I’ve been fortunate in my career to counsel musicians and athletes on how to do their
best under extreme pressure and achieve peak performances at the right time. One
thing I focus on is learning how to control and channel performance energy. While the
mental training for athletes and musicians is similar, the ultimate results are more
apparent and quantifiable with the Olympians than with performing artists. It is difficult to
objectively measure a peak performance in the arts and it is unclear exactly how music
performance is affected by beta blockers.

In Olympic events, peak performances can be accurately measured (rather than
subjectively judged, as at an audition). Whether it’s the 200 meter butterfly, the high
jump, or the 100 meter hurdles, a new record is soon posted for all the world to see.
Oftentimes when a new Olympic record is set, a world record has also been achieved.
Athletes compete year-round in regional championships, nationals, Olympic festivals,
Pan Am Games, World University games, etc., when they’re always trying to do their
best. So why do these athletes set so many new records only every four years at the
Olympic Games?

Photo Credit: Bryan Turner
In my view, it’s because U.S. Olympic teams have sports psychologists teach athletes
how to make adrenaline work for them. Olympic athletes learn exactly how to channel
extreme levels of performance energy when they’re feeling the immense pressure of the
whole world watching them. Musicians however, are usually encouraged to play their
best “in spite of” nervous energy, instead of being taught how to use the extra pressure.
In a 2012 study at University of Paderborn in Germany, 30% of the orchestra members
who were surveyed said that they suffered from stage fright. More than 13% of the
musicians described their anxiety as being severe. A study of 74 gifted adolescent
musicians, published in 2013, found that one-third of the group was “distinctly
handicapped by their anxiety”.

Unfortunately, in the face of normal performance anxiety, many performing artists turn
to beta blockers like Inderal, Propranolol, Metoprolol, and Levatol. In 1987, a formal
study on stage fright was conducted with 2,000 professional musicians from the 51
largest orchestras in the United States. More than 27% of those musicians used beta
blockers for their nerves at least once, if not more often. Of those, 70% said that they
had not gotten prescriptions for the drugs.

John Beder recently directed a documentary on performance anxiety called Composed.
He surveyed over 5,000 classical musicians and found that 72% of the musicians in his
study use or had used beta blockers.

In my own informal survey a few months ago on Facebook with more than 500
performing artist respondents, I found that 40% of them experienced nerves every time
they perform. At least 56% of the experienced performers indicated that they felt anxiety
on some occasions when they performed. Of that 56%, more than 20% stated they
found beta blockers helpful in dealing with their performance anxiety.

What are beta blockers?
Beta blockers are a category of prescription heart medications that are used to lower
blood pressure, heart rate, and blood flow. They are also used to decrease the
physiological symptoms of the fight/flight response. These drugs prevent or block the
adrenal glands’ stress hormones (adrenaline and noradrenaline) from attaching to the
sympathetic nervous system’s beta receptors. These receptors get activated by fear,
anxiety, or panic. Once the beta receptors are blocked by the drug, the heart rate
begins to slow down.

Beta blockers also prevent the kidneys from producing a hormone called angiotensin.
Without this hormone in the system, there is a resulting drop in blood pressure and
blood flow. Beta blockers are specifically used to treat cardiovascular conditions like
irregular heartbeat, angina, atrial fibrillation, and congestive heart failure, as well as
hyperthyroidism, chest pains, and glaucoma. They are not intended as the primary
treatment for anxiety, but physicians prescribe beta blockers “off-label”, meaning that
the drugs are not officially approved for use for anxiety by the FDA, but are prescribed
anyway. The result of decreased heart rate, blood pressure, and blood flow give the
performer a sense of calm and security. Beta blockers are often obtained from alternate
sources, like friends and colleagues.

The list of potential side effects of beta blockers include: irregular heart rate, dry mouth,
shortness of breath, low energy, drowsiness, dizziness, swelling of extremities, brain
fog, physical weakness, impaired circulation, cold hands or feet, blurred vision,
headaches, insomnia, muscle cramps, unexpected weight gain, upset stomach,
vomiting, depression, and loss of drive. These side effects are usually mild but can
become severe for individuals who have other medical conditions.
If you are going to take them, here is what you need to know.

Photo Credit: FreeStocks

If you are going to take them, here is what you need to know.

Those who have low blood pressure, low heart rate, diabetes, asthma, Raynaud’s
Phenomenon, emphysema, or allergies should not take beta blockers without consulting
with a physician. These drugs can mask the signs of low blood sugar or cause
significant changes in blood sugar levels. They can cause severe asthmatic reactions
and cause extreme metabolism changes in a short amount of time. It’s important to
avoid taking beta blockers with alcohol or caffeine, as the drug interactions can cause
an adverse reaction.

Although beta blockers are not physically addictive, they have the potential for
psychological dependence. Like all drugs, more than occasional use of beta blockers
will increase tolerance. Over time, the dosage and/or frequency will need to be
increased to produce the same effects. I knew an orchestral musician who told me in
confidence that she needed 50 milligrams just to get through every rehearsal, not to
mention what she took for concerts. After a while, some users may feel that they can’t
go on stage without them.

Beta blockers are not a cure for nerves, they just mask the problem. Beta blockers do
not alleviate anxiety or inner nervousness, they just block the outward, physical signs of
anxiety. The drugs only block the physiological action of adrenaline, they don’t stop it, or
solve the underlying causes of the anxiety.

Talk to Your Physician

If you still want to try beta blockers or continue using them, talk to your doctor. This is
critical if you have any medical conditions. List what prescription medications you take,
especially for blood pressure, antidepressants, diabetes, asthma, chronic bronchitis, or
allergies, as well as any over the counter drugs for coughs or colds you take. Your
doctor may require a blood test or electrocardiogram before writing your prescription.

Then you need to experiment with them in a safe performance environment (not a big
performance or audition) to learn how they affect you. The usual dosage is between 10
and 60 mg. They can take anywhere between 1 and 4 hours (depending on dosage,
tolerance, body weight, and chemistry) to reach their maximum effectiveness. You also
need to determine how long before the effects wear off, and what you would do after
that if you needed to play another audition round later in the day, or in the finals in the
evening. By that point, will you still have the vital energy left to play with excitement,
presence, and focus so you can win the audition? Or will it be buried under a heavy
blanket of beta blockers?

You can guess how I feel about performers taking beta blockers. I have never
suggested to an Olympic swimmer or 100-meter runner that they drink some vodka to
calm down before their race. Nor have I ever recommended beta blockers to any of the
performing artists that I have counseled to win auditions for more than 30 years. It just
doesn’t make sense to me. Why would any athlete or performer want to mess with their
energy before an important event with alcohol or drugs?

Beta blockers may give performing artists a temporary sense of comfort, but comfort
should not be the goal. The goal is to win the audition. That takes a lot of energy, over
several rounds. Beta blockers may get you through the first round, or even past the
semifinals, but they won’t help you to win the audition. In fact, they could cause you to
lose in the finals. You don’t want to start the finals with suppressed or depleted energy.
Not if you want to stand up and blow the audition panel away with your energetic
performance. You want to still be going for it with power, until the last note, long after
your competitors have fallen away.

In the last Olympic Games in Rio in 2016, fourteen of the track and field athletes I
counseled reached the awards podium (top 3 in their events), while 5 of them won gold.
In the same year, several of my clients and students won big auditions, including
principal positions with professional orchestras and dance companies. Not one of the
Olympic athletes, professional musicians, or dancers I had trained used beta blockers
on the way to their awesome victories.

In my article next month, I’ll discuss natural alternatives to beta blockers, including what
I call a real powerhouse solution to performance nerves.