Beta Blockers

Let’s talk about drugs!

My pharmacist summed up exactly how I feel as she handed me my prescription, “Have you tried these yet? This stuff is good!”

I’m going to get this out of the way early - if you are even considering using beta blockers, just go and get them right now. RIGHT NOW PEOPLE! I kept going back and forth about it and my performance anxiety only got worse when I could have freed myself much earlier. The truth is, you do need them.

What do beta blockers do?

Without getting too sciencey, my general summarization - especially for a musician’s purpose - is that beta blockers lessen or get rid of physical symptoms of performance anxiety so you can focus on the mental and expressive aspects of performing.

These physical symptoms may manifest as a combination of involuntary disengagement of the fingers, limbs, embouchure, and vocal muscles, shortness of breath, and loss of focus or confusion. A shaky voice, fast heartbeat, sweating or dizziness are also common symptoms. These are the potential realities of performance anxiety. Imagine trying to play an instrument through this, let alone play it well! These symptoms are the result of the classic adrenaline inducing, fight or flight response our bodies use to protect us from stress. However, we don’t have the same kind of life threatening stresses we used to and some of our bodies have not gotten that memo. Silly evolution!

With the intention of survival, sometimes our bodies and minds get confused, or jump to conclusions, and don’t always act in our best interest. Stress and stressors are almost always referred to with it’s bad connotations, and a lot of stress is bad. However, some stressors can be good! Like how the heightened risk of performing motivates us to work hard, or how feeling hungry encourages us to eat. The body is obsessed with feeling comfortable, so much so that it trains itself to trigger stress hormones in order to avoid feeling otherwise, whether it will benefit the situation or not. The body begins diverting it’s resources away from productive action and mental focus towards defensive reflex and even inflammation.

Worrying about the physical symptoms of anxiety showing up at the next performance often causes more anxiety that feeds back into itself. Each performance becomes more and more difficult to stay composed through - the bare minimum goal when performing. The body gradually tries to urge you into the flight option as fighting gets to be too hard.

Needless to say, these symptoms can be very jarring! Not only is it distracting to the performer, but it can distract the audience as well. If you can eliminate that huge distraction with beta blockers, you can finally begin to implement all the typical advice teachers give for dealing with basic stage fright, usually as an innocent attempt to remedy performance anxiety. This would be the mental aspects of performing, like focusing on the musical storytelling, trusting your preparation, and remembering that your audience wants you to do well (though to be honest, oftentimes in a conservatory setting that’s not always the case, which is why it’s so common for musicians to develop performance anxiety during college).

In a small aside, I would like to highlight how some advice can be potentially dangerous to hypersensitive students. Teachers, be careful to not accuse them of being under prepared. “If you had practiced more, then you wouldn't be so nervous or sound so bad.” That can lead to internalizing how they must not be working hard enough. They feel labeled, and may feel helpless to improve if they truly did work hard. These students could start getting discouraged and apathetic OR start to over do it and resort to obsessive preparation tactics such as mindless repetition until a passage is habitually correct, or staying up all night to make “the perfect reed” instead of healthy or thoughtful ones. They may do this subconsciously as a desperate attempt to make their next performance a good one. It usually ends up having the opposite effect by increasing anxiety/pressure around that performance and can lead to stress injuries/tendonitis. After all, some teachers insist on practicing until the anxiety goes away. If the anxiety is real, such approaches only do more damage since performance anxiety is too environmentally and contextually specific. Truly anxious minds will work themselves to the bone, and still struggle. Please remember, all practicing is invisible to the teacher. You never really know how hard your students are working. Communication is important in these situations, students should be given an opportunity to discuss what’s truly going on.

I am speaking directly from experience. We don’t sound like that in our practice room, it’s the anxiety that makes us sound like that. So teachers, be extra aware of your wording when dealing with a student who struggles with fully fledged performance anxiety compared to those with regular stage fright or those who genuinely aren’t showing interest in doing the work. Students, if you hear this kind of response after honestly expressing your struggles then it is probably time to look for a teacher who is more understanding or familiar with what you are actually dealing with. It will be extremely important to have a sympathetic mentor if you want to resolve these issues. And no this anxiety does not necessarily mean you should quit music.

Now to get a little more sciencey, beta blockers do exactly what they say. They block stress hormones, adrenaline, cortisol, and others, from making contact with your heart’s beta receptors. This keeps your heart rate steady, manages all the previously mentioned musculoskeletal symptoms, and conserves energy better used for playing beautiful music. By decreasing your body’s physical reaction to stress, you will begin to worry less about the symptoms which helps prevent that anxiety from fueling itself. Usually, each performance will get a little bit easier over time. You may not even feel the need to take beta blockers after awhile.

It is important to know that beta blockers do not treat long term anxiety or any underlying psychological causes of it. Some people no longer need to use them for performances after addressing the source of their daily anxieties with the help of mental health professionals and other medication. Take time to consider what the underlying cause is for you. Beta blockers can be a good start, but not a long term solution for everyone.

Beta blockers are as sensitive a subject as any mental health medication. Way more people are taking them than are openly admitting - not that they need to. There is somehow still stigma attached to having to take a teeny tiny baby pill in order to perform your best. That stigma is extremely hypocritical considering it’s common knowledge many famous musicians would, or do, drink hard alcohol and/or smoke before a show. No judgement here, maybe the times were different, but it’s clear which is the healthier choice.

Some people are afraid needing to take a pill looks bad when it comes to getting solo parts or job positions. Similar insecurities are associated with struggling with tendonitis, carpal tunnel syndrome, or focal dystonia. The fear that if our bodies cannot meet the highly competitive demands of the classical music world, we might be overlooked for someone “healthier” or even labeled as a lesser musician - even if it only appears as if our bodies or minds are less able.

This is extremely isolating for those struggling with these insecurities. It is exactly why I’m writing this and started my blog in the first place.

Now, some of these roadblocks are very serious and can unfortunately have a point of no return. However, some can be worked through to the other side, or at the very least managed. I would place performance anxiety in that box, however it of course depends on the individual and their experiences. It has to be worth the extremely difficult fight.

If you don’t need to take beta blockers then that’s so great and I’m envious of you! Some think those taking beta blockers somehow have an extra assist. I would argue that musicians who don’t need a pill actually have an upper hand. No one taking beta blockers, or most pills for that matter, wants to be taking them (until they experience the benefits and understand what their body needs in order to function most effectively). Believe me, if our brains and bodies could just chill the f*** out, then we probably wouldn’t be taking them. We take them because we have a huge crutch to deal with when it comes to performing. It’s usually the result of caring a lot combined with being very hard on ourselves.

But let me tell you! This is absolutely no steroid drug to help you get ahead of anyone else. If you are bad, then you are just bad. This pill will not help you practice. Someone described them to me as performance enablers, not enhancers. Love it, it’s perfect.

This pill in no way fixes all of your performance anxiety problems. Things don’t go back to “the way they used to be.” However, at least for me, they helped my shaky limbs and uncontrollable embouchure slow down a minute. This allowed me to focus on what I needed to do mentally in order to keep myself in the moment of that performance so I could start to trust myself, my preparation, my reeds, and my abilities again. So I could simply start to enjoy playing my instrument again! Only then was I able to implement all of that common advice spewed at me about performance anxiety that’s likely about common nerves. Totally different thing. At least two to five levels more chill than performance anxiety. If the common advice doesn’t work, and you know it doesn’t, beta blockers are your next step.

Another common concern is that beta blockers can make your mind a bit fuzzy, or block the adrenaline too much so you feel like a zombie while playing. The worry is that your music would probably sound flat and not very interesting. I have personally not met anyone who’s experienced this, nor have I myself. Perhaps if you didn’t have fully fledged performance anxiety and took a beta blocker, you might feel like this? (Like I keep saying, anxiety is much more serious than stage fright and at this point we should probably just rename it because people use the term too flippantly.) But again, everyone is different! It’s always worth a try and quite honestly during those very low times I would have preferred feeling like a zombie than a cocaine addict during performances.

Beta blockers work better some days than others. Some days I don’t even need to take them for a performance, but other days I need to take them for just a rehearsal - or even a mere practice session when I was at my lowest. You’ll figure it out as you go and as you start to understand your performance anxiety catalysts. Not all performances are created equally. Usually people take beta blockers for just about everything when they first start using them. This is for insurance/experimental purposes and maybe even a nice placebo effect. Never underestimate the power of a nice placebo effect!

My prescription: Propranolol 10mg (common brand name: Inderal). There are many brands of beta blockers that are very affordable, GoodRx brings mine below $15.

I take 5mg, about 30-40 minutes before I perform. Occasionally if I feel like I’m starting to get anxious earlier than that, like during my travel to the performance location, I’ll just pop one in to stop freaking out.

If I feel like I might need more than that because I’ll be extra anxious, I take a full 10mg pill, about 1 hour before performing. BUT this takes longer to kick in for me, which usually creates a longer build up of anxiety that’s hard to come back from…

I needed to take 10mg when I first started using beta blockers but now I find it’s not as effective as taking 5mg. You’ll feel it out as you go and begin to get more comfortable. You’ll miscalculate and bomb a performance after taking a pill sometimes too. It’s all part of the healing and managing process. Just remember there will always be another performance while you work on strengthening your humility. It is perfectly ok if your primary goal is related to managing your anxiety while your performance quality takes a back seat for awhile.

Occasionally I get dry mouth from taking beta blockers. That’s easy to combat by keeping water with you while you perform. This seems to happen less often or I could be noticing it less or just less bothered by it. Actually, lately I’ve been feeling extra spitty when I practice. I don’t know what that’s about but a drier mouth is sometimes welcomed.

So, how do you get beta blockers?

You can literally just go to a regular physician and say why you need this and they will more or less give it to you after asking some questions about family history, heart disease, etc. What you take is such a small amount that it’s pretty inconsequential. Smaller than an over the counter pain killer or anti-inflammatory.

BEWARE! Most doctors won’t really understand what you’re talking about...They might accidentally give you the wrong prescription, like say, the kind you take every day that they think is less addicting...and they would be wrong.

Don’t say, “Well they’re a doctor, surely they know what they’re talking about!”

They don’t. Ok?

That kind of pill will only make things much worse, obviously because you are not in a constant state of performing. You probably don’t need to be calmed down when you’re being normal, unless you need a different medication. It made my performance anxiety symptoms even worse than before and I started feeling anxious while I was not performing. I don’t remember the name of that prescription but be wary of any similar suggestions.

Of course I learned this the hard way and upon my return to the doctor, they had done research and felt bad about giving me the wrong prescription. The doctor walked in and said, “I gave you the wrong prescription.”

I replied, “Yes.” And then my face turned all red because someone was looking at me and I just spoke out loud.

To reiterate, performance anxiety is an unintentional and irrational physical reaction to the sudden increase of stress that comes with performing, even if that stress is considered ‘good’ or motivational. My friend compared it to an allergy; just because you are allergic to trees or grass doesn’t mean you stay inside all day! You take a pill or use nasal spray so you can live a normal life instead of wasting the body’s involuntary function. It can happen to anybody, but that doesn’t mean it should. This is true for all involuntary responses your body can get incorrect, we have the science to fix it.

The main takeaway is to not wait to get the help you need, especially when this kind of help is a bit easier and cheaper to get than others. The time is long over due to #endthestigma so we can create a community of support within this competitive field. Needing beta blockers does not mean you are a bad musician or artist, in fact, some of the best performers use it without you even knowing!

Like I keep saying, everyone is different, but it will be worth the extra hassle of getting beta blockers in order to return to loving what you love to do. Reward yourself for the hard work you put in, take the tiny pill, and revel in every minute you are able to speak clearly to your audience.