Too Shook Up To Speak Out?

Is there any way to treat fear or anxiety associated with public speaking? It is something I must (and want) to overcome to develop both my professional and private goals.

– November 15, 2004

Many people, including professional actors and politicians, get nervous before speaking in public. This can be a lot worse when fear of public speaking is a manifestation of social anxiety disorder or social phobia, defined as a persistent and irrational fear of situations that may involve scrutiny or judgment by others. Fear of speaking in public is a very common type of social phobia. According to the National Institute of Mental Health, in any given year approximately 5.3 million Americans suffer from social phobia. We don’t know what causes these problems. They may be learned, inherited or, possibly, biochemical in nature. Researchers are exploring the idea that heightened sensitivity to disapproval may be physiologically or hormonally based.

As someone who does a lot of public speaking, I have learned that a bit of anxiety can be a helpful way of focusing my energy before a talk. I wouldn’t want to eliminate it completely, but here are some recommendations for managing anxiety when it is too overwhelming to be useful:


  • Learn breathing exercises. Practice them regularly and do them before speaking to keep yourself calm.
  • Work with a hypnotherapist. To find one in your area experienced in treating fear of public speaking, go to, the Web site of the American Society of Clinical Hypnosis.
  • Take a dose of a beta-blocker, such as Atenolol, 30 minutes before you have to speak. Beta-blockers are drugs usually prescribed to control high blood pressure. Consult your family physician, or a psychartrist who treats anxiety disorders, particularly social phobias.
  • Consider cognitive behavioral therapy, which is very useful in treating social phobia. The goal of this form of treatment involves helping patients gradually become more comfortable with situations they fear. It includes deep breathing to control anxiety.


Andrew Weil, M.D.

Updated 4/13/2005

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