In last month’s column, I discussed beta blockers and their effects. As you know, these drugs are widely used by musicians to lower their heart rate and blood pressure, and to decrease other physiological symptoms of the fight/flight response. Like any other drug, beta blockers have several side effects, including dependence and increased tolerance. While these drugs may produce temporary relief, they do nothing to take away the inner feeling of dread or improve your confidence. They do not solve the underlying causes of nervousness, and they will never produce your best performances.

In the meantime, beta blockers will make focusing on the task at hand under pressure even more difficult. It takes immense energy to concentrate intensely for extended periods of time, like playing three rounds of auditions, the Ring Cycle, or gaining tenure after winning an audition with an orchestra. Beta blockers will not increase your ability to trust your talent and to go for it, while causing a false sense of security. Eventually, the diminished returns and risks of taking the drugs will outweigh the potential benefits.

If they want to wean themselves off beta blockers, I make sure they know that it will take some time and an effective plan. I do not recommend quitting abruptly by going “cold turkey”, especially if they have some important performance or auditions coming up soon. The practical solution is to learn more effective and natural ways to deal with the anxiety that often comes with performing classical music in front of an audience who expect you to do well. Here are some ways that I recommend to you:

Making a Plan – First, make up your mind that over time, you’re going to learn how to use your extra performance energy to achieve your peak performances under pressure, rather than trying to suppress the energy with beta blockers. Set reasonable goals for how long it may take, as well as tangible rewards for doing so.

Next, consult with your physician about your plan for gradually tapering off the drug. You need to learn more about the drug and specifically how it affects you, your body chemistry, and your mind. Tell your doctor about any and all other drugs that you’re taking. Ask about the half-life of the beta blocker and how long it takes to metabolize out of your system. Then find out if you can start taking half the usual dosage for two weeks, and then possibly half of that as the next step, two weeks later.

At each step, you want to notify your doctor about any adverse reactions you are experiencing. It may take two months or more before you notice any remaining symptoms. Your body and mind need to relearn how to deal with stress and adrenaline without beta blockers. Your heart may race at times, and your blood pressure might skyrocket for a while, until you learn how to manage your anxiety by channeling the extra energy into power, presence, and focus. That energy is what wins Olympic gold medals and orchestral auditions. That’s how I train athletes and performers to thrive under extreme pressure, when it really counts, without drugs.

Magnesium and complex carbs – There are several different things you may consider to help you deal with anxiety. You might change your diet to include foods that are rich in magnesium, such as spinach, almonds, halibut, and mackerel. Other foods that can reduce anxiety are complex carbohydrates, salmon, olive oil, garlic, sunflower seeds, dark chocolate, walnuts, bananas (very good an hour before you perform), pomegranates, blueberries, raspberries, apples, strawberries, and pineapples. You can also drink decaffeinated green tea, or chamomile tea. Try to reduce or eliminate caffeine, alcohol, and carbonated or sugary drinks, and replace them with pomegranate juice or vegetable juice, and lots of water.

Supplements and vitamins – There are also herbs that may reduce anxiety: Hawthorn, indian coleus, passion flower, kava extract, St. John’s Wort, ashwagandha, inositol, 5- HTP, bacopa monnieri, rhodiola rosea, and lavender. You might consider certain vitamins or supplements like vitamin A, B, C, niacin, calcium, antioxidants (lycopene and beta-carotene), and fish oil, as well as certain amino acids: GABA (Gamma AminoButyric Acid), L-Arginine, Tryptophan, and L-Theanine. Please check with a qualified health practitioner about dosage, proper use, and potential side effects before using any of these substances.

Discussing anxiety – Teaching performers how to deal with their nerves and performance anxiety is a new model of pedagogy. Many music, voice, and dance teachers do not discuss this important topic with their students or offer them viable solutions. Some teachers may need proper training in dealing with anxiety just as much as their students. It is best to surround yourself with people and materials where you can openly communicate about any anxiety felt.

Self-Talk – While beta blockers may help reduce the physical manifestations of performance stress, no matter how much you take, they don’t produce any meaningful mental or emotional changes. This means they don’t decrease negative thinking, mental noise, doomsday thinking, or worrying, nor do they increase desire, motivation, inspiration, resilience, courage, or mental toughness. Creating positive affirmations, writing them down, and repeating them can have a strong effect on your confidence by reprogramming your negative self-talk.

Preparation – Nothing takes the place of daily practice and proper preparation, which are very real and practical solutions to managing one’s performance anxiety. If you need to upgrade your technical skills, find a teacher you respect and follow their guidance. Plan to practice, practice, practice, both physically and mentally every day. There is no substitute or better way to build your confidence and sense of competence. Strive for excellence, not perfection, daily in the practice room.

Natural remedies – In my opinion, the most natural remedies for dealing with performance anxiety are the most effective. These include aerobic exercise, meditation, prayer, mindfulness, zazen, positive affirmations, yoga, Chi Gong, breathing techniques, T’ai Chi, cognitive-behavioral therapy, guided imagery, sufficient rest and sleep, neuro- linguistic programming, Aikido, biofeedback, EFT, systematic desensitization, self- hypnosis, mental rehearsal, autogenic training, the Silva Method, and my personal and professional favorite, the Centering Process. I recommend that performers master the Centering Process to control and channel performance energy without taking beta blockers. It’s the main strategy that I’ve taught to hundreds of clients and students at Juilliard, the New World Symphony, and the Colburn School.

Let’s get real. Performance pressure will never go away. You can just learn better ways to handle it. Some methods are more beneficial (and less harmful) than others. My belief is that beta blockers will prevent you from achieving your full potential as a musician. If you’re interested in doing your absolute best, I suggest that you pursue extra energy and excellence, not the comfort and relaxed state that you may get through drugs. I always recommend to those clients who wish to feel comfortable and relaxed, “Either go lay on the beach in Hawaii or choose to learn how to use your performance energy to do your best when it counts.”

To learn more about my Centering exercises, please visit my website (www.winningonstage.com/products/#online-courses) to find the comprehensive program.

Let’s get real. Performance pressure will never go away. You can just learn better ways to handle it. Some methods are more beneficial (and less harmful) than others. My belief is that beta blockers will prevent you from achieving your full potential as a musician. If you’re interested in doing your absolute best, I suggest that you pursue extra energy and excellence, not the comfort and relaxed state that you may get through drugs. I always recommend to those clients who wish to feel comfortable and relaxed, “Either go lay on the beach in Hawaii or choose to learn how to use your performance energy to do your best when it counts.”

To learn more about my Centering exercises, please visit my website (www.winningonstage.com/products/#online-courses) to find the comprehensive program.

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?

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.

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.

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.