“Performance anxiety is the kind of problem that rears its ugly head in both straightforward and subtle ways.”
–Eric Maisel, author and psychologist
If you’re an active performer, then I expect that you or a musician you know has taken a beta-blocker to alleviate stage jitters.
This article probes whether beta-blockers are safe, effective, and appropriate for performers to use.
What Are Beta-Blockers?
Beta-blockers are so named because they stop adrenaline from binding to the beta receptors in our bodies. If we become anxious and our fight-or-flight response activates, by taking these drugs, we can, by and large, prevent butterflies, tremor, rapid heartbeat, and the like from occurring.
Not surprisingly, many musicians view beta-blockers as a godsend. Others are ambivalent about their use for reasons we’ll examine in a moment.
First of all, although plenty of musicians use beta-blockers on occasion (in a classic 1986 study, about 20% of professional orchestral players admitted to occasional use), be aware that these are prescription drugs primarily given to people with heart conditions.
Beta-blockers also come with potentially dangerous side effects, especially for people who use other medications or have asthma, diabetes, or low blood pressure. They should never be taken without a doctor’s prescription and guidance.
Still, are beta-blockers safe for select musicians to use under medical supervision?
Safety & Effectiveness
According to arts medicine specialist Dr. Alice Brandfonbrener, “Beta-blocking drugs, primarily propranolol, have proved to be safe and effective for many musicians as one means of temporarily controlling the negative physiological symptoms of performance anxiety.”*
That’s not to say that all musicians have the same response to these drugs, even at the low doses that performers typically take – e.g., 10 mg. of propanolol, 60-90 minutes before performing.**
Some performers report feeling indifferent and non-expressive when taking beta-blockers; others claim to lose control of their vibrato. Some assert that the drugs make them lethargic while others describe a range of effects that render them unable to perform at their best.
Even so, many musicians don’t experience any of those negative outcomes and, on the contrary, report wholly positive benefits such as relief from tremor, making it possible for them to play or sing successfully at high-pressure events such as auditions.
Confounding things further, research yields inconclusive results regarding the prevalence of undesirable effects.
“Beta-blocking drugs, primarily propranolol, have proved to be safe and effective for many musicians as one means of temporarily controlling the negative physiological symptoms of performance anxiety.” -Dr. Alice Brandfonbrener
So, given this information, if we accept that these drugs can be used reliably and safely by some musicians, then it’s up to us in the performing arts community to confront the stickier issue of if and when beta-blockers might be appropriate.
Are Beta-Blockers Appropriate for Musicians?
I expect that we’d all agree that these drugs should not be used by students who are beginning to learn how to perform.
Nor should musicians think of beta-blockers as panaceas for performance problems. After all, these drugs only assuage the straightforward, physical symptoms of stage fright; they have no effect on the underlying, often subtle reasons why musicians get the jitters, nor do they directly alter the mental and emotional effects of nervousness.
That said, I believe that beta-blockers suit some musicians in specific circumstances.
In particular, a subset of adult musicians who deal with extreme physical effects from stress – e.g., shaking hands – or those with enduring troubles on stage can benefit from doctor-supervised treatment with beta-blockers along with performance coaching.
Then, with time and effort, they can build up the performance skills described in The Musician’s Way, boost their self-assurance, and lessen their dependence on medical support.
By the way, beta-blockers aren’t physically addicting, although they can prompt psychological dependence. All the more reason to employ these drugs with caution and together with an inclusive skill-development plan.
I think that beta-blockers also make sense for certain musicians to use at occasional, high-stakes performance situations, such as professional auditions, where the stresses and demands can be severe.
But now we’re heading into a controversial area:
- If musicians are going to compete for paid positions in professional ensembles, will those who use beta-blockers have an unfair advantage over those who don’t? And should employers and co-performers be concerned that they might hire musicians who can’t play or sing well in public without drugs?
- On the other hand, if some musical artists are exceptionally affected by nerves, shouldn’t they be able to take a safe, legal medication that enables them to express the artistry that they’d otherwise be unable to share?
Musicians and employers can sensibly argue both sides of this issue. However, I believe that musicians who take beta-blockers – whether prescribed for performance anxiety or chronic health conditions – should not be thought less of nor excluded from performing and competing because they access medical aid.
Also, adult amateur musicians who seldom perform might benefit from beta-blockers to ease their nerves at concerts that they might otherwise shy away from due to stage fright.
“Musicians who take beta-blockers – whether prescribed for performance anxiety or chronic health conditions – should not be thought less of nor excluded from performing and competing because they access medical aid.” -Gerald Klickstein
If nervousness scuttles your performances, before you turn to medications, I invite you to assess your practice and performance skills using the self-evaluation tools found on pages 112-113 & 204-205 of The Musician’s Way.
Then, apply the guidelines in the text and collaborate with a music teacher, performance coach, or therapist to determine the best course of action for you to realize your musical goals.
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Related posts can be found under the Performance Anxiety category. Additional articles about beta-blockers are compiled on the Performance Page at MusiciansWay.com.
*Brandfonbrener, Alice, “Beta-blockers in the treatment of performance anxiety,” Medical Problems of Performing Artists, Vol. 5, No. 1, 1990.
**Musicians who use beta-blockers solely for performance jitters take the medication occasionally, not daily, and only prior to high-stress events.
© 2010 Gerald Klickstein
Photo licensed from Shutterstock
I am an amateur musician. I have always been somewhat nervous when playing in public–for 40 years now.
I play piano normally and at times the organ, normally in church settings.
I played a funeral recently on a pipe organ. I did not have time to adequately prepare or to become really familiar. The other pianist would not attempt it. I played much better and with greater certainty when I was alone.
Would beta blockers have helped me–or is it like me driving to the Indy 500 and then driving a race car?
Would beta blockers
Hi Jim – Thanks for contributing. Your situation fits one of those I mention above. From my perspective, if nervousness has reduced your ability to perform for so many years, then you might see your doctor and inquire whether beta-blockers are appropriate for you to use occasionally. If your doctor says yes, then you could try a dose in a non-performance situation to ensure that you’re comfortable. Assuming that you don’t notice anything undesirable, you could then try a dose in a performance situation and determine for yourself whether they help you.
Hi Mary – Excellent questions.
Although some musicians report those dulling effects, it appears that the vast majority of performers who take low-dose beta-blockers for performance nerves don’t notice feeling any different then when they don’t take beta-blockers except for the fact that they don’t experience jitters, a racing heartbeat, etc.
I encourage you to go forward enthusiastically on your musical journey with the expectation that you’ll achieve your goals over time, including the mastery of vibrato.
So I have to take a beta blocker for a heart condition I’ve had since birth…… I am still an amateur musician, and I don’t know if the beta blockers are affecting my performance in these ways or not….
“Some performers report feeling indifferent and non-expressive when taking beta-blockers; others claim to lose control of their vibrato. Some assert that the drugs make them lethargic while others describe a range of effects that render them unable to perform at their best.”
But if they are, how do I overcome these effects? I have yet to be able to master a breath vibrato…. Is it because of the beta blocker?
Thanks for being open about your experiences, Bobby. Your story will help other musicians make informed choices about whether to try beta-blockers for high-stakes performances. I hope that you’ll read and contribute to more posts here on The Musician’s Way Blog.
This is a great page and its great to be able to hear the opinions of so many intelligent people about what has often been a subject of shame for many musicians. I have performed and loved it for 30 years since early childhood both as soloist and in orchestra but have found that auditions are truly not my forte. The stress involved with the feeling that getting this or that job will set up my entire adult life combined with the pressing knowledge that the margins of difference between any candidate and the next are so ,so tiny results in a very anxious performance. In fact my performance spills over a line I feel clearly in my mind between excitement and fear. Therefore the taking of a beta blocker before an audition has greatly helped my life and my performance. These days I mostly cant wait to perform and feel that excitement but sometimes , especially in concerto or chamber situations the fear line is crossed. In these moments a beta blocker enables me to much better do my job but I definitely dont feel anything like the rush afterwards and also feel somewhat detatched and out of body during the performance.
No beta blockers should be involved in professional musicians. If you are taking one than you are not profesional musician because professional musician never need one. He enjoys playing in front of audience, he mastered his skills so no need for any invalid device. Period.
Hi Molly – Thanks for contributing.
Although in an ideal world no professional musicians would need medical support to perform at their best, in reality, people come with diverse backgrounds and medical histories.
Some artists, for example, are highly anxious by nature or studied with incompetent or abusive teachers during their childhoods, which amplifies their fight-or-flight reactions in high-stakes performance situations.
Should such musicians, pros or amateurs, be thought less of because they benefit from the use of a beta-blocker?
I think not. I believe that musicians who wrestle with nerves merit our compassion.
I am on beta blockers myself for both high blood pressure and anxiety, and have often wondered whether musicians take beta blockers for stage fright, and in particular Adele because we all know how badly she gets stage fright.
as a life long musician, in his fifties. i can tell you taking a beta blocker once a day has made living much better. you think more clearly, and you dont get the physical issues that make your performance suffer…. i only wish i found this out in my early twenties….
Thanks, Louisa – I mention the issue of psychological dependence above, but I think the topic merits more attention, so I’m grateful that you bring it up.
As we know, performance anxiety is a complex phenomenon, and the use of beta-blockers alone won’t address the underlying causes of stage jitters.
So nervous performers should keep in mind that, if their sole mode of treatment is to take a pill as opposed to digging up the roots of their anxiety, then psychological dependence on that pill is likely to arise.
Fantastic article Gerald, thank you!
I also think there are certainly instances where BBs are helpful (necessary even), but there are certainly drawbacks, not always immediately apparent.
Some of the musicians that I have treated (who have taken beta blockers) have reported that their levels of confidence and belief in their ability to perform well WITHOUT beta blockers had progressively eroded over time with continued use of BBs.
Unfortunately, this can leave musicians with a strong psychological dependence on beta blockers and less confidence within themselves in a performance context.
And while this can be addressed and treated, even at this stage, it appears to be one of the nastier side effects of prolonged BB use.
Hi Mark. To my knowledge, that BP is in the normal range for young adults and wouldn’t by itself present a contraindication. But be sure to check with a physician to ensure your safety.