Performance anxiety is one of the most common complaints of musicians, from amateur performers to top professionals. While it is completely normal for a musician to get nervous before a performance, some find that the manifestation of their symptoms is enough to keep them from performing at their best. Luckily, this subject has had lots of light shed on it in the past few years.

Although a bout of nerves may spur a performer to do well, some people find that they “believe they have to suffer to perform well,” says Helen Spielman, a performance anxiety coach, in her wonderful article “Conquering Performance Anxiety from Inside Out.” This suffering can be more than just butterflies in the stomach, and can suck the joy out of performing, or in the worst cases, end a career. Musicians can find it difficult to breathe because of constricted airways, nausea or dizziness, shaking limbs, or debilitating general anxiety. Many of these symptoms come about through a cycle of negative self-talk, especially before a performance. Personally, I hype myself up to the point of expecting perfection from every performance, and I convince myself that anything less will be a failure.

Thankfully, there have been many developments in the study and treatment of performance anxiety in the past decade or so. Progressive relaxation, breathing techniques such as alternate nostril breathing, and coaching and therapy are all very effective. There is also a class of drugs, called beta-blockers, that can be used to change the chemistry of the brain that causes these physical and emotional symptoms. Beta blockers block the receptors for the physical effects of a person’s natural fight or flight response: they chemically fit into beta receptors and prevent norepinephrine from binding to the receptors that cause the symptoms of the fight-or-flight response. These can be quite helpful, especially in severe cases, but they can only be obtained with a doctor’s examination and prescription.