza of the Saint Louis Symphony Orchestra makes the parallel in an article, that rather than Beta Blockers being correlated with Performance Enhancement Drugs, Beta Blockers are like aspirin for musicians. If you’re a Clarinetist who’s about to go in and win your position with the New York Philharmonic and you have a splitting headache, no one thinks twice about taking Advil so that your head is not pounding, and you go in and win the audition. If you had a headache there’s no way that you could go in and play that high C# that would cause your head to explode. Roger makes this parallel that by controlling the Adrenaline rushes we get, that is essentially what propranolol does for us in performance situations. That it removes that sort of headache related type pain that is uncontrollable.
I encourage people to use it. Introduce that as an option for people to mull over. If you know what this feels like and you can take something to stop that from happening, why the fuck wouldn’t you?
If you could offer a piece of advice about Performance Anxiety or one of the methods you mentioned, what would it be?
By no means am I advocating against all the other methods that people have for performance anxiety, whatever they are. I am a graduate, and have hosted Jeff Nelsen’s Fearless Performance Workshop at Ithaca College. I think it’s a brilliant methodology. It changed a number of perspectives about a number of things for me. But Propanol stops the uncontrollable shaking. Doing anything that’s going to add to your comfort level on stage is never a bad thing, how could it be? There is nothing that replaces outrageous amounts of preparation, and you can’t take that away. But if you can take a little Tylenol/Propanolol that makes you not shake uncontrollably then you might be able to play really well.
It was a pleasure to be able to interview both Grant Abelson and Alex Shuhan on their experiences with Beta Blockers and how they've been incredibly helpful for them. Thank you both for sharing!
Stay tuned for more recommended relief methods and interviews in the coming weeks! For now, have a produtive week of positive practicing!
