Terrified About That Big Speech? A Commonly Used Blood Pressure Medication Can Work Like Magic

For those with social anxiety, speaking in front of a crowd may be impossible. Propranolol and other commonly used beta blockers may help make it go away with a single dose.

I’ve been reading a lot of posts about social anxiety lately. These articles catch my attention because I have a very serious case of the disorder to the point I was practically phobic as a child. I hardly spoke to anyone, especially kids my own age.

I can still remember an assignment I had in middle school where we had to interview a business executive. The people we were given to call were all relatives or friends of our teachers and agreed ahead of time to participate so they knew we were calling and what we were calling about. This would seem to make things easier for me plus we only had to ask something like five simple questions. But I remember panicking.

First, I made a case with the teacher to try to avoid the assignment. I offered to write ten papers if she’d just let me off the hook. Despite clearly having an anxiety attack during the conversation, she wouldn’t give in.

I couldn’t come up with any way possible that I would be able to do this assignment. My next option was to try to get a friend in the neighborhood who was in my class to do it for me. She kept resisting saying she’d already done hers and didn’t want to do mine also. I don’t remember how long it took, but eventually she agreed — I think just to get me to stop begging and pleading with her. I don’t remember how many of her papers I ended up writing, but I do know that I would have agreed to practically anything.

Once I became an adult and realized I couldn’t get my friends to do my work for me, I developed strategies to help. These included things like writing out everything I wanted to say during a phone call and practicing it beforehand, getting places at least an hour early to scope it out so I’d be a bit more comfortable with the surroundings, and putting together as much information as possible about someone I’d be speaking with.

While these strategies didn’t cause the anxiety to completely evaporate, it usually helped enough to get me through formal social interactions. At the same time, if even one small thing was thrown out of whack I’d go back into an anxiety attack which would often affect me enough to torpedo whatever the situation was.

Though not nearly as bad as I was, I had a cousin who had some similar characteristics. She attended Brandeis and was named Valedictorian. She was quite excited until being informed she’d have to make a graduation speech. She was then determined to turn down the honor.

Her father was a physician and he had heard about the off label use of Propanol for performance anxiety. He prescribed a dose for her and she went on to give the speech without much of problem.

An number of years after this, I was completing my post doctoral fellowship and facing interviews for faculty positions. In addition to interviewing with all the faculty, dean, and graduate student body, I was required to give two hour long symposia, one on something clinically related and one presenting original data based research I’d conducted.

I remember the panic I felt at the thought of getting up in front of the entire department and sometimes the entire graduate school complete with a dean or two and presenting my own work to faculty who had been doing this for much longer than I had. It seemed overwhelming. It seemed impossible.

The presentation itself wasn’t the end of the world. I had control over that part. I could practice and prepare to my heart’s content. So on a scale of one to ten in terms of anxiety, this probably only came in at a seven. Heck, that was practically relaxed for me.

What I had no way of planning for however, were the 15 -20 minutes of questions that were asked. I had no idea what would be coming at me. When the first interview was scheduled I was beside myself. I really didn’t think I was going to be able to do it.

Then I remembered my cousin’s experience and called up her father. He agreed to give me a few doses recommending I try one in a similar situation before the interview so I’d know what to expect.

I asked all the interns and other postdocs where I was completing my fellowship if I could do a practice run of my research talk in front of them. Despite the fact that I knew all of them and was supervising several of the interns, I was still just as panicked.

I took the pill an hour before my presentation and started noticing a decrease in my anxiety starting about a half an hour later. My hands stopped shaking, my pulse stopped racing, my breathing eased and I stopped feeling like I was about to jump out of my skin. The anxiety didn’t increase any when I entered the room not even when two faculty supervisors walked in at the last minute, something that would normally have pushed me over the edge.

I won’t say the presentation went perfectly. I had no teaching experience and other than the few times I had to present for a class, no real presentation experience either. But it was clear what I needed to work on, things like timing, the speed I spoke at, and my ability to engage an audience without notes or cards to fall back on. These things would have been controllable even without the medication.

The miracle came from the almost complete lack of anxiety I felt. I won’t say it was gone 100 percent, but then I wouldn’t have wanted it to be. I wouldn’t have known what to do without at least some nervousness. Mild-moderate anxiety motivates me and keeps me sharp. But this experience was something else entirely.

I’d never known what it felt like to be in any type of social situation and not be scared into silence. In this situation I was calm and confident about my abilities. I didn’t say anything stupid or answer a question that hadn’t been asked. My mind didn’t go blank and I was able to handle the feedback I received graciously without becoming awkward.

I had two more pills and I took one for my first interview. It went so well that my confidence was boosted enough I didn’t feel the need to take the last one for the next interview. I saved it in case I had some kind of power interview or was interviewing at a school known for conducting “stress interviews.” I got through 12 interviews without ever taking that last pill.

Trying to think about what had changed for me when I took the medication, I realized it wasn’t something cognitive. This surprised me because I always thought that it was my thoughts that got me into trouble. Thoughts like, “They’ll never like me,” “What makes me think I can possibly hold my own with full faculty members,” or “Everyone else they’re interviewing will be much better than me.” After all, I was a cognitive behaviorist and knew all about how thoughts affect our emotions and behaviors.

It just seemed logical that it had to be the thoughts that triggered all of the physical symptoms. After all, how could the physical symptoms begin out of the blue without any type of cognitive input and go on to cause the thoughts to occur?

But although the medication didn’t directly affect thoughts, the lack of physiological symptoms evidently made my brain think, “Hmmm, pulse normal, dry palms, normal respiration? Can’t be anxious then.” The astounding thing was that this seemed to then caused my mind to shelve the negative thoughts. What was even more amazing was that one success experience was enough for me to not need the medication any more.

I can’t say there wasn’t anxiety or that the anxiety wasn’t higher than it had been when I took the medication. But it was manageable. For the first time it didn’t torpedo my professional interactions.

Beta-blockers aren’t new, they’ve actually been around for decades. Although they’re considered to be an effective treatment option for heart and blood pressure conditions, some doctors say they aren’t an ideal option for situational anxiety. But many others believe that for people who suffer from strong physical anxiety symptoms beta blockers can be extremely helpful.

With paralyzing social anxiety, the effects of the anxiety often result in exactly what the person is afraid of. For me, when I tried to force myself to interact socially, I would stumble and falter, say the wrong thing, try to enter a conversation clumsily, or not be able to think fast enough to generate an appropriate response.

This resulted in some degree of social rejection and bullying in school when I was growing up. I could avoid some of this by just not interacting with my peers which greatly decreased the anxiety while I was avoiding it. But didn’t allow me to learn how to interact appropriately with peers as a child.

The constant fear of judgement, negative evaluation and rejection helps maintain social anxiety over time. Like with any anxiety disorder, avoidance of what you fear results in avoiding or preventing the anxiety. For those who don’t have social anxiety (social phobia) you have no idea what a relief it is to avoid this reaction.

The best thing about beta blockers is that when you face your fear, without having the physical symptoms you normally associate with anxiety, eventually that fear diminishes or even goes away all together. While, like anything, this type of medication doesn’t work for everyone and there are reports that say it hasn’t been shown to be effective, I do know that it was for me. It made the difference between being able to interview competently and not suffer while doing it and coming across as someone who’d be unable to interact in a professional setting. So, just how big of a difference was that really, you ask?

Well, I’d say about as big as the difference between getting zero offers after twelve interviews and getting twelve.

Natalie C. Frank, has a Ph.D. in Clinical Psychology. Her area of specialization is Pediatric Psychology and Behavioral Medicine.

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