“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
Next Steps
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.
* * *
Subscribe to The Musician’s Way Newsletter for updates about this and other topics of interest to musicians.
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
Thanks, Gerald. My blood pressure is normally 120/70. Is that too low for a beta?
Good points, Janis. Thanks for contributing.
I’m glad that you brought up the placebo issue, because researchers do find that the placebo effect is real (i.e., some people who take a sugar pill but think they’re getting a drug report feeling better).
That said, researchers studying musicians taking beta-blockers have demonstrated that the heart rates and degrees of perspiration among a group of musicians taking beta-blockers were reduced when compared with a control group who didn’t receive the drug.
But that’s not the whole story.
When speaking of people in general, a measurable effect has been found. But with a particular individual, it’s possible that these drugs would not bring about such effects, perhaps due to differences in beta receptors.
Bottom line: these drugs may help some people but not others. And a pill alone would never provide a complete remedy, as many of us observe, because these drugs don’t directly alter the mental/emotional effects of performance anxiety.
I have to admit, I’m a skeptic as to the utility of beta blockers as anything other than a placebo. I’m on them for other reasons — a genetic heart defect that runs in my family — and as a result, I take way more than most musicians would take for performances, two 50mg tablets a day for the past ten-plus years.
They do ZILCH for me in terms of performance anxiety, which I do have, enough that I detest playing for others and avoid it at all opportunities. (The nervous jitters that come with stage fright and arrhythmic palps are not the same thing, at all.) They also do zilch for me in terms of mood or attitude alteration. They calm the body, but they do not seem to affect the mind at all. The only real change they brought about was that my hands get very cold easily — not exactly a good thing for a musician.
Honestly, beta blockers are already prescribed for lots of people; there are huge populations of people with heart problems and high blood pressure who already take these things. This marijuana-like total lack of anxiety is just not anything we’ve ever talked about or pursued; the placebo effect is indeed very real, but I still think this beta blocker fascination a placebo. If it helps, go for it, but I can’t help thinking it’s a sugar pill.
Its an interesting topic and it makes me think of two points. The first being that I believe prescription medication is a necessity for some cases but for most I believe people have the skills to overcome whatever phycological ailment is standing in their way. The second is the comparison to the blog argument. I believe that a performing artist can overcome the rough bout of performance anxiety with the right coaching and approach. Considering that some people might have a very deep psychological feud with performing, I don’t see beta-blockers as a problem for use in special occasions. For me however, having the rush and the giant wave of raw and instinctual emotion simultaneously in a single moment is the greatest part of the performance. I wouldn’t want anything to stand in its way.
Gerald, thanks for your comments and encouragement. I don’t suffer from the shakes or dry mouth at all, just a very rapid heartbeat and as I said a very temporary blackout (say 1/2 bar, 1/3 of a second say) that occurred recently and I seem to remember happened to me on several occassions very many years ago when I first played first oboe in an amateur orchestra. Thanks again for your comments and I’ll explore the options.
Beautifully said, Noa. I’m in full agreement that we musicians typically grow our skills in an educational culture that largely ignores the development of performance skills – both inner and outer skills. I’m doing all I can to help turn that around. Thanks for contributing and for all you do to help musicians become fearless performers.
Hello, Gerald. Excellent (and fair) presentation of the use of beta-blockers among musicians. I was especially glad to see your article explain how beta-blockers target only the physical component of the anxiety response – the “fine print,” if you will, that often goes overlooked.
It’s unfortunate that we spend most of our time learning how to learn music, and very little time learning how to perform music. I liken this to learning how to speak a foreign language, but never experiencing the thrill of making a connection with a native speaker outside of the classroom. Ever notice that look of joy on a toddler’s face when they realize you actually understood something they said (and the frustration when you can’t for the life of you figure out what “popiskpo” means)?
Learning how to perform more effectively is such an empowering skill to develop; not just for students who plan on a music career, but those who will eventually become doctors, lawyers, or other professionals. I know that in this age of fast food and FedEx we tend to gravitate towards the “quick fix”, but as Beverly Sills once said, “There are no shortcuts to any place worth going.”
Roger: Thanks for the question. And bravo to you for considering fresh tactics.
If you’ve been wrestling for years with physical symptoms on stage such as shakes, dry mouth, rapid heartbeat, and the like, then why not check with your doctor regarding the suitability of beta-blockers? If your doctor finds that they’re safe and appropriate for you to try, then they might help you attain new levels of excellence and enjoyment on stage (you could experiment with them at a rehearsal before using them in a performance). I encourage you not to shy away from exploring your options.
That said, beta-blockers will temper the physical manifestations of nervousness, but they won’t directly affect the mental and emotional ones, so they might or might not satisfactorily alleviate your situation – it’s impossible to say from here.
With that in mind, if you haven’t already done so, you might want to seek the advice of a performance coach, an Alexander technique teacher, and a veteran oboist.
Hope that’s helpful. Please keep in touch, and let us know how things progress.
I am an amateur oboist and find that solo phrases in orchestral pieces are generally not as good as they should be due to I imagine stress. Recently whilst playing Tchaikovsky 5th I messed up 3 notes in a very important solo in the second movement. It happened after counting about 30 (very slow) bars rest (just counting very accurately stressful), then is the reed going to respond after perhaps drying out (stressful). The outcome was my mind actually blacked out for I guess 1/2 second at the crucial moment. I thought I knew how to manage stress but it got the better of me. Do you think I am one of these people that should consider beta blockers for a performance ?
George (aka Hucbald): Thanks for the complimentary words and for the illustrative comment. Great to hear that you’ve built up solid performance skills and are now playing your best when in front of an audience. A terrific example.
This is an awesome blog Gerald.
I got over performance anxiety the old fashioned way: I built up to performing five to seven nights a week. Previously, I’d choke under the slightest pressure – even performing for fellow students – and now I perform in a quite detached manner if I’m background music – I “people watch” to be honest – and actually enjoy the attention of being on a stage.
After years of being an awful performer, I just made the decision to get over it: I started out by playing in a Church – the friendliest audiences in the world – then, when I was comfortable there, I moved up to restaurants, and finally stages. Personally, I can’t see taking beta blockers as anything but a negative, because now I play better for an audience than I do when practicing; I feed off of the energy that performing for an audience gives me.
I’m bummed if all I can do for an audience is what I do for myself at home.
Thanks, Ryan. The most powerful anxiety-buster is thorough preparation, of course. Beyond that, anxious musicians over the generations have employed all sorts of things that we wouldn’t recommend today, including, still, alcohol and other drugs.
The central message of my work is that, with some exceptions, we all have the potential to make music and express ourselves authentically in performance, without being undermined by nerves and without needing drugs. Comprehensive facility with the musician’s creative process is what liberates us from our fears and empowers us to be in command on stage.
Nonetheless, some people haven’t had the opportunity to acquire inclusive creative skills; others are wired with very sensitive fight-or-flight responses and truly benefit from medical support. So we shouldn’t look down on those who need beta-blockers to perform well. Rather, I want to encourage music lovers to grow artistically and bring more and more music into the world.
Well written and interesting!
This article makes me wonder about performers throughout the ages and what performance anxiety “alleviators” may have been used prior to modern pharmaceuticals. (I used the quotes because the only things I could think of that may have been commonly used in the past are now illicit and/or libations.)
If anybody has any knowledge on this subject, I’d love to hear it.
Great example, Vanessa! Thanks for sharing.
Max: I’m with you on this one. Still, those who argue ‘unfair advantage’ point to the ban on beta-blockers in the likes of competitive pistol shooting – not that I see much similarity between artistic music making and shooting or other competitive sports – but I do my best to weigh all views: http://blogs.discovermagazine.com/80beats/2008/08/18/olympic-pistol-shooter-used-anti-trembling-drug-to-steady-his-hands/.
I don’t see the controversial aspect of taking beta blockers. At least from the aspect of users having an “unfair advantage.” As I see it, those who find a way to perform the task should not be penalized for essentially being wise enough to learn of and use beta blockers. There’s nothing illegal, and the one thing I might recognize from one who used them is that they had a job to do, and they did what it took to get it done. Sounds rather respectful to me.
Beautifully stated, Gerald, thank you for posting this. One of my hypnotherapy clients, a professional musician who took beta blockers, once told me, “When you’re on stage, these pills are really good and really bad. They’re really good because I feel like I’m just in my living room playing for myself. They’re really bad because I feel like I’m just in my living room playing for myself.”
Thanks, Julie. Your points are most helpful.
Good comments, evenly presented. I think musicians who use beta blockers should be well-informed of pros and cons of all treatment options…but not to think of BB (or any drug) as a panacea for performance anxiety – even if that drug diminishes unwelcome symptoms. I have found in my work with performers and others that it is important to understand what fuels performance anxiety and keeps it “alive” . Also it is helpful to know what drugs mean/represent to an individual. Or why some people avoid drugs when they clearly could help. This, too, can be analyzed with the help of a professional. Of importance, use of beta blockers should be prescribed and dose regulated by a physician. While generally safe in the doses used by musicians, they can have serious side effects in those who are susceptible.
Well-thought out discussion, and the conclusion is principled.