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Fear of public speaking: how can i overcome it, how can i overcome my fear of public speaking.

Fear of public speaking is a common form of anxiety. It can range from slight nervousness to paralyzing fear and panic. Many people with this fear avoid public speaking situations altogether, or they suffer through them with shaking hands and a quavering voice. But with preparation and persistence, you can overcome your fear.

These steps may help:

• Know your topic. The better you understand what you're talking about — and the more you care about the topic — the less likely you'll make a mistake or get off track. And if you do get lost, you'll be able to recover quickly. Take some time to consider what questions the audience may ask and have your responses ready.
• Get organized. Ahead of time, carefully plan out the information you want to present, including any props, audio or visual aids. The more organized you are, the less nervous you'll be. Use an outline on a small card to stay on track. If possible, visit the place where you'll be speaking and review available equipment before your presentation.
• Practice, and then practice some more. Practice your complete presentation several times. Do it for some people you're comfortable with and ask for feedback. It may also be helpful to practice with a few people with whom you're less familiar. Consider making a video of your presentation so you can watch it and see opportunities for improvement.
• Challenge specific worries. When you're afraid of something, you may overestimate the likelihood of bad things happening. List your specific worries. Then directly challenge them by identifying probable and alternative outcomes and any objective evidence that supports each worry or the likelihood that your feared outcomes will happen.
• Visualize your success. Imagine that your presentation will go well. Positive thoughts can help decrease some of your negativity about your social performance and relieve some anxiety.
• Do some deep breathing. This can be very calming. Take two or more deep, slow breaths before you get up to the podium and during your speech.
• Focus on your material, not on your audience. People mainly pay attention to new information — not how it's presented. They may not notice your nervousness. If audience members do notice that you're nervous, they may root for you and want your presentation to be a success.
• Don't fear a moment of silence. If you lose track of what you're saying or start to feel nervous and your mind goes blank, it may seem like you've been silent for an eternity. In reality, it's probably only a few seconds. Even if it's longer, it's likely your audience won't mind a pause to consider what you've been saying. Just take a few slow, deep breaths.
• Recognize your success. After your speech or presentation, give yourself a pat on the back. It may not have been perfect, but chances are you're far more critical of yourself than your audience is. See if any of your specific worries actually occurred. Everyone makes mistakes. Look at any mistakes you made as an opportunity to improve your skills.
• Get support. Join a group that offers support for people who have difficulty with public speaking. One effective resource is Toastmasters, a nonprofit organization with local chapters that focuses on training people in speaking and leadership skills.

If you can't overcome your fear with practice alone, consider seeking professional help. Cognitive behavioral therapy is a skills-based approach that can be a successful treatment for reducing fear of public speaking.

As another option, your doctor may prescribe a calming medication that you take before public speaking. If your doctor prescribes a medication, try it before your speaking engagement to see how it affects you.

Nervousness or anxiety in certain situations is normal, and public speaking is no exception. Known as performance anxiety, other examples include stage fright, test anxiety and writer's block. But people with severe performance anxiety that includes significant anxiety in other social situations may have social anxiety disorder (also called social phobia). Social anxiety disorder may require cognitive behavioral therapy, medications or a combination of the two.

Craig N. Sawchuk, Ph.D., L.P.

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• Social anxiety disorder (social phobia). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association, 2013. http://dsm.psychiatryonline.org. Accessed April 18, 2017.
• 90 tips from Toastmasters. Toastmasters International. https://www.toastmasters.org/About/90th-Anniversary/90-Tips. Accessed April 18, 2017.
• Stein MB, et al. Approach to treating social anxiety disorder in adults. http://www.uptodate.com/home. Accessed April 18, 2017.
• How to keep fear of public speaking at bay. American Psychological Association. http://www.apa.org/monitor/2017/02/tips-sidebar.aspx. Accessed April 18, 2017.
• Jackson B, et al. Re-thinking anxiety: Using inoculation messages to reduce and reinterpret public speaking fears. PLOS One. 2017;12:e0169972.
• Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. April 24, 2017.

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How to Manage Public Speaking Anxiety

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

Luis Alvarez / Getty Images

Speech Anxiety and SAD

How to prepare for a speech.

Public speaking anxiety, also known as glossophobia , is one of the most commonly reported social fears.

While some people may feel nervous about giving a speech or presentation if you have social anxiety disorder (SAD) , public speaking anxiety may take over your life.

Public speaking anxiety may also be called speech anxiety or performance anxiety and is a type of social anxiety disorder (SAD). Social anxiety disorder, also sometimes referred to as social phobia, is one of the most common types of mental health conditions.

Public Speaking Anxiety Symptoms

Symptoms of public speaking anxiety are the same as those that occur for social anxiety disorder, but they only happen in the context of speaking in public.

If you live with public speaking anxiety, you may worry weeks or months in advance of a speech or presentation, and you probably have severe physical symptoms of anxiety during a speech, such as:

• Pounding heart
• Quivering voice
• Shortness of breath
• Upset stomach

Causes of Public Speaking Anxiety

These symptoms are a result of the fight or flight response —a rush of adrenaline that prepares you for danger. When there is no real physical threat, it can feel as though you have lost control of your body. This makes it very hard to do well during public speaking and may cause you to avoid situations in which you may have to speak in public.

How Is Public Speaking Anxiety Is Diagnosed

Public speaking anxiety may be diagnosed as SAD if it significantly interferes with your life. This fear of public speaking anxiety can cause problems such as:

• Changing courses at college to avoid a required oral presentation
• Changing jobs or careers
• Turning down promotions because of public speaking obligations
• Failing to give a speech when it would be appropriate (e.g., best man at a wedding)

If you have intense anxiety symptoms while speaking in public and your ability to live your life the way that you would like is affected by it, you may have SAD.

Public Speaking Anxiety Treatment

Fortunately, effective treatments for public speaking anxiety are avaible. Such treatment may involve medication, therapy, or a combination of the two.

Short-term therapy such as systematic desensitization and cognitive-behavioral therapy (CBT) can be helpful to learn how to manage anxiety symptoms and anxious thoughts that trigger them.

Ask your doctor for a referral to a therapist who can offer this type of therapy; in particular, it will be helpful if the therapist has experience in treating social anxiety and/or public speaking anxiety.

Research has also found that virtual reality (VR) therapy can also be an effective way to treat public speaking anxiety. One analysis found that students treated with VR therapy were able to experience positive benefits in as little as a week with between one and 12 sessions of VR therapy. The research also found that VR sessions were effective while being less invasive than in-person treatment sessions.

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If you live with public speaking anxiety that is causing you significant distress, ask your doctor about medication that can help. Short-term medications known as beta-blockers (e.g., propranolol) can be taken prior to a speech or presentation to block the symptoms of anxiety.

Other medications may also be prescribed for longer-term treatment of SAD, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). When used in conjunction with therapy, you may find the medication helps to reduce your phobia of public speaking.

In addition to traditional treatment, there are several strategies that you can use to cope with speech anxiety and become better at public speaking in general . Public speaking is like any activity—better preparation equals better performance. Being better prepared will boost your confidence and make it easier to concentrate on delivering your message.

Even if you have SAD, with proper treatment and time invested in preparation, you can deliver a successful speech or presentation.

Pre-Performance Planning

Taking some steps to plan before you give a speech can help you better control feelings of anxiety. Before you give a speech or public performance:

• Choose a topic that interests you . If you are able, choose a topic that you are excited about. If you are not able to choose the topic, try using an approach to the topic that you find interesting. For example, you could tell a personal story that relates to the topic as a way to introduce your speech. This will ensure that you are engaged in your topic and motivated to research and prepare. When you present, others will feel your enthusiasm and be interested in what you have to say.
• Become familiar with the venue . Ideally, visit the conference room, classroom, auditorium, or banquet hall where you will be presenting before you give your speech. If possible, try practicing at least once in the environment that you will be speaking in. Being familiar with the venue and knowing where needed audio-visual components are ahead of time will mean one less thing to worry about at the time of your speech.
• Ask for accommodations . Accommodations are changes to your work environment that help you to manage your anxiety. This might mean asking for a podium, having a pitcher of ice water handy, bringing in audiovisual equipment, or even choosing to stay seated if appropriate. If you have been diagnosed with an anxiety disorder such as social anxiety disorder (SAD), you may be eligible for these through the Americans with Disabilities Act (ADA).
• Don’t script it . Have you ever sat through a speech where someone read from a prepared script word for word? You probably don’t recall much of what was said. Instead, prepare a list of key points on paper or notecards that you can refer to.
• Develop a routine . Put together a routine for managing anxiety on the day of a speech or presentation. This routine should help to put you in the proper frame of mind and allow you to maintain a relaxed state. An example might be exercising or practicing meditation on the morning of a speech.

Practice and Visualization

Even people who are comfortable speaking in public rehearse their speeches many times to get them right. Practicing your speech 10, 20, or even 30 times will give you confidence in your ability to deliver.

If your talk has a time limit, time yourself during practice runs and adjust your content as needed to fit within the time that you have. Lots of practice will help boost your self-confidence .

• Prepare for difficult questions . Before your presentation, try to anticipate hard questions and critical comments that might arise, and prepare responses ahead of time. Deal with a difficult audience member by paying them a compliment or finding something that you can agree on. Say something like, “Thanks for that important question” or “I really appreciate your comment.” Convey that you are open-minded and relaxed. If you don’t know how to answer the question, say you will look into it.
• Get some perspective . During a practice run, speak in front of a mirror or record yourself on a smartphone. Make note of how you appear and identify any nervous habits to avoid. This step is best done after you have received therapy or medication to manage your anxiety.
• Imagine yourself succeeding . Did you know your brain can’t tell the difference between an imagined activity and a real one? That is why elite athletes use visualization to improve athletic performance. As you practice your speech (remember 10, 20, or even 30 times!), imagine yourself wowing the audience with your amazing oratorical skills. Over time, what you imagine will be translated into what you are capable of.
• Learn to accept some anxiety . Even professional performers experience a bit of nervous excitement before a performance—in fact, most believe that a little anxiety actually makes you a better speaker. Learn to accept that you will always be a little anxious about giving a speech, but that it is normal and common to feel this way.

Setting Goals

Instead of trying to just scrape by, make it a personal goal to become an excellent public speaker. With proper treatment and lots of practice, you can become good at speaking in public. You might even end up enjoying it!

Put things into perspective. If you find that public speaking isn’t one of your strengths, remember that it is only one aspect of your life. We all have strengths in different areas. Instead, make it a goal simply to be more comfortable in front of an audience, so that public speaking anxiety doesn’t prevent you from achieving other goals in life.

A Word From Verywell

In the end, preparing well for a speech or presentation gives you confidence that you have done everything possible to succeed. Give yourself the tools and the ability to succeed, and be sure to include strategies for managing anxiety. These public-speaking tips should be used to complement traditional treatment methods for SAD, such as therapy and medication.

Crome E, Baillie A. Mild to severe social fears: Ranking types of feared social situations using item response theory . J Anxiety Disord . 2014;28(5):471-479. doi:10.1016/j.janxdis.2014.05.002

Pull CB. Current status of knowledge on public-speaking anxiety . Curr Opin Psychiatry. 2012;25(1):32-8. doi:10.1097/YCO.0b013e32834e06dc

Goldstein DS. Adrenal responses to stress . Cell Mol Neurobiol. 2010;30(8):1433-40. doi:10.1007/s10571-010-9606-9

Anderson PL, Zimand E, Hodges LF, Rothbaum BO. Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure . Depress Anxiety. 2005;22(3):156-8. doi:10.1002/da.20090

Hinojo-Lucena FJ, Aznar-Díaz I, Cáceres-Reche MP, Trujillo-Torres JM, Romero-Rodríguez JM. Virtual reality treatment for public speaking anxiety in students. advancements and results in personalized medicine .  J Pers Med . 2020;10(1):14. doi:10.3390/jpm10010014

Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A. Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis . J Psychopharmacol (Oxford). 2016;30(2):128-39. doi:10.1177/0269881115612236

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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To Overcome Your Fear of Public Speaking, Stop Thinking About Yourself

• Sarah Gershman

Tips for before and during your presentation.

Even the most confident speakers find ways to distance themselves from their audience. It’s how our brains are programmed, so how can we overcome it? Human generosity. The key to calming the amygdala and disarming our panic button is to turn the focus away from ourselves — away from whether we will mess up or whether the audience will like us — and toward helping the audience. Showing kindness and generosity to others has been shown to activate the vagus nerve, which has the power to calm the fight-or-flight response. When we are kind to others, we tend to feel calmer and less stressed. The same principle applies in speaking. When we approach speaking with a spirit of generosity, we counteract the sensation of being under attack and we feel less nervous.

Most of us — even those at the top — struggle with public-speaking anxiety. When I ask my clients what makes them nervous, invariably they respond with the same answers:

• Sarah Gershman is an executive speech coach and CEO of Green Room Speakers. She is a professor at the McDonough School of Business at Georgetown University, where she teaches public speaking to leaders from around the globe.

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How to Reduce the Anxiety of Public Speaking

Most people hate it. here's one way to hate it less..

Posted November 22, 2021 | Reviewed by Gary Drevitch

• What Is Anxiety?
• Find a therapist to overcome anxiety

Anxiety and stress go with public speaking for all but a lucky few. Now a recent study underscores the importance of recognizing and accepting those emotions rather than trying to deny them. According to the study, if you journal about your anxieties and stress, and accept them, letting them run their course, the result is improved mental health compared to the rest of us who judge ourselves. The negative moods don’t last as long and are not as powerful.

I like this strategy. Denying that I was anxious was certainly my standard operating procedure when I was beginning in the business, first as an actor and then as a speaker on speaking, communications, storytelling, and body language . Denial didn’t help me, of course, just as it has helped no one else, and it wasn’t long before my anxiety was reaching epic proportions and the beginnings of speeches were going by in a blur of adrenaline. I had to do something, and so began my lifelong pursuit of ways to reduce the pain of public speaking for myself and others.

In these early days, it never occurred to me to look straight into the heart of darkness: the anxious core of public speaking, the self-consciousness that intrudes when we feel exposed standing before a group of people. Most of my methods involved tricking or distracting my brain long enough to give the speech and get to the bar. For example, getting some moderate exercise before a speech allows some of the nervous energy to dissipate so that you are calmer than you otherwise would be. Meditating can work, too, for those who have some experience with that form of mental discipline. My favorite distraction from those days turned out to be having the airline lose my luggage – with my speaking suit in it – so that I had to go shopping at 9:00 before the speech at 10:00. Good thing I could walk right into a 42 Long. I was so distracted by the suit crisis that I never got nervous for the speech.

That’s an expensive distraction, however, and I don’t recommend it as a long-term solution. Also, I started carrying my suit in my carry-on luggage, so the tactic no longer worked in any case.

My father passed away the day before a speech years ago, and I was too distraught to be nervous. But again, I don’t recommend that as a permanent solution, since our supply of fathers is generally limited to one or two.

Eventually, I focused on three truly helpful strategies.

1. A simple physical exercise that helps control anxiety: deep, slow breathing. The key is to breathe out on a longer count than the in-breath.

2. Positive self-talk . Find your mantra and repeat it ad infinitum. Whenever you have a dull moment, whenever you are nervous or anxious about an upcoming speech, and whenever you have trouble sleeping . I’ve used this technique for years, and I’m pleased to say I’ve just about wiped my mental slate clean of debilitating negative patterns of thinking. I’ve also witnessed many clients and friends benefitting from this technique. If it sounds New-Agey to you, get over yourself and get to work. In the long run, you’ll thank me.

3. Finally, the most powerful technique for getting over stage fright is to realize that a speech is not about you, but about the audience. Put yourself in service to the audience in front of you, get out of your own way, and think about them. You will be liberated and even find the joy in public speaking, and that is indeed a good place for both audience and speaking to be.

Now we can add journaling to our arsenal of mental weapons designed to keep anxiety and stress at bay. May we all write our way to the calm after the storm.

Nick Morgan, Ph.D. , is president of Public Words Inc., a communications consulting company, and the author of books including Can You Hear Me?: How to Connect with People in a Virtual World.

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Understanding And Overcoming Public Speaking Anxiety

Most of us might experience what is commonly known as stage fright or speaking anxiety, nervousness and stress experienced around speaking situations in front of audience members. Even for experienced speakers, this can be a normal response to pressurized situations in which we are the focus of attention—such as we might encounter in front of an audience. For some people, though, the fear of public speaking and nervous energy can be much more severe, and can be a sign of an anxiety disorder. 

Speaking anxiety is considered by many to be a common but challenging form of social anxiety disorder that can produce serious symptoms, and can possibly impact an individual’s social life, career, and emotional and physical well-being. 

In this article, we’ll explore what speaking anxiety is, common symptoms of it, and outline several tips for managing it.

Identifying public speaking anxiety: Definition, causes, and symptoms

According to the American Psychological Association,  public speaking anxiety  is the “fear of giving a speech or presentation in public because of the expectation of being negatively evaluated or humiliated by others”. 

Often associated with a lack of self-confidence, the disorder is generally marked by severe worry and nervousness, in addition to several physical symptoms. The fear can be felt by many, whether they are in the middle of a speech or whether they are planning to speak at a future point. They may also generally fear contact with others in informal settings.

Public speaking anxiety can be a common condition, with an with an  estimated prevalence of 15-30%  among the general population.

Public speaking anxiety is considered by many to be a form of social anxiety disorder (SAD). The Diagnostic and Statistical Manual of Mental Disorder (DSM-V) includes a  performance specifier that allows a SAD diagnosis to relate specifically to anxiety surrounding public speaking or performing. For some extreme forms of this mental health condition, a medical professional may prescribe medication that can help overcome severe symptoms—although for most people this won’t be necessary.

The symptoms of performance-type social anxiety can include:

• Worry or fear surrounding public speaking opportunities or performing, even in front of friendly faces
• Avoiding situations in which public speaking or performing may be necessary
• Shaky voice, especially when one has to speak in public
• Stomach pain or gastrointestinal discomfort
• Rapid breathing

There are several strategies for addressing the symptoms of this and feeling more confident with your oratory skills, whether you need to use them at work, in formal social settings or simply in front of friends. 

The following are several strategies you can employ to address the fear of public speaking and manage your fear when it arises.

While the primary concern for those who experience speaking anxiety might typically be the fear of judgment or embarrassment when speaking publicly, there can be other causes contributing to distress. To figure out how to address this, it can help to understand potential contributing factors—as well as how others may be dealing with it on their own. 

First, it can be helpful to determine where the fear came from in the first place. Here are some  common sources of public speaking anxiety :

• Negative past experiences with public speaking
• Lack of preparedness
• Low self-esteem (this possible cause can cause feelings of overwhelm if one has to give a speech) 
• Inexperience with public speaking 
• Unfamiliar subject matter
• Newness of environment
• Fear of rejection (such as from an audience) 

Practice deep breathing

Public speaking anxiety might often be accompanied by feelings of stress, and also often affects physical factors such as increased speed of heart rate, tension, and rapid breathing. If you’re dealing with speaking anxiety and want to calm your nerves before a public speaking event, it can be helpful to practice deep breathing exercises. Deep breathing is considered by many to be a widely utilized technique  that can help bring your nervous system out of fight-or-flight mode, relax your body, and quiet your mind. Many find it to be one of the most convenient ways to manage symptoms, as many can do it anywhere as needed. 

To practice deep breathing prior to speaking, consider using a method called box breathing: breathe in for a four count, hold for a four-count, breathe out for a four count and hold again for a four count. You can repeat this process three to four times, possibly incorporating it with other relaxation techniques. It can also help to be mindful of your breathing as you’re presenting, which can help you steady your voice and calm your nerves.  

Practice visualization

When we experience nervousness, we can sometimes focus on negative thoughts and worst-case scenarios, despite the reality of the situation. You can work to avoid this by practicing positive visualization—such as imagining friendly faces in the crowd or you acing the main content of your speech. Positive thinking can be an effective technique for managing performance anxiety. 

Visualization is generally regarded as a research-backed method of addressing speaking anxiety that involves imagining the way a successful scenario will progress in detail. 

Having a clear idea of how your presentation will go, even in your mind’s eye, can help you gain confidence and make you feel more comfortable with the task at hand.

Understand your subject matter 

The fear of speaking in front of others can be related to potential embarrassment that may occur if we make a mistake. To reduce the risk of this possibility, it can help to develop a solid understanding of the material you’ll be presenting or performing and visualize success. For example, if you’re presenting your department’s sales numbers at work, familiarizing yourself with the important points and going over them multiple times can help you better retain the information and feel more comfortable as you give the presentation. 

Set yourself up for success

Doing small things to prepare for a speech or performance can make a big difference in helping to alleviate public speaking anxiety. If possible, you may want to familiarize yourself with the location in which you’ll be speaking. It can also help to ensure any technology or other media you’ll be setting up is functional. For example, if you’re using visual aids or a PowerPoint deck, you might make sure it is being projected properly, the computer is charged and that you can easily navigate the slides as you present.

You might even conduct run-throughs of the presentation for your speaking experience. You can practice walking the exact route you’ll take to the podium, setting up any necessary materials, and then presenting the information within the time limit. Knowing how you’ll arrive, what the environment looks like and where exactly you’ll be speaking can set you up for success and help you feel more comfortable in the moment.

Practicing your presentation or performance is thought to be a key factor in reducing your fear of public speaking. You can use your  practice time  to recognize areas in which you may need improvement and those in which you excel as a speaker. 

For example, you might realize that you start rushing through your points instead of taking your time so that your audience can take in the information you’re presenting. Allowing yourself the chance to practice can help you get rid of any filler words that may come out during a presentation and make sure all your points are clear to keep the audience’s interest. Additionally, a practice run can help you to know when it is okay to pause for effect, take some deep breaths, or work effective body language such as points of eye contact into your presentation. 

It may also be helpful to practice speaking in smaller social situations, in front of someone you trust, or even a group of several familiar people. Research suggests that practicing in front of an audience of supportive, friendly faces can improve your performance—and that the larger the mock audience is, the better the potential results may be. 

To do this, you can go through the process exactly like you would if they were real audience. Once you’re done, you can ask them for feedback on the strengths and weaknesses of your presentation. They may have insights you hadn’t considered and tips you can implement prior to presenting, as well as make you feel confident and relaxed about your material. 

Self-care leading up to the moment you’re speaking in public can go a long way in helping you reduce nervousness. Regular physical activity is generally considered to be one proven strategy for reducing social anxiety symptoms . Exercise can help to release stress and boost your mood. If you’re giving a big presentation or speech, it may be helpful to go for a walk or do some mild cardio in the morning. 

Additionally, eating a healthy diet and drinking enough water can also help promote a sense of well-being and calm. You may choose to be mindful of your consumption of caffeinated beverages, as caffeine may worsen anxiety. 

How online therapy can help

If you experience anxiety when you need to speak in front of other people and want additional support for your communication apprehension, it can help to talk to a licensed mental health professional. According to the American Psychiatric Association, a therapist can work with you to find effective ways to manage public speaking anxiety and feel more confident performing in front of others.

Is Online Therapy Effective?

Studies suggest that online therapy can help individuals who experience anxiety related to presenting or performing in public. In a study of 127 participants with social anxiety disorder, researchers found that online cognitive behavioral therapy was effective in treating the fear of public speaking , with positive outcomes that were sustained for a year post-treatment. The study also noted the increased convenience that can often be experienced by those who use online therapy platforms. 

Online therapy is regarded by many as a flexible and comfortable way of connecting with a licensed therapist to work through symptoms of social anxiety disorder or related mental disorders. With online therapy through  BetterHelp , you can participate in therapy remotely, which can be helpful if speaking anxiety makes connecting in person less desirable. 

BetterHelp works with thousands of mental health professionals—who have a variety of specialties—so you may be able to work with someone who can address your specific concerns about social anxiety.

Therapist reviews

“I had the pleasure of working with Ann for a few months, and she helped me so much with managing my social anxiety. She was always so positive and encouraging and helped me see all the good things about myself, which helped my self-confidence so much. I've been using all the tools and wisdom she gave me and have been able to manage my anxiety better now than ever before. Thank you Ann for helping me feel better!”

Brian has helped me immensely in the 5 months since I joined BetterHelp. I have noticed a change in my attitude, confidence, and communication skills as a result of our sessions. I feel like he is constantly giving me the tools I need to improve my overall well-being and personal contentment.”

If you are experiencing performance-type social anxiety disorder or feel nervous about public speaking, you may consider trying some of the tips detailed above—such as practicing with someone you trust, incorporating deep breathing techniques and visualizing positive thoughts and outcomes. 

If you’re considering seeking additional support with social anxiety disorder, online therapy can help. With the right support, you can work through anxiety symptoms, further develop your oratory skills and feel more confidence speaking in a variety of forums.  

Studies suggest that online therapy can help individuals who experience nervousness related to presenting or speaking in public. In a study of 127 participants with social anxiety disorder, researchers found that online cognitive behavioral therapy was effective in treating the fear of public speaking , with positive outcomes that were sustained for a year post-treatment. The study also noted the increased convenience that can often be experienced by those who use online therapy platforms.

• How To Manage Travel Anxiety Medically reviewed by Paige Henry , LMSW, J.D.
• The Correlation Between Certain Mental Disorders Medically reviewed by Paige Henry , LMSW, J.D.
• Relationships and Relations

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10.1 Managing Public Speaking Anxiety

Learning objectives.

• Discuss common sources of public speaking anxiety.
• Identify strategies for addressing public speaking anxiety.
• Employ strategies for addressing public speaking anxiety.

If you feel fear, anxiety, or discomfort when confronted with the task of speaking in front of an audience, you are not alone. National polls consistently show that public speaking is among Americans’ top fears (Bodie, 2010). Yet, since we all have to engage in some form of public speaking, this is a fear that many people must face regularly. Effectively managing speaking anxiety has many positive effects on your speech. One major area that can improve with less anxiety is delivery. Although speaking anxiety is natural and normal, it can interfere with verbal and nonverbal delivery, which makes a speech less effective. In this chapter, we will explore causes of speaking anxiety, ways to address it, and best practices of vocal and physical delivery.

Sources of Speaking Anxiety

Aside from the self-reported data in national surveys that rank the fear of public speaking high for Americans, decades of research conducted by communication scholars shows that communication apprehension is common among college students (Priem & Solomon, 2009). Communication apprehension (CA) is fear or anxiety experienced by a person due to real or perceived communication with another person or persons. CA is a more general term that includes multiple forms of communication, not just public speaking. CA can be further broken down into two categories. Trait CA refers to a general tendency to experience anxiety related to communication, in essence incorporating it into a person’s personality. State CA refers to anxiety related to communication that occurs in a particular situation and time (Bodie, 2010). Of college students, 15 to 20 percent experience high trait CA, meaning they are generally anxious about communication. Seventy percent of college students experience some trait CA, which means that addressing communication anxiety in a class like the one you’re taking now stands to benefit the majority of students (Priem & Solomon, 2009). Whether CA is a personal trait or not, we all occasionally experience state CA. Think about the jitters you get before a first date, a job interview, or the first day of school. The novelty or uncertainty of some situations is a common trigger for communication anxiety, and public speaking is a situation that is novel and uncertain for many.

Public speaking anxiety is a type of CA that produces physiological, cognitive, and behavioral reactions in people when faced with a real or imagined presentation (Bodie, 2010). Physiological responses to public speaking anxiety include increased heart rate, flushing of the skin or face, and sweaty palms, among other things. These reactions are the result of natural chemical processes in the human body. The fight or flight instinct helped early humans survive threatening situations. When faced with a ferocious saber-toothed tiger, for example, the body released adrenaline, cortisol, and other hormones that increased heart rate and blood pressure to get more energy to the brain, organs, and muscles in order to respond to the threat. We can be thankful for this evolutionary advantage, but our physiology hasn’t caught up with our new ways of life. Our body doesn’t distinguish between the causes of stressful situations, so facing down an audience releases the same hormones as facing down a wild beast.

The root of public speaking anxiety is the fight or flight instinct that is triggered when we face a fear. While we can’t completely eliminate anxiety, we can change how we cognitively process it.

Practical Cures – Anxiety – CC BY 2.0.

Cognitive reactions to public speaking anxiety often include intrusive thoughts that can increase anxiety: “People are judging me,” “I’m not going to do well,” and “I’m going to forget what to say.” These thoughts are reactions to the physiological changes in the body but also bring in the social/public aspect of public speaking in which speakers fear being negatively judged or evaluated because of their anxiety. The physiological and cognitive responses to anxiety lead to behavioral changes. All these thoughts may lead someone to stop their speech and return to their seat or leave the classroom. Anticipating these reactions can also lead to avoidance behavior where people intentionally avoid situations where they will have to speak in public.

Addressing Public Speaking Anxiety

While we can’t stop the innate physiological reactions related to anxiety from occurring, we do have some control over how we cognitively process them and the behaviors that result. Research on public speaking anxiety has focused on three key ways to address this common issue: systematic desensitization, cognitive restructuring, and skills training (Bodie, 2010). In addition, it is important to address the physical manifestations of speaking anxiety.

Systematic Desensitization

Although systematic desensitization may sound like something that would be done to you while strapped down in the basement of a scary hospital, it actually refers to the fact that we become less anxious about something when we are exposed to it more often (Bodie, 2010). As was mentioned earlier, the novelty and uncertainty of public speaking is a source for many people’s anxiety. So becoming more familiar with public speaking by doing it more often can logically reduce the novelty and uncertainty of it.

Systematic desensitization can result from imagined or real exposure to anxiety-inducing scenarios. In some cases, an instructor leads a person through a series of relaxation techniques. Once relaxed, the person is asked to imagine a series of scenarios including speech preparation and speech delivery. This is something you could also try to do on your own before giving a speech. Imagine yourself going through the process of preparing and practicing a speech, then delivering the speech, then returning to your seat, which concludes the scenario. Aside from this imagined exposure to speaking situations, taking a communication course like this one is a great way to directly engage in systematic desensitization. Almost all my students report that they have less speaking anxiety at the end of a semester than when they started, which is at least partially due to the fact they were forced to engage with speaking more than they would have done if they weren’t taking the class.

Cognitive Restructuring

Cognitive restructuring entails changing the way we think about something. A first step in restructuring how we deal with public speaking anxiety is to cognitively process through our fears to realize that many of the thoughts associated with public speaking anxiety are irrational (Allen, Hunter & Donohue, 2009). For example, people report a fear of public speaking over a fear of snakes, heights, financial ruin, or even death. It’s irrational to think that the consequences of giving a speech in public are more dire than getting bit by a rattlesnake, falling off a building, or dying. People also fear being embarrassed because they mess up or are evaluated negatively. Well, you can’t literally die from embarrassment, and in reality, audiences are very forgiving and overlook or don’t even notice many errors that we, as speakers, may dwell on. Once we realize that the potential negative consequences of giving a speech are not as dire as we think they are, we can move on to other cognitive restructuring strategies.

Communication-orientation modification therapy (COM therapy) is a type of cognitive restructuring that encourages people to think of public speaking as a conversation rather than a performance (Motley, 2009). Many people have a performance-based view of public speaking. This can easily be seen in the language that some students use to discuss public speaking. They say that they “rehearse” their speech, deal with “stage fright,” then “perform” their speech on a “stage.” I like to remind my students that there is no stage at the front of our classroom; it is a normal floor. To get away from a performance orientation, we can reword the previous statements to say that they “practice” their speech, deal with “public speaking anxiety,” then “deliver” their speech from the front of the room. Viewing public speaking as a conversation also helps with confidence. After all, you obviously have some conversation skills, or you wouldn’t have made it to college. We engage in conversations every day. We don’t have to write everything we’re going to say out on a note card, we don’t usually get nervous or anxious in regular conversations, and we’re usually successful when we try. Even though we don’t engage in public speaking as much, we speak to others in public all the time. Thinking of public speaking as a type of conversation helps you realize that you already have accumulated experiences and skills that you can draw from, so you aren’t starting from scratch.

Thinking of public speaking as a conversation with an audience rather than a performance for an audience can help reduce speaking anxiety.

The Open University – Speech – CC BY-NC-ND 2.0.

Last, positive visualization is another way to engage in cognitive restructuring. Speaking anxiety often leads people to view public speaking negatively. They are more likely to judge a speech they gave negatively, even if it was good. They’re also likely to set up negative self-fulfilling prophecies that will hinder their performance in future speeches. To effectively use positive visualization, it’s best to engage first in some relaxation exercises such as deep breathing or stretching, which we will discuss more later, and then play through vivid images in your mind of giving a successful speech. This should be done a few times before giving the actual speech. Students sometimes question the power of positive visualization, thinking that it sounds corny. Ask an Olympic diver what his or her coach says to do before jumping off the diving board and the answer will probably be “Coach says to image completing a perfect 10 dive.” Likewise a Marine sharpshooter would likely say his commanding officer says to imagine hitting the target before pulling the trigger. In both instances, positive visualization is being used in high-stakes situations. If it’s good enough for Olympic athletes and snipers, it’s good enough for public speakers.

Skills Training

Skills training is a strategy for managing public speaking anxiety that focuses on learning skills that will improve specific speaking behaviors. These skills may relate to any part of the speech-making process, including topic selection, research and organization, delivery, and self-evaluation. Skills training, like systematic desensitization, makes the public speaking process more familiar for a speaker, which lessens uncertainty. In addition, targeting specific areas and then improving on them builds more confidence, which can in turn lead to more improvement. Feedback is important to initiate and maintain this positive cycle of improvement. You can use the constructive criticism that you get from your instructor and peers in this class to target specific areas of improvement. Self-evaluation is also an important part of skills training. Make sure to evaluate yourself within the context of your assignment or job and the expectations for the speech. Don’t get sidetracked by a small delivery error if the expectations for content far outweigh the expectations for delivery. Combine your self-evaluation with the feedback from your instructor, boss, and/or peers to set specific and measurable goals and then assess whether or not you meet them in subsequent speeches. Once you achieve a goal, mark it off your list and use it as a confidence booster. If you don’t achieve a goal, figure out why and adjust your strategies to try to meet it in the future.

Physical Relaxation Exercises

Suggestions for managing speaking anxiety typically address its cognitive and behavioral components, while the physical components are left unattended. As we learned earlier, we can’t block these natural and instinctual responses. We can, however, engage in physical relaxation exercises to counteract the general physical signs of anxiety caused by cortisol and adrenaline release, which include increased heart rate, trembling, flushing, high blood pressure, and speech disfluency.

I liken confronting the physical aspects of public speaking anxiety to chemical warfare. Some breathing and stretching exercises release endorphins, which are your body’s natural antidote to stress hormones. Deep breathing is a proven way to release endorphins. It also provides a general sense of relaxation and can be done discretely, even while waiting to speak. In order to get the benefits of deep breathing, you must breathe into your diaphragm. The diaphragm is the muscle below your lungs that helps you breathe and stand up straight, which makes it a good muscle for a speaker to exercise. To start, breathe in slowly through your nose, filling the bottom parts of your lungs up with air. While doing this, your belly should pooch out. Hold the breath for three to five full seconds and then let it out slowly through your mouth. After doing this only a few times, many students report that they can actually feel a flooding of endorphins, which creates a brief “light-headed” feeling. I lead my class in breathing exercises before the first few days of speeches. Once you have practiced and are comfortable with the technique, you can do this before you start your speech, and no one sitting around you will even notice. You might also want to try this technique during other stressful situations. Deep breathing before dealing with an angry customer or loved one, or before taking a test, can help you relax and focus.

Discretely stretching your wrists and calf muscles is a good way to relieve anxiety and get your energy flowing while waiting to speak.

Public Domain Pictures – public domain.

Stretching is another way to quickly and effectively release endorphins. Very old exercise traditions like yoga, tai chi, and Pilates teach the idea that stretching is a key component of having a healthy mind and spirit. Exercise in general is a good stress reliever, but many of us don’t have the time or willpower to do it. We can, however, all take time to do some stretching. Obviously, it would be distracting for the surrounding audience if a speaker broke into some planking or Pilates just before his or her speech. Simple and discrete stretches can help get the body’s energy moving around, which can make a speaker feel more balanced and relaxed. Our blood and our energy/stress have a tendency to pool in our legs, especially when we’re sitting. The following stretch can help manage the physical manifestations of anxiety while waiting to speak. Start with both feet flat on the floor. Raise your back heels off the floor and flex and release your calf muscles. You can flex and release your calves once before putting your heels back down and repeating, or you can flex a few times on each repetition. Doing this three to five times should sufficiently get your blood and energy moving around. Stretching your wrists can also help move energy around in your upper body, since our huge amounts of typing and using other electronic controllers put a lot of stress on this intersection of muscles, tendons, and bones. Point one hand up at the wrist joint, like you’re waving at someone. Then use your other hand to pull, gently, the hand that’s pointing up back toward your elbow. Stop pulling once you feel some tension. Hold the hand there for a few seconds and release. Then point the hand down at the wrist joint like you’re pointing at something on the floor, and use the other hand to push the hand back toward your elbow. Again, stop pushing when you feel the tension, hold the stretch for a few seconds, and release. You can often do this stretch discretely as well while waiting to speak.

Vocal Warm-Up Exercises

Vocal warm-up exercises are a good way to warm up your face and mouth muscles, which can help prevent some of the fluency issues that occur when speaking. Newscasters, singers, and other professional speakers use vocal warm-ups. I lead my students in vocal exercises before speeches, which also helps lighten the mood. We all stand in a circle and look at each other while we go through our warm-up list. For the first warm-up, we all make a motorboat sound, which makes everybody laugh. The full list of warm-ups follows and contains specific words and exercises designed to warm up different muscles and different aspects of your voice. After going through just a few, you should be able to feel the blood circulating in your face muscles more. It’s a surprisingly good workout!

Sample Vocal Warm-Ups

• Purse your lips together and make a motorboat sound. Hold it for ten seconds and repeat. “BBBBBBBBBBBBBBBBBBBBBBBBBBB.”
• Clench your teeth and say, “N, N, N, N,” to stretch your cheek muscles.
• Say “Mum” five times, and open your mouth and eyes wide each time you say it.
• Say “Puh” five times, making sure to use your diaphragm to enunciate the h .
• Say “Red Rover” ten times, overenunciating each r .
• Say “Wilbur” ten times, overenunciating the w and r .
• Say “Bumblebee” ten times, enunciating each b .
• Say “Red letter, yellow letter” five times, making sure to distinctly pronounce each word.
• Say “Selfish shellfish” five times, making sure to distinctly pronounce each word.
• Say “Unique New York” five times, enunciating the q and k .

Top Ten Ways to Reduce Speaking Anxiety

As you can see in this section, there are many factors that contribute to speaking anxiety, and there are many ways to address it. The following is a list of the top ten ways to reduce speaking anxiety that I developed with my colleagues, which helps review what we’ve learned.

• Remember, you are not alone. Public speaking anxiety is common, so don’t ignore it—confront it.
• Remember, you can’t literally “die of embarrassment.” Audiences are forgiving and understanding.
• Remember, it always feels worse than it looks.
• Take deep breaths. It releases endorphins, which naturally fight the adrenaline that causes anxiety.
• Look the part. Dress professionally to enhance confidence.
• Channel your nervousness into positive energy and motivation.
• Start your outline and research early. Better information = higher confidence.
• Practice and get feedback from a trusted source. (Don’t just practice for your cat.)
• Visualize success through positive thinking.
• Prepare, prepare, prepare! Practice is a speaker’s best friend.

“Getting Critical”

How Much Emphasis Should We Place on Delivery?

Before you read the rest of the chapter, take some time to think about the balance between the value of content and delivery in a speech. We know it’s important to have solid content and to have an engaging and smooth delivery to convey that content, but how should each category be weighted and evaluated? Most people who have made it to college can put the time and effort into following assignment guidelines to put together a well-researched and well-organized speech. But some people are naturally better at delivering speeches than others. Some people are more extroverted, experience less public speaking anxiety, and are naturally more charismatic than others. Sometimes a person’s delivery and charisma might distract an audience away from critically evaluating the content of their speech. Charismatic and well-liked celebrities and athletes, for example, are used to endorse products and sell things to the public. We may follow their advice because we like them, instead of basing our choice on their facts or content. Aristotle, Cicero, and other notable orators instructed that delivery should be good enough to present the material effectively but not so good or so bad that it draws attention to itself. But in today’s celebrity culture, the bling or packaging is sometimes more valued than the contents. This leads us to some questions that might help us unpack the sometimes tricky relationship between content and delivery.

• Do you think worries about content or delivery contribute more to speaking anxiety? Explain your choice.
• How should someone be evaluated who works hard to research, organize, and write a speech, but doesn’t take the time to practice so they have a good delivery? What if they practice, but still don’t deliver the speech well on speech day?
• How should we evaluate a speaker who delivers an engaging speech that gets the audience laughing and earns a big round of applause but doesn’t verbally cite sources or present well-organized ideas?
• Is it ethical for someone to use their natural charisma or speaking abilities to win over an audience rather than relying on the merit and strength of their speech content? In what speaking situations would this be more acceptable? Less acceptable?

Key Takeaways

• Getting integrated: Public speaking anxiety is a form of communication apprehension (CA) that is commonly experienced by many people and can be effectively managed using a variety of strategies. While we most often think of public speaking anxiety as an issue in the classroom and workplace, it can affect communication in personal and civic contexts as well.
• Systematic desensitization helps lessen public speaking anxiety through repeated exposure to real or imagined public speaking scenarios.
• Cognitive restructuring addresses public speaking by replacing negative thoughts with more positive thoughts, and COM therapy can help you view public speaking as a conversation rather than a performance.
• Skills training allows you to focus on improving specific skills related to public speaking, which can increase confidence and lead to further skill development.
• Physical relaxation exercises like deep breathing and stretching allow us to voluntarily use our bodies to address involuntary bodily reactions to anxiety.
• Test your speaking anxiety using McCroskey’s “Personal Report of Public Speaking Anxiety” (PRPSA). You can access the scale here: http://www.jamescmccroskey.com/measures/prpsa.htm . Follow the directions to determine your score. Do you agree with the result? Why or why not?
• Of the strategies for managing public speaking anxiety listed in the chapter (systematic desensitization, cognitive restructuring, skills training, physical relaxation exercises), which do you think would be most useful for you and why?
• When you take a communication course like this one, you are automatically engaging in some skills training. What are some public speaking skills that you are already good at? What are some skills that you should work on? Write out three goals you would like to accomplish for your next speech that focus on improving your public speaking skills.

Allen, M., John E. Hunter, and William A. Donohue, “Meta-analysis of Self-Report Data on the Effectiveness of Public Speaking Anxiety Treatment Techniques,” Communication Education 38, no. 1 (2009): 54–76.

Bodie, G. D., “A Racing Heart, Rattling Knees, and Ruminative Thoughts: Defining, Explaining, and Treating Public Speaking Anxiety,” Communication Education 59, no. 1 (2010): 70.

Motley, M. T., “COM Therapy,” in Avoiding Communication: Shyness, Reticence, and Communication Apprehension , eds. John A. Daly, James C. McCroskey, Joe Ayres, Tim Hopf, and Debbie M. Ayers Sonandre (Cresskill, NJ: Hampton Press, 2009), 379–400.

Communication in the Real World Copyright © 2016 by University of Minnesota is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

Speech anxiety

Being nervous and anxious are normal reactions when preparing and delivering a speech. There is no real way to completely remove these feelings, but there are some ways to lessen them or to even use them to enhance the speech.

Confidence in the content and importance of a speech will take away most anxiety. It is hard to be confident if time has not been spent preparing and practicing. Remember a speech does NOT have to be perfect. They are meant to be a conversation with the audience.

Procrastination is the enemy

• Information will come more naturally to you as you are speaking
• The need to refer to notes lessens the more you practice making you more confident

Topic selection

• Select a topic that is familiar—allows you to have a connection with the topic. This connection will show as you relate information to the audience.
• Convey your enthusiasm about your topic to your audience
• Keep the speech conversational—comfort with the topic will make it easier for you to relay your thoughts and findings to the audience.

Be prepared

The more prepared you are for your speech the more familiar the information will be to you, allowing for your memory to fill in gaps as you are giving the speech.

• The more you know about the topic, the more confident you will be with the information you are relaying
• Having a prepared outline gives you a safety net. You may never refer to it, but it is there if you need a reminder of where you are
• The more comfortable you are with your speech the more relaxed and less anxious you will appear

Know the introduction and conclusion

• The audience may not remember the details in the middle of speech but they will remember the beginning and ending
• Audience will believe you covered all of your points
• Words will come naturally and not feel as though you are forcing the topic

Remember to breathe

Take a few deep breaths before standing up to speak—studies show this actually helps to reduce stress and anxiety.

• Try to relax your entire body—will make you appear at ease to the audience

Remember general health

Make sure you eat, get sleep and drink water prior to your speech.

• One time when caffeine may not be your friend—treat yourself to Starbucks after your speech

Nervous energy

The goal is to appear as calm, relaxed, and poised as possible to build credibility with the audience and boost your confidence.

• Take a slow walk before your speech—clears your mind and helps you focus
• Keep both feet planted on the floor as you wait—keeps you from toe tapping or looking too antsy
• Gently squeeze the edge of the chair—eases tension in your upper body and helps avoid fidgeting
• Think and act calm—especially during the walk to front of room. The calmer you appear the more you will believe you are calm.
• Take a moment—look for a friendly face, then begin

Additional tips to remember

• The audience doesn’t want you to fail (all your peers in the room are going through the same thing)
• Some nervous energy is good—it can be channeled into your delivery
• Focus on the audience (how can you relate to them or bring them into the speech?)
• Be in the moment. Enjoy telling and conversing with the audience about your topic

Beebe, S. A., & Beebe, S. J. (2012). A concise public speaking handbook . Boston: Allyn & Bacon.

Lucas, S. (2012). The art of public speaking . New York, NY: McGraw-Hill.

Sprague, J. & Stuart, D. (2013). The speaker's compact handbook, 4th ed . Portland: Ringgold, Inc.

Vrooman, S. S. (2013). The zombie guide to public speaking: Why most presentations fail, and what you can do to avoid joining the horde . Place of publication not identified: CreateSpace.

PUBLIC SPEAKING ANXIETY

The fear of public speaking is the most common phobia ahead of death, spiders, or heights. The National Institute of Mental Health reports that public speaking anxiety, or glossophobia, affects about 40%* of the population. The underlying fear is judgment or negative evaluation by others. Public speaking anxiety is considered a social anxiety disorder. * Gallup News Service, Geoffrey Brewer, March 19, 2001.

The fear of public speaking is worse than the fear of death

Evolution psychologists believe there are primordial roots. Our prehistoric ancestors were vulnerable to large animals and harsh elements. Living in a tribe was a basic survival skill. Rejection from the group led to death. Speaking to an audience makes us vulnerable to rejection, much like our ancestors’ fear.

A common fear in public speaking is the brain freeze. The prospect of having an audience’s attention while standing in silence feels like judgment and rejection.

Why the brain freezes

The pre-frontal lobes of our brain sort our memories and is sensitive to anxiety. Dr. Michael DeGeorgia of Case Western University Hospitals, says: “If your brain starts to freeze up, you get more stressed and the stress hormones go even higher. That shuts down the frontal lobe and disconnects it from the rest of the brain. It makes it even harder to retrieve those memories.”

The fight or flight response activates complex bodily changes to protect us. A threat to our safety requires immediate action. We need to respond without debating whether to jump out of the way of on oncoming car while in an intersection. Speaking to a crowd isn’t life threatening. The threat area of the brain can’t distinguish between these threats.

Help for public speaking anxiety

We want our brains to be alert to danger. The worry of having a brain freeze increases our anxiety. Ironically, it increases the likelihood of our mind’s going blank as Dr. DeGeorgia described. We need to recognize that the fear of brain freezing isn’t a life-or-death threat like a car barreling towards us while in a crosswalk.

Change how we think about our mind going blank.

De-catastrophize brain freezes . It might feel horrible if it happens in the moment. The audience will usually forget about it quickly. Most people are focused on themselves. We’ve handled more difficult and challenging situations before. The long-term consequence of this incident is minimal.

Leave it there . Don’t dwell on the negative aspects of the incidents. Focus on what we can learn from it. Worry that it will happen again will become self-fulfilling. Don’t avoid opportunities to create a more positive memory.

Perfectionism won’t help . Setting unachievable standards of delivering an unblemished speech increases anxiety. A perfect speech isn’t possible. We should aim to do our best instead of perfect.

Silence is gold . Get comfortable with silence by practicing it in conversations. What feels like an eternity to us may not feel that way to the audience. Silence is not bad. Let’s practice tolerating the discomfort that comes with elongated pauses.

Avoidance reinforces . Avoiding what frightens us makes it bigger in our mind. We miss out on the opportunity to obtain disconfirming information about the trigger.

Rehearse to increase confidence

Practice but don’t memorize . There’s no disputing that preparation will build confidence. Memorizing speeches will mislead us into thinking there is only one way to deliver an idea. Forgetting a phrase or sentence throw us off and hastens the brain freeze. Memorizing provides a false sense of security.

Practice with written notes. Writing out the speech may help formulate ideas. Practice speaking extemporaneously using bullet points to keep us on track.

Practice the flow of the presentation . Practice focusing on the message that’s delivered instead of the precise words to use. We want to internalize the flow of the speech and remember the key points.

Practice recovering from a brain freeze . Practice recovery strategies by purposely stopping the talk and shifting attention to elsewhere. Then, refer to notes to find where we left off. Look ahead to the next point and decide what we’d like to say next. Finally, we’ll find someone in the audience to start talking to and begin speaking.

Be prepared for the worst . If we know what to do in the worst-case scenario (and practice it), we’ll have confidence in our ability to handle it. We do that by preparing what to say to the audience if our mind goes blank. Visualizing successful recovery of the worst will help us figure out what needs to be done to get back on track.

Learn to relax

Remember to breathe . We can reduce anxiety by breathing differently. Take slow inhalations and even slower exhalations with brief pauses in between. We’ll be more likely to use this technique if practiced in times of low stress.

Speak slowly . It’s natural to speed up our speech when we are anxious. Practice slowing speech while rehearsing. When we talk quickly, our brain sees it is a threat. Speaking slowly and calmly gives the opposite message to our brain.

Make eye contact with the audience . Our nerves might tell us to avoid eye contact. Making deliberate eye contact with a friendly face will build confidence and slow our speaking.

Join a group . Practice builds confident in public speaking. Groups like Toastmasters International provide peer support to hone our public speaking skill. Repeated exposure allows us to develop new beliefs about our fear and ability to speak in public.

The fear of our mind going blank during a speech is common. Job advancement or college degree completion may be hampered by not addressing this fear.

How to Get Help for Social Anxiety

The National Social Anxiety Center (NSAC) is an association of independent Regional Clinics and Associates throughout the United States with certified cognitive-behavioral therapists (CBT) specializing in social anxiety and other anxiety-related problems.

Find an NSAC Regional Clinic or Associate which is licensed to help people in the state where you are located.

Places where nsac regional clinics and associates are based.

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Chapter 1: The Speech Communication Process

Speech Anxiety

What is it.

Speech anxiety is best defined as the nervousness that a speaker feels before and/or during a presentation.  Sweating palms, a shaky voice, a dry throat, difficulty breathing, and even memory loss are all common symptoms of anxiety. The symptoms you, as an individual, will feel are hard to predict. But it helps if you remember that nearly every speaker has experienced some degree of speech anxiety. Even professional speakers occasionally feel a small amount of apprehension at times. Anxiety levels vary. Some speakers will report little to no anxiety while speaking; others will confess that they are petrified at the thought of speaking in public. Jerry Seinfeld used to joke that “at a funeral, the average person would rather be in the casket than giving the eulogy. ” Now that is fear!

Why Anxiety and Public Speaking?

Scholars at the University of Wisconsin-Stout (“Public Speaking Anxiety,” 2015) explain that anxiety in public speaking can result from one of several misperceptions:

•  “all or nothing” thinking—a mindset that if your speech falls short of “perfection” (an unrealistic standard), then you are a failure as a public speaker;

•     overgeneralization—believing that a single event (such as failing at a task) is a universal or “always” event; and

•     fortune telling—the tendency to anticipate that things will turn out badly, no matter how much practice or rehearsal is done.

Likewise, many new college students operate under the false belief that intelligence and skill are “fixed.” In their minds, a person is either smart or skilled in something, or they are not. Some students apply this false belief to math and science subjects, saying things like “I’m just no good at math and I never will be,” or even worse, “I guess I am just not smart enough to be in college.” As you can tell, these beliefs can sabotage someone’s college career. Also unfortunately, the same kind of false beliefs are applied to public speaking, and people conclude that because public speaking is hard, they are just not “naturally good” at it and have no inborn skill. They give up on improving and avoid public speaking at all costs.

There is more to Dr. Dweck’s research. We would recommend her book Mindset . Many students enter a public speaking class thinking “I’m just no good at this and never will be,” just like some students feel about college algebra or science. Dr. Dweck and other learning psychologists show that learning a new skill might be hard work, but the difficulty is not a sign that learning is impossible. Modern research by Stanford University psychologist Carol Dweck (2007) and others shows that intelligence and related skills are “malleable,” meaning that they are open to change and growth. Understanding and accepting that your intelligence and skill in different areas is not fixed or “stuck,” but open to growth, will have a significant influence on your success in life. It will also help you see that just because learning a subject or task is hard does not mean you are not or cannot be good at it. Obstacles and barriers that make learning hard are opportunities for growth, not “getting off places.”

Along with the wrong way of thinking about one’s learning and growth, two other fears contribute to anxiety in public speaking. The first is fear of failure. This fear can result from several sources: real or perceived bad experiences involving public speaking in the past, lack of preparation, lack of knowledge about public speaking, not knowing the context, and uncertainty about one’s task as a public speaker (such as being thrown into a situation at the last minute).

It is not the goal of this book to belittle that fear. It is real and justified to some extent because you might lack understanding of the public speaking task or lack good speaking experiences upon which to build. One of the goals and fringe benefits of this course is that you are not just going to learn about public speaking, but you are going to do it—at least four or five times—with a real audience. You will overcome some of your fears and feel that you have accomplished something of personal benefit.

The second fear is fear of rejection of one’s self or one’s ideas. This one is more serious in some respects. You may feel rejection because of fear of failure, or you may feel that the audience will reject your ideas, or worse, you as a person. Knowing how to approach the public speaking task and explain your ideas can help. However, you should ask yourself deep and probing questions as to why you believe that your audience will reject you because this fear is rooted in a belief. You should ask yourself what possibly false belief is causing your anxiety.

One of the core attitudes an effective and ethical public speaker must have is respect for and empathy with the audience. Your audience in this class is your peers who want to learn and want to get through the class success- fully (just like you do). Your audience also includes your instructor who wants to see you succeed in the course as well. Believe me, public speaking teachers get a lot of pleasure from hearing successful student speeches!

Your audience wants you to succeed if for no other reason than a good speech is much easier and pleasant to listen to than a poor one. Again, gaining practice in this class with a real, live audience can help you work through the roots of your fear of rejection.

Beyond dealing with the root fears that may cause you to have a “fright or flight” response when it comes to public speaking, there are some practical answers to dealing with fears about public speaking. Of course, fear responses can be reduced if you know how public speaking works, as you will see throughout this textbook. But there are some other strategies, and most of them have to do with preparation.

How Do I Overcome My Fear?

There are many reasons why a speaker might feel anxious, but there are several steps you can take to reduce your anxiety. First, remember that everyone has experienced some level of anxiety during a presentation. Knowing that you are not the only one feeling nervous should help a bit. Keep in mind that most listeners won’t even be aware of your anxiety. They often don’t see what you thought was glaringly obvious; they’re busy preparing themselves for their turn up front. It is perfectly normal to feel nervous when you find yourself in an unfamiliar setting or situation. You probably felt nervous the first time you had to shoot a foul shot in front of a large crowd of basketball fans. Or you might recall the anxiety you felt during your first piano recital as a child, or that first job interview. Think of this nervous feeling as your body readying itself for an important activity.

Also, you might feel anxious if you have not adequately prepared for the presentation. Preparing and practicing your presentation are two of the surest ways to minimize nervousness. No one wants to feel embarrassed in public, but knowing that you have done everything possible to ensure success should help you feel more confident. Do your research and organize your ideas logically. Then practice several times. Try to find someone to listen as you practice -your family, your friends, your roommate -and listen to their feedback. Even if they don’t know your topic, they know you. They may even be able to point out some areas in your presentation that still need improvement. The more you prepare and practice, the more successful your presentation will likely be.

Finally, be optimistic and focus on the positives. Use positive self-talk as you prepare. Don’t tell yourself that you’ll perform horribly or that you can’t do it. Have you ever heard of a self-fulfilling prophecy? What you expect to happen may be exactly what does happen. So tell yourself that you’re well prepared and that you will improve every time you speak. Remind yourself that you are calm and in control of the situation and be sure to take a deep breath whenever necessary. Imagine yourself speaking clearly and effortlessly. Find a couple of friendly faces in the crowd and focus on them. If they’re sending positive energy your way, grab it!

Addressing Public Speaking Anxiety

Mental Preparation

If your neighbor’s house were on fire, getting to the phone to call the fire department would be your main concern. You would want to get the ad- dress right and express the urgency. That is admittedly an extreme exam ple, but the point is about focus. To mentally prepare, you want to put your focus where it belongs, on the audience and the message. Mindfulness and full attention to the task are vital to successful public speaking. If you are concerned about a big exam or something personal going on in your life, your mind will be divided, and that division will add to your stress.

The main questions to ask yourself are “Why am I so anxiety-ridden about giving a presentation?” and “What is the worst that can happen?” For example, you probably won’t know most of your classmates at the beginning of the course, adding to your anxiety. By midterm, you should be developing relationships with them and be able to find friendly faces in the audience. However, very often we make situations far worse in our minds than they actually are, and we can lose perspective. One of the authors tells her students, “Some of you have been through childbirth and even through military service . That is much worse than public speaking!” Your instructor will probably try to help you get to know your classmates and minimize the “unknowns” that can cause you worry.

Physical preparation

The first step in physical preparation is adequate sleep and rest. You might be thinking such a thing is impossible in college, where sleep deprivation and late nights come with the territory. However, research shows the extreme effects a lifestyle of limited sleep can have, far beyond yawning or dozing off in class (Mitru, Millrood, & Mateika, 2002; Walker, 2017). As far as public speaking is concerned, your energy level and ability to be alert and aware during the speech will be affected by lack of sleep.

Secondly, you would be better off to eat something that is protein-based rather than processed sugar-based before speaking. In other words, cheese or peanut butter on whole grain toast, Greek yogurt, or eggs for breakfast rather than a donut and soft drink. Some traditionalists also discourage the drinking of milk because it is believed to stimulate mucus production, but this has not been scientifically proven (Lai & Kardos, 2013).

A third suggestion is to wear clothes that you know you look good in and are comfortable but also meet the context’s requirements (that is, your instructor may have a dress code for speech days). Especially, wear comfort- able shoes that give you a firm base for your posture. Flip- flops and really high heels may not fit these categories.

A final suggestion for physical preparation is to utilize some stretching or relaxation techniques that will loosen your limbs or throat. Essentially, your emotions want you to run away, but the social situation says you must stay, so all that energy for running must go somewhere. The energy might go to your legs, hands, stomach, sweat glands, or skin, with undesirable physical consequences. Tightening and stretching your hands, arms, legs, and throat (through intentional, wide yawns) for a few seconds before speaking can help release some of the tension. Your instructor may be able to help you with these exercises, or you can find some on the Internet.

Contextual preparation

The more you can know about the venue where you will be speaking, the better. For this class, of course, it will be your classroom, but for other situations where you might experience “communication apprehension,” you should check out the space beforehand or get as much information as possible. For example, if you were required to give a short talk for a job interview, you would want to know what the room will be like, if there is equipment for projection, how large the audience will be, and the seating arrangements. If possible, you will want to practice your presentation in a room that is similar to the actual space where you will deliver it.

The best advice for contextual preparation is to be on time, even early. If you have to rush in at the last minute, as so many students do, you will not be mindful, focused, or calm for the speech. Even more, if you are early, you can make sure equipment is working, and can converse with the audience as they enter. Professional speakers often do this to relax themselves, build credibility, and gain knowledge to adapt their presentations to the audience. Even if you don’t want to “schmooze” beforehand, being on time will help you create a good first impression and thus enhance your credibility before the actual speech.

Speech preparation

Procrastination, like lack of sleep, seems to just be part of the college life. Sometimes we feel that we just don’t get the best ideas until the last minute. Writing that essay for literature class at 3:00 a.m. just may work for you. However, when it comes to public speaking, there are some definite reasons you would not want to do that. First, of course, if you are finishing up your outline at 3:00 a.m. and have a 9:00 speech, you are going to be tired and unable to focus. Second, your instructor may require you to turn in your outline several days ahead of the speech date. However, the main reason is that public speaking requires active, oral, repeated practice before the actual delivery.

You do not want the first time that you say the words to be when you are in front of your audience. Practicing is the only way that you will feel confident, fluent, and in control of the words you speak. Practicing (and timing yourself) repeatedly is also the only way that you will be assured that your speech meets the assignment’s time limits, and speaking within the expected time limits is a fundamental rule of public speaking. You may think your speech is five minutes long but it may end up being ten minutes the first time you practice it—or only two minutes!

Your practicing should be out loud, standing up, with shoes on, with someone to listen, if possible (other than your dog or cat), and with your visual aids. If you can record yourself and watch it, that is even better. If you do record yourself, make sure you record yourself from the feet up- or at least the hips up—so you can see your body language. The need for oral practice will be emphasized over and over in this book and probably by your instructor. As you progress as a speaker, you will always need to practice but perhaps not to the extent you do as a novice speaker.

As hard as it is to believe, YOU NEVER LOOK AS NERVOUS AS YOU FEEL.

You may feel that your anxiety is at level seventeen on a scale of one to ten, but the audience does not perceive it the same way. They may perceive it at a three or four or even less. That’s not to say they won’t see any signs of your anxiety and that you don’t want to learn to control it, only that what you are feeling inside is not as visible as you might think. This principle relates back to focus. If you know you don’t look as nervous as you feel, you can focus and be mindful of the message and audience rather than your own emotions.

Also, you will probably find that your anxiety decreases throughout the class (Finn, Sawyer, & Schrodt, 2009). In her Ted Talk video , Harvard Business School social psychologist Amy Cuddy discusses nonverbal communication and suggests that instead of “faking it until you make it,” that you can, and should, “fake it until you become it.” She shares research that shows how our behavior affects our mindsets, not just the other way around. Therefore, the act of giving the speech and “getting through it” will help you gain confidence. Interestingly, Dr. Cuddy directs listeners to strike a “power pose” of strong posture, feet apart, and hands on hips or stretched over head to enhance confidence.

Final Note: If you are an audience member, you can help the speaker with his/her anxiety, at least a little bit. Mainly, be an engaged listener from beginning to end. You can imagine that a speaker is going to be more nervous if the audience looks bored from the start. A speaker with less anxiety is going to do a better job and be more interesting. Of course, do not walk into class during your classmates’ speeches, or get up and leave. In addition to being rude, it pulls their minds away from their message and distracts the audience. Your instructor will probably have a policy on this behavior, too, as well as a dress code and other expectations on speech days. There are good reasons for these policies, so respect them.

Fundamentals of Public Speaking Copyright © by Lumen Learning is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Difficulty Talking, Speaking, Moving Mouth and Tongue Anxiety Symptoms

Difficulty speaking and talking, or moving the mouth, tongue, or lips are common symptoms of anxiety disorder , including generalized anxiety disorder , social anxiety disorder , panic disorder , and others.

This article explains the relationship between anxiety and the difficulty talking symptom.

Difficulty speaking, talking, moving mouth, tongue, or lips anxiety symptoms descriptions:

• Having difficulty or unusual awkwardness speaking; pronouncing words, syllables, or vowels.
• Having difficulty moving your mouth, tongue, or lips.
• Suddenly become self-conscious of your problems talking, speaking, moving your mouth, tongue, or lips.
• Uncharacteristically slurring your speech.
• You are uncharacteristically speaking much slower or faster than normal.
• You are uncharacteristically jumbling up words or fumbling over your words when speaking.
• You find that your mouth, tongue, or lips aren’t moving the way they normally would.
• Your mouth, tongue, lips, or facial muscles aren’t responding the way they normally do.
• It can feel as if your face muscles are unusually stiff, which is making talking difficult and forced.
• It can feel as if your face has been anesthetized somewhat, making speaking or moving your mouth, tongue, or lips difficult.

This symptom is often described as “slurred speech.”

This symptom can persistently affect just the mouth, lips, or tongue only, can affect more than one at the same time, can shift from one to another, and can involve all of them over and over again.

Having difficulty speaking can come and go rarely, occur frequently, or persist indefinitely. For example, you might have difficulty speaking once in a while and not that often, have difficulty speaking or moving your mouth, tongue or lips off and on, or have difficulty all the time.

Difficulty speaking can precede, accompany, or follow an escalation of other anxiety sensations and symptoms, or occur by itself. It can also precede, accompany, or follow an episode of nervousness, anxiety, fear, and elevated stress, or occur “out of the blue” and for no apparent reason.

This symptom can range in intensity from slight, to moderate, to severe. It can also come in waves where these mouth and speaking symptoms are strong one moment and ease off the next.

This symptom can change from day to day and from moment to moment.

All of the above combinations and variations are common.

Difficulty speaking or moving your mouth, tongue, or lips can seem more troublesome when in social, professional, or public settings.

To see if anxiety might be playing a role in your anxiety symptoms, rate your level of anxiety using our free one-minute instant results Anxiety Test , Anxiety Disorder Test , or Hyperstimulation Test .

The higher the rating, the more likely it could be contributing to your anxiety symptoms, including having difficulty talking or moving your mouth, tongue, or lips.

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Why does anxiety cause difficulty speaking, talking, or moving your mouth, tongue, or lips?

Medical Advisory

When this symptom is caused by anxiety, there are many reasons why anxiety can cause this symptom. Here are two of the most common:

1. Stress response

Behaving anxiously activates the stress response , also known as the fight or flight response . The stress response causes body-wide changes that prepare the body for immediate emergency action.[ 1 ][ 2 ] Because of the many changes, stress responses stress the body.

A part of these changes include altering brain function so that our attention is primarily focused on danger detection and reaction, and stimulating the nervous system so that the body is energized and can react quickly.[ 2 ] These changes can affect muscle movements, including the muscles in the mouth, tongue, and lips.

Many people experience difficulty talking and moving their mouth, tongue, or lips when anxious and stressed.

2. Hyperstimulation

Hyperstimulation can keep the stress response changes active even though a stress response hasn’t been activated. Chronic difficulty speaking, talking, and co-ordination problems with the mouth, tongue, and lips are common symptoms of hyperstimulation.

There are many other reasons why anxiety can cause this symptom. We explain these additional reasons under the symptom “Difficulty Speaking” in the Symptoms section (chapter 9) in the Recovery Support area of our website. The Symptoms section lists and explains all of the symptoms associated with anxiety.

How to stop the difficulty talking and moving the mouth, tongue, or lips anxiety symptoms?

When this anxiety symptom is caused by apprehensive behavior and the accompanying stress response changes, calming yourself down will bring an end to the active stress response and its changes. As your body recovers from the active stress response, this anxiety symptom should subside. Keep in mind it can take up to 20 minutes or more for the body to recover from a major stress response. This is normal and shouldn’t be a cause for concern.

When difficulty speaking or moving your mouth, tongue, or lips is caused by chronic stress (hyperstimulation), such as from overly apprehensive behavior, it can take much longer for the body to calm down and recover, and to the point where this anxiety symptom subsides.

Nevertheless, since this symptom is a common symptom of anxiety and stress, it needn't be a cause for concern or worry. This symptom subsides when you’ve eliminated the active stress response or hyperstimulation.

As the body recovers, difficulty speaking and talking, or moving your mouth, tongue, and lips problems disappear and normal functioning returns.

Many of those who struggle with anxiety worry that MS, ALS, a brain tumor, or other neurological condition may be the cause of their symptoms. Checking on the Internet may cause more anxiety, since co-ordination problems are common symptoms of these medical conditions.

But again, these types of symptoms are common for anxiety and stress. Therefore, they needn’t be a cause for concern.

For a more detailed explanation about all anxiety symptoms, why symptoms can persist long after the stress response has ended, common barriers to recovery and symptom elimination, and more recovery strategies and tips, we have many chapters that address this information in the Recovery Support area of our website.

If you are having difficulty containing your worry, you might want to connect with one of our recommended anxiety disorder therapists to help you learn this important skill. Working with an experienced anxiety disorder therapist is the most effective way to overcome what seem like unmanageable worry and problems with anxiety.

Common Anxiety Symptoms

• Heart palpitations
• Dizziness, lightheadedness
• Muscle weakness
• Numbness, tingling
• Weakness, weak limbs
• Asthma and anxiety
• Shooting chest pains
• Trembling, shaking
• Depersonalization
• Chronic pain
• Chronic fatigue
• Muscle tension
• Lump in throat

Additional Resources

• For a comprehensive list of Anxiety Disorders Symptoms Signs, Types, Causes, Diagnosis, and Treatment.
• Anxiety and panic attacks symptoms  can be powerful experiences. Find out what they are and how to stop them.
• How to stop an anxiety attack and panic.
• Anxiety Test
• Anxiety Disorder Test
• Social Anxiety Test
• Generalized Anxiety Test
• Hyperstimulation Test
• Anxiety 101 is a summarized description of anxiety, anxiety disorder, and how to overcome it.

Return to our anxiety disorders signs and symptoms page.

anxietycentre.com: Information, support, and therapy for anxiety disorder and its symptoms, including Difficulty Talking, Speaking, Moving The Mouth Anxiety Symptoms.

1. Selye, H. (1956). The stress of life. New York, NY, US: McGraw-Hill.

2. Folk, Jim and Folk, Marilyn. “ The Stress Response And Anxiety Symptoms. ” anxietycentre.com, August 2019.

3. Hannibal, Kara E., and Mark D. Bishop. “ Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation. ” Advances in Pediatrics., U.S. National Library of Medicine, Dec. 2014.

4. Justice, Nicholas J., et al. “ Posttraumatic Stress Disorder-Like Induction Elevates β-Amyloid Levels, Which Directly Activates Corticotropin-Releasing Factor Neurons to Exacerbate Stress Responses. ” Journal of Neuroscience, Society for Neuroscience, 11 Feb. 2015.

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30 ways to manage speaking anxiety, initial considerations.

Glossophobia – the fear of public speaking

It is the single most common phobia (fear)

Approximately 75% of people experience this

You are not alone in your fear

You cannot eliminate your fear–but you CAN manage and reduce it. 

Thirty ways to manage public speaking anxiety

Getting ready .

Select a topic of interest to you

Prepare carefully–know your material

Practice–rehearse your talk with a friend

Know your audience

Challenge negative thinking–make 3 x 5 cards of positive thoughts or have friends write out inspirational thoughts for you.

Expect positive reactions–expect success!

Know the room–if unfamiliar, visit your speaking space before you talk.

Employ aerobic exercise strategies–daily aerobic exercise can cut anxiety by 50%.

Eat for success–foods containing tryptophan (dairy products, turkey, salmon) and complex carbohydrates tend to calm the body. Eliminate caffeine, sweets, and empty calories.

Sleep for success–know and get the number of hours of sleep you need for optimal performance. 

The Day of the Presentation 

11.   Eat several hours before the talk–not immediately before 

12.  Dress for success–your success! Dress comfortably and appropriately for the situation. Look your best

13.  Challenge negative thinking–Continue positive thinking

14.  If you need to, express your fears to a friend 

15.  Review 3 x 5 cards of inspirational thoughts

16.  Practice your talk one last time

17.  Go to the room early to ready equipment and your podium.

18.  Exercise immediately before the talk to reduce adrenalin levels. 

• Employ anxiety reduction techniques
• Aerobic exercise
• Deep muscle relaxation
• Visualization strategies
• Deep, rhythmic breathing (4 hold 7) 

19.  Use the restroom immediately before the talk 

20. Take a glass of water to the talk 

The Presentation: A positive experience stemming from careful preparation! 

21.  Interpret anxiety symptoms as excitement

22. Use the podium to practice grounding strategies. Touch the podium to steady yourself and to remind yourself that you are safely connected to the ground which is firm and steady beneath your feet.

23. Take a security blanket with you–a complete typed version of your talk to only be used as a backup strategy.

24. Use tools to reduce audience attention on you.

• PowerPoint presentation 
• Video film clips
• “Show and tell” objects to pass

25.  Get out of yourself–engage the audience

26.  Look at friendly faces in your audience

27.  Use humor as needed

28.  Use the room’s physical space to your advantage–walk around as appropriate.

29.  Appropriately regulate your voice

• Speak clearly–enunciate
• Open your mouth–do not mumble
• Slow down if necessary
• Lower your voice–speak from your diaphragm
• Project your voice–use energy when you speak
• Use appropriate animation 

Additional Considerations 

Seek out public speaking opportunities to desensitize (reduce) your fear of communication apprehension.

Consider use of anti-anxiety medication

Join Toastmasters International to have a supportive and safe way to practice

public speaking

Gain experience–practice makes perfect. 

• academic skills

Current enrolled students can call University Counseling Service at 319-335-7294 to schedule an appointment. Initial Consultation appointments can also be scheduled online. Students must be in the state of Iowa to attend virtual/Zoom appointments.

Dealing with Speech Anxiety

Dealing with speech anxiety (view pdf).

People get anxious about public speaking for all sorts of reasons. Sometimes we are nervous because of who is in the audience, sometimes because of the topic, or sometimes we are just generally anxious about speaking up. Anxiety takes the form of sweaty palms, shaking hands, pacing, wobbly voices, or any number of other clues.

Two pieces of good news: 1. The anxiety is rarely as noticeable to others as it is to you, and 2. There are clear steps that you can take to help yourself.

Strategies for Handling Anxiety

Be prepared . It seems obvious, but if you are more familiar with your material, you will have less to be nervous about.

Practice . Practice early and often. The closer you can come to recreating the speaking experience, the more effective the practice will be. Stand up when rehearsing and actually speak aloud. You can practice with an audience after you've done a few run-throughs on your own.

Get comfortable in the space . Check out the room where you will be speaking ahead of time. Even if you will speak in the same room in which you've had class all semester, take a moment to stand at the front of the room and look out at where your audience will be. Making yourself familiar with the view from the front of the room, eliminates one more aspect that can trip you up. 

Plant a friendly face . Have a friend in the class? Someone you would like to have as a friend? Use that person as a touchstone. If you are comfortable, you can let that person know that you tend to get nervous and ask them to give you extra encouragement. Seeing that smiling face (and maybe the occasional thumbs up) can give you a boost in the moment.

Visualize your success . A common strategy for athletics and other performers works for speaking too. Visualize yourself in the speaking event. Visualize yourself giving the speech confidently and successfully. Pay attention to how it feels to do well and hold on to those feelings for when you get nervous.

Shake it off . Take a minute to literally get out the jitters before speaking. Stretch out your arms, run in place, roll your shoulders, move your neck and jaw around --- anything that gets you moving. This helps you relax by loosening up those muscles that you have been tensing. You just may not want to do this at the front of the room. :-)

Breathe . Take a few calming breaths before you go to the front of the room, and take another one before you begin. Inhale through your nose for a count of ten, hold that breath for a count of ten, then exhale slowly out of your mouth for a count of ten. Doing this a few times before you get up to speak will slow your racing heart and give your brain important oxygen.

Use your resources . The OCC tutors are trained in helping you prepare your presentation and rehearse it. By recording your rehearsal and providing constructive feedback, a tutor can help you improve and know that you are going into your presentation as well prepared as possible. If you find that you have anxiety in other areas of your life as well, don't forget that the Counseling Center and Peer Counselors are both available to you.

Office / Department Name

Oral Communication Center

Contact Name

Amy Gaffney

Oral Communication Center Director

Help us provide an accessible education, offer innovative resources and programs, and foster intellectual exploration.

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Social Anxiety

How anxiety can affect speech patterns.

• Anxiety is overwhelming, and it is not surprising that it affects speech.
• We identify at least 5 different examples of how anxiety affects speech.
• Speech typically requires focus and concentration, two things anxiety affects.
• Some types of anxiety are directly related to anxiety while speaking.
• Some public speaking techniques can also help with anxiety-related speech problems, but addressing anxiety itself will still be most important.

Fact Checked

Micah Abraham, BSc

Last updated March 1, 2021

In many ways, anxiety is an overwhelming condition. It overwhelms your senses, it overwhelms your thoughts, and it overwhelms your body. That's why it should come as little surprise to anyone that is suffering from anxiety that it can affect your speech patterns as well.

Anxiety is often apparent in your voice, which is why people can sometimes tell when you're feeling nervous. In this article, we explore some of the ways that anxiety affects speech patterns and what you can do to stop it.

How Anxiety Affects Speech

Different forms of anxiety seem to affect speech in different ways. You should absolutely make sure that you're addressing your anxiety specifically.

Anxiety causes both physical and mental issues that can affect speech. These include:

• Shaky Voice Perhaps the most well-known speech issue is simply a shaky voice. When you're talking, it feels like your voice box is shaking along with the rest of your body (and it is). That can make it sound like it is cracking or vibrating, both of which are a sign to others that you're nervous.
• Quiet Voice Those with anxiety - especially social phobia - often find that they also have a hard time speaking up in public. This type of quietness is very common, and while not technically a speech pattern, it can make your entire voice and the way you speak sound different to others. Although many will think of this in terms of volume, talking down at your feet will also exacerbate the effect.
• Dry Throat/Loss of Voice Some people find that anxiety seems to dry out their throat, or cause them to feel as though they're losing their voice.. One possible reason is that anxiety can make acid reflux symptoms worse, and those with acid reflux do have a tendency to wake up with sore throat and a loss of voice. Anxiety also increases the activity of your nervous system; when your fight or flight response is activated your mouth will naturally produce less saliva as a natural side effect.
• Trouble Putting Thoughts to Words Not all of the speech pattern symptoms of anxiety are physical either. Some of them are mental. Anxiety can make it much harder to for you to think about the words you're going to say, which can cause you to step over yourself, forget words, replace words with incorrect words, and more. Speaking generally has to be natural to be clear, and when you overthink it's not uncommon to find the opposite effect.
• Stuttering Similarly, anxiety can create stuttering. Stuttering itself is a separate disorder that can be made worse by anxiety. But beyond that, those that are overthinking their own sentences and word choices often find they end up stuttering a considerable amount, which in turn can create this feeling of embarrassment.

These are only a few of the issues that anxiety has with speech and speech patterns. There are even those that are bilingual that find that when they have anxiety they mix up the languages. Anxiety can do some unusual things to the way you talk to others, and that means that your speech patterns are occasionally very different than you expect them to be.

Are There Ways to Overcome This Type of Anxiety Issue?

Changes in speech patterns can be embarrassing and very unusual for the person that is suffering from them. It's extremely important for you to address your anxiety if you want these speech issues to go away. Only by controlling your anxiety can you expect your ability to speak with others to improve.

That said, there are a few things that you can do now:

• Start Strong Those with anxiety have a tendency to start speaking quietly and hope that they find it easier to talk later. That rarely works. Ideally, try to start speaking loudly and confidently (even if you're faking it) from the moment you enter a room. That way you don't find yourself muttering as often or as easily.
• Look at Foreheads Some people find that looking others in the eyes causes further anxiety. Try looking at others in the forehead. To them it tends to look the same, and you won't have to deal with the stress of noticing someone's eye contact and gestures.
• Drink Water Keeping your throat hydrated and clear will reduce any unwanted sounds that may make you self-conscious. It's not necessarily a cure for your anxiety, but it will keep you from adding any extra stress that may contribute to further anxiousness.

These are some of the most basic ways to ensure that your anxiety affects your speech patterns less. But until you cure your anxiety, you're still going to overthink and have to consciously control your voice and confidence.  

Summary: Anxiety is a distracting condition, making it hard to speak. During periods of intense anxiety, adrenaline can also cause a shaky voice and panic attacks can take away the brain’s energy to talk – leading to slurs and stutters. Identifying the type of speech problem can help, but ultimately it is an anxiety issue that will need to be addressed with a long-term strategy. 

Questions? Comments?

Do you have a specific question that this article didn’t answered? Send us a message and we’ll answer it for you!

Where can I go to learn more about Jacobson’s relaxation technique and other similar methods? – Anonymous patient

You can ask your doctor for a referral to a psychologist or other mental health professional who uses relaxation techniques to help patients. Not all psychologists or other mental health professionals are knowledgeable about these techniques, though. Therapists often add their own “twist” to the technqiues. Training varies by the type of technique that they use. Some people also buy CDs and DVDs on progressive muscle relaxation and allow the audio to guide them through the process. – Timothy J. Legg, PhD, CRNP

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Mini review article, speech anxiety in the communication classroom during the covid-19 pandemic: supporting student success.

• The University of Tennessee, Knoxville, TN, United States

A wealth of literature clearly supports the presence of speech anxiety in the communication classroom, especially in those classes with a focus on public speaking and/or presentations. Over the years, much work has been done on intentional approaches to empowering students to effectively manage their speech anxiety in face-to-face, hybrid, and online communication courses. These research-based findings have led to best practices and strong pedagogical approaches that create a supportive classroom culture and foster engaged learning. Then COVID-19 appeared, and things changed. In an effort to keep campuses safe and save the spring semester, everyone jumped online. Many instructors and students were experiencing online education for the first time and, understandably, anxiety exploded. Between the uncertainty of a global pandemic, the unchartered territory of a midterm pivot to fully online education, and the unknown effects of the situation on our educational system, our stress levels grew. Public speaking and presentations took on new meaning with Zoom sessions and webcams and our speech anxiety, undoubtedly, grew, as well. Reflecting upon the scholarship of the past with an appreciation of our present situation and looking toward the future, we will curate a list of best practices to prepare students to effectively manage their speech anxiety with agency, ability, and confidence.

Introduction

It is impossible for Isabella to catch her breath. Her pulse is racing, she is flushed, and her thoughts are a jumbled mess. She is desperately trying to remember her plan, slow her breathing and visualize success but it is impossible to do anything but panic. She is convinced she will embarrass herself and fail her assignment. Why had she postponed taking her public speaking class? Yes, it would have been bad in a “normal” term but now, amidst the coronavirus pandemic, she had to take the class online. Though it seems unimaginable that the class could be more terrifying, add Zoom sessions, internet connection issues, and little engagement with her teacher or classmate and Isabella’s out of control speech anxiety is completely understandable . If you have been in a college classroom, most likely, you have had to deliver a presentation, lead a discussion, or share a poster presentation. If so, you know what speech anxiety is like. Most of us have experienced the racing heart rate, difficulty concentrating and sensory overload characteristic of speech anxiety ( Dwyer, 2012 ). For some of us, like Isabella, the speech anxiety is almost debilitating. Even if you are one of the rare people who does not experience speech anxiety, you probably witnessed your classmates struggle with the stress, worry and insecurity caused by speech anxiety. It was prevalent before the arrival of COVID-19 and now with the stressors associated with the pandemic, virtual learning, and social distancing it will most likely increase. Fortunately, we have the research, resources, and resolve to intentionally craft classroom culture that will support communication success.

Meeting the Challenges of COVID-19

In the early spring of 2020, the coronavirus pandemic arrived in the United States, and required an unprecedented mid-term pivot. Classes rapidly moved from face-to-face instruction to online platforms in days. Teachers who had never taught online were learning while teaching, managing that additional workload while trying to stay connected with students who were worried and often overwhelmed. In addition to the public and personal health concerns of the virus, there were worries about online learning, the economy, and mental health. The bright spot was that in so many classes, the connections had been established before the pivot and so teachers and students were able to engage with familiar people in new ways. It was not an ideal situation but there was a sense that we were all in this together.

The fall of 2020 found many institutions of higher education and their faculty, staff, and students once again engaged in online instruction and it looks like it will be that way for the near future. We were faced with the new challenge of creating supportive and engaging class spaces completely virtual (in many cases) or in hybrid form with some classes combining online coursework with limited in-person instruction. Experience taught us that our students were speech anxious and that we needed to intentionally design safe and engaging spaces to support their success even before the arrival of COVID-19. Our challenge was to adopt a new skillset and look to the online learning community for resources, suggestions, and best practices.

Pandemic Pedagogy

Articles and emerging research on the response to the pandemic at the institutional, classroom, and individual level provide a glimpse into how we can craft virtual classroom spaces that support learning while meeting the needs created by COVID-19. Common themes for solid pandemic pedagogy include a focus on student mental health and well-being ( Gigliotti, 2020 ; Burke, 2021 ), an appreciation of technology challenges and access issues ( Turner et al., 2020 ; Burke, 2021 ; Singh, 2021 ), and a commitment to engaged teaching and learning ( Turner et al., 2020 ; Jenkins, 2021 ; Lederman, 2021 ). The fundamentals of good teaching are the same regardless of the modality and the foundational pedagogical practices are also similar, yet the primary difference is that solid online education has been designed for a virtual modality, not adapted to fit it (Kelly and Westerman, 2016 ). How can we craft safe and supportive online and virtual spaces for students to find, develop, and then actively share? A good place to start is with wayfinding which can “reinforce ways of knowing and problem solving,” ( Petroski and Rogers, 2020 , p. 125). Wayfinding supports efficacy and empowerment while meeting the challenges of pandemic pedagogy and can be incorporated into online communication classes to reduce speech anxiety and build classroom culture.

Speech Anxiety

The fear of public speaking, known as glossophobia, is a common and real form of anxiety ( Sawchuk, 2017 ) affecting as much as 75% of the population ( Black, 2019 ). In the scholarly literature, it is usually referred to as communication anxiety, communication apprehension, or communication avoidance ( Richmond and McCroskey, 1998 ). In more popular sources, such as Harvard Management Communication Letter, it has been called stage fright ( Daly and Engleberg, 1999 ) and speech anxiety ( Getting over speech anxiety, 2001 ). In this work, we will refer to it as speech anxiety as that term most closely targets the experience we are exploring.

Regardless of the label, it is our innate survival mode of flight, fight, or flee in the face of imminent (real or perceived) danger ( Thomas, 1997 ; Dwyer, 1998 ). Our mind feels a threat from a public speaking situation and our body responds accordingly. Common symptoms can include increased heart rate, blood pressure, and breathing; excessive perspiration, skin flush or blush; shaky voice; trembling hands and feet; or dry mouth and nausea ( Thomas, 1997 ; Dwyer, 1998 ; Black, 2019 ).

There are many tips and techniques that can help those with speech anxiety manage their symptoms and communicate effectively across a variety of modalities. Some common strategies include relaxation, visualization, cognitive restructuring, and skills training ( Motley, 1997 ; Thomas, 1997 ; Richmond and McCroskey, 1998 ; Dwyer, 2012 ).

(1) Typical relaxation tips can include mindfulness, deep breathing, yoga, listening to music, and taking long walks,

(2) Visualization involves inviting the speaker to imagine positive outcomes like connecting with their audience, making an impact, and sharing their presentation effectively ( Thomas, 1997 ; Dwyer, 1998 ). It replaces much of the negative self-talk that tends to occur before a speech opportunity and increases our anxiety.

(3) Cognitive restructuring is a more advanced technique with the goal “to help you modify or change your thinking in order to change your nervous feelings,” ( Dwyer, 2012 , p. 93). In essence, it involves replacing negative expectations and anxious feelings about public speaking opportunities with more positive and self-affirming statements and outlooks.

(4) Skills training is what we do in our classrooms and during professional workshops and trainings. It can include exploring speech anxiety and discussing how common it is as well as ways to effectively manage it ( Dwyer, 2012 ). It also involves analysis of the component parts, such as delivery and content ( Motley, 1997 ) practicing and delivering speeches in low stakes assignments, collaborating with classmates, and engaging in active listening ( Simonds and Cooper, 2011 ).

Ideally, solid skills training introduces the other techniques and encourages individuals to experiment and discover what works best for them. There is no one-size-fits-all solution to speech anxiety.

Classroom Culture

According to the Point to Point Education website, “Classroom culture involves creating an environment where students feel safe and free to be involved. It’s a space where everyone should feel accepted and included in everything. Students should be comfortable with sharing how they feel, and teachers should be willing to take it in to help improve learning,” ( Point to Point Education, 2018 , paragraph 2). Regardless of subject matter, class size, format, or modality, all college classes need a supportive and engaging climate to succeed ( Simonds and Cooper, 2011 ). Yet having a classroom culture that is supportive and conducive to lowering anxiety is especially critical in public speaking courses ( Stewart and Tassie, 2011 ; Hunter et al., 2014 ). Faculty are expected to engage and connect with students and do so in intentional, innovative, and impactful ways. These can be simple practices, like getting to know students quickly and referring to them by their preferred name, such as a middle name or shortened first name ( Dannels, 2015 ), or more elaborate practices like incorporating active learning activities and GIFTS (Great Ideas for Teaching Students) throughout the curriculum ( Seiter et al., 2018 ). We want to create a positive and empowering classroom climate that offers equitable opportunities for all students to succeed. As educators, we can infuse empathy, spontaneity, and equality into our pedagogy while being mindful of different learning styles and committed to supporting diversity and inclusion ( Simonds and Cooper, 2011 ; Dannels, 2015 ). Furthermore, our communication classrooms need to be intentional spaces where challenges, such as anxiety disorders, mental health issues, learning disabilities and processing issues, are supported and accommodated ( Simonds and Hooker, 2018 ).

Ideally, we want to cultivate a classroom culture of inquiry, success, and connection. We also want to foster immediacy, the “verbal and nonverbal communication behaviors that enhance physical and psychological closeness,” ( Simonds and Cooper, 2011 , p. 32). Multiple studies support that teachers who demonstrate immediate behaviors are regarded as more positive, receptive to students, and friendly ( Simonds and Cooper, 2011 ). As teachers and scholars, we want to make a positive impact. Dannels (2015) writes that “teaching is heart work,” (p. 197) and she is right. It demands an investment of our authentic selves to craft a climate of safety and support where comfort zones are expanded, challenges are met, and goals are reached.

Educators need to be mindful of and responsive to the challenges COVID-19 presents to the health and well-being of our students, colleagues, and communities. In May of 2020, the National Communication Association (NCA) devoted an entire issue of its magazine to “Communication and Mental Health on campus 2020,” ( Communication and mental health on campus, 2020 ) highlighting the importance of this issue in our communication education spaces. Suggestions included learning more about mental health issues, engaging in thoughtful conversations, listening intentionally and actively, promoting well-being, and serving as an advocate and ally ( Communication and mental health on campus, 2020 ).

Scholarship about instructional communication, computer mediated communication and online education ( Kelly and Fall, 2011 ) offers valuable insights into effective practices and adaptations as we intentionally craft engaging and supportive spaces, so our students feel empowered to use their voice and share their story, even those with high speech anxiety. Instructional communication scholars focus on the effective communication skills and strategies that promote and support student success and an engaged learning environment ( Simonds and Cooper, 2011 ).

General strategies to teach effectively during the pandemic can be helpful and easily adaptable to our public speaking classrooms. Being flexible with assignments, deadlines and attendance can support student success and well-being as can creativity, engagement activities, and appealing to different learning styles and strengths ( Mahmood, 2020 ; Singh, 2021 ). It seems everyone is presenting virtually now, not just in our communication classrooms and that can take some getting used to. Educators can model and promote effective communication by being conversational and engaging and empathizing with the many challenges everyone is facing ( Gersham, 2020 ; Gigliotti, 2020 ; Jenkins, 2021 ; Singh, 2021 ).

This is also a great opportunity to innovate and cultivate a new classroom climate looking at communication in a new way for a new, digital age. During this time of change we can harness opportunities and encourage our students to develop the skillsets needed to communicate effectively during COVID-19 and after. Preparing them as digital communicators with a focus on transferable and applicable skills would help them in other classes and the job market ( Ward, 2016 ). Innovations to our courses, assessment tools, and learning outcomes can all happen now, too ( Ward, 2016 ). This is the time to innovate our course experiences across all modalities, reinvent what public speaking means in the modern, digital age and intentionally craft learning spaces for all students in which speech anxiety is intentionally addressed and effectively managed.

Best Practices

(1) Be flexible, as a matter of practice not exception. Speech anxiety was experienced by most students to some degree and was debilitating for some pre-pandemic and adds another layer of stress for students who are capable and resilient yet dealing with a lot. Podcasts are a common communication medium and may ease the anxiety of some students while highlighting the importance of word choice, rate, and tone. They also involve less bandwidth and technology and may be easier for many students to create.

(2) Reframe communication as a skill of the many, not just the few. Highly speech anxious students tend to believe they are the only ones who have a fear of presenting and only certain, confident individuals can present well. Neither of these are true. If we reframe presentations as conversations, demystify speech anxiety by discussing how common it is, and empower our students with the knowledge that they can effectively communicate, we can reduce anxiety, build confidence, and develop important skills that transcend disciplines and promote self-efficacy.

(3) Build a community of support and success. When we see our students as individuals, celebrate connection and collaboration, and actively engage to learn and grow, we co-create an impactful and empowering space that supports success not by being rigid and demanding but by being innovative, intentional, and inspiring.

Author Contributions

I am thrilled to contribute to this project and explore ways we can empower our students to effectively manage their speech anxiety and share their stories.

Conflict of Interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: speech anxiety, public speaking anxiety, instructional communication, communication pedagogy, Best Practices

Citation: Prentiss S (2021) Speech Anxiety in the Communication Classroom During the COVID-19 Pandemic: Supporting Student Success. Front. Commun. 6:642109. doi: 10.3389/fcomm.2021.642109

Received: 15 December 2020; Accepted: 08 February 2021; Published: 12 April 2021.

Reviewed by:

Copyright © 2021 Prentiss. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Suzy Prentiss, [email protected]

This article is part of the Research Topic

Cultural Changes in Instructional Practices Due to Covid-19

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Anxiety Attack

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An anxiety attack is an episode of anxiety that comes on suddenly. If you're experiencing an anxiety attack, you may develop emotional symptoms like overwhelming fear or excessive worry and physical symptoms like shortness of breath and chest pain.

Everyone experiences some anxiety from time to time—and that's OK. However, if you're having anxiety attacks frequently, getting support from a mental healthcare provider and practicing mindfulness can improve your quality of life.  

Anxiety Attack Symptoms

Having an anxiety attack can be a scary experience. Anxiety can take over your whole body, causing a series of both emotional and physical symptoms .

With an anxiety attack, you may develop these emotional symptoms:

• Excessive worry
• Intense and overwhelming fear 
• Feeling like you're losing control
• A sense of impending doom
• Restlessness or nervousness
• Difficulty thinking

Physical symptoms can also occur alongside an anxiety attack, which may include:

• Excessive sweating
• A racing heart
• Shortness of breath
• Trembling or shaking

Anxiety attacks are intense but temporary episodes that usually last between a few minutes and a couple of hours.

What Causes an Anxiety Attack?

It's common to experience anxiety about certain experiences or problems in your life. Maybe you have an important life event (such as your wedding) coming up or are worried about performing well on a test at school. These feelings are completely normal.

If you feel as though your anxiety attacks are disrupting your daily life constantly, it may be a sign of an underlying anxiety disorder.

The following anxiety disorders may cause frequent anxiety attacks:

• Generalized anxiety disorder (GAD): Extreme worry or nervousness about everyday activities or events, even if there are no obvious or immediate threats
• Panic disorder: Causes unexpected and sudden panic attacks that can occur several times a week without any signs of imminent danger
• Phobias : Intense fears about various objects or experiences (e.g., fear of heights or spiders) that can cause anxiety attacks when you're exposed to the fear

Risk Factors

Anyone can develop anxiety, but some factors may increase your risk of experiencing an anxiety attack, such as:

• Having a family history of anxiety disorders
• Experiencing traumatic events
• Living with chronic stress
• Using substances excessively, such as stimulants or caffeine
• Possessing certain personality traits such as shyness or perfectionism

If you're experiencing symptoms of anxiety or having frequent anxiety attacks, seeing a healthcare provider to learn more about your condition and diagnose you properly can help. Your provider can offer several treatment options and recommend prevention tactics to reduce your symptoms more effectively.

You might visit your primary healthcare provider (PCP) for an initial evaluation. However, they'll likely refer you to a mental health provider (such as a psychologist or psychiatrist ) for additional testing. A mental health provider will perform a thorough psychological evaluation, ask about your symptoms, learn what may be triggering your anxiety attacks, and inquire about your personal and family medical history.

While there are no official lab tests (e.g., a blood test) that can diagnose you for an anxiety attack, your provider will use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to see if you meet the criteria for any underlying anxiety disorder.

It can be overwhelming to receive a diagnosis for an anxiety disorder. It's important to know that you are not your diagnosis. Your diagnosis is just a new part of your life. That said, getting the right treatment for you can help reduce the severity and frequency of your anxiety attacks and improve your quality of life. Your healthcare provider will likely recommend the following treatment options:

• Cognitive-behavioral therapy (CBT): Helps restructure your thoughts by encouraging you to learn and develop problem-solving skills and effective coping strategies to reduce anxiety and fear
• Acceptance and commitment therapy (ACT): Reduces feelings of intense fear through strategies such as mindfulness and relaxation techniques
• Beta-blocker medications: Blood pressure medications that can also help relieve symptoms of an anxiety attack, such as trembling and a rapid heart rate
• Anti-anxiety medications: Treat generalized anxiety disorder to reduce feelings of anxiety and prevent anxiety attacks from occurring

In some cases, your healthcare team may also recommend antidepressants , such as selective serotonin reuptake inhibitors (SSRIs), to reduce symptoms of anxiety and depression. This may be the case if you're having anxious thoughts and depressive moods together, which is a common experience for many people.

How To Prevent an Anxiety Attack

You can’t always prevent an anxiety attack, as the nature of these episodes is sudden and unexpected. However, if you're experiencing anxiety attacks often, certain strategies can reduce the likelihood of future episodes. These include the following:

• Keep track of any common triggers and avoiding them if possible
• Practice mindfulness and relaxation techniques, such as meditation or yoga
• Prioritize sleep
• Get regular physical activity or exercise
• Lower your intake of alcohol and caffeine
• Eat multiple times throughout the day
• Try stress management techniques such as spending time with loved ones or doing a hobby you enjoy

Many people with frequent anxiety attacks also have other mental health conditions that can occur alongside anxiety. If you have an anxiety disorder, you may also have a history of or be at higher risk for the following conditions:

• Depression  
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder  
• Personality disorders
• Substance use disorder
• Eating disorders

Living With Anxiety Attacks

Anxiety attacks can affect many aspects of your daily life—and living in constant anxiety can be a scary and frustrating experience. People with anxiety disorders are more likely to use drugs and alcohol, have trouble staying employed, and experience conflict in their relationships. They may also avoid social events and other potentially enjoyable activities for fear of triggering an anxiety attack.  

The good news is that anxiety disorders are treatable. Psychotherapy and medication are highly effective in relieving symptoms and preventing future episodes. Your healthcare provider may also recommend other lifestyle adjustments such as trying mindfulness, getting enough sleep, going out in nature, and spending more time with loved ones. You may not find the cure to your anxiety attacks on day one, but staying the course and learning what works for you will be helpful in the long run.

Frequently Asked Questions

The 3-3-3 rule is a grounding technique. It’s meant to help you calm down and stay present when you are feeling anxious or experiencing the beginnings of an anxiety attack. This technique involves noticing three things you can hear, three things you can see, and three things you can touch in your immediate environment.

Certain prescription medications, such as beta-blockers, are often prescribed to relieve acute (severe) anxiety quickly. You can also use simple mindfulness and relaxation techniques to relieve anxiety in the moment.

Several dietary supplements can help reduce anxiety. Studies suggest that magnesium supplements can reduce self-reported stress and anxiety levels. High-dose vitamin B6 supplements may work to relieve symptoms of both depression and anxiety. For people with vitamin D deficiency, taking vitamin D supplements can also help curb worries.

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Zhu C, Zhang Y, Wang T, Lin Y, Yu J, Xia Q, Zhu P, Zhu DM. Vitamin D supplementation improves anxiety but not depression symptoms in patients with vitamin D deficiency . Brain Behav . 2020;10(11):e01760. doi:10.1002/brb3.1760

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‘Inside Out 2’ Goes Full ‘All About Eve’ with Anxiety and Joy

Bill desowitz.

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Pixar director Kelsey Mann pitched “Inside Out 2” (in theaters June 14) as a hostile takeover of Riley’s (Kensington Tallman) emotions during the onslaught of puberty, led by Anxiety (Maya Hawke ) and cohorts Envy (Ayo Edebiri), Ennui (Adèle Exarchopoulos), and Embarrassment (Paul Walter Hauser).

In fact, Mann found it analogous to “All About Eve,” with Anxiety as the emotional ingenue willing at first to support Joy and learn from her. That is, until she realizes that she needs to supersede her after Joy blows Riley’s first opportunity to make a good first impression on high school hockey star Valentina (Lilimar Hernandez) at summer camp. Rather than having Riley play it cool, as Anxiety suggests, Joy dials up the emotion and embarrasses her.

Soon after, Anxiety takes over Headquarters and explains her plan for “Operation New Riley”: “My job is to protect her from the scary stuff she can’t see. I plan for the future.” Then, she bottles up Joy and her support team in a jar as suppressed emotions and banishes them to Riley’s vault of secrets.

The orange Anxiety is like a Seussified Muppet with her stringy carrot top, bulging eyeballs, wide mouth, and skinny body. Mann told IndieWire that her fast-talking entrance pushed the boundaries of what she could do physically, so he requested that she move comically fast. “She could pop over here, over there, and over there,” he said. “And she could drop down from the top of the frame. And they asked how she was going to do that. I didn’t know. We just did it, and she was funny.”

New tech was also required for the different personality poses of Anxiety’s wild-looking hair. “The sim department have always had the ability to change the hair on a character to be messy or a little bit more straight,” Bonifacio added. “On Anxiety, we felt that those changes needed to be tied to her performance so that when she’s normal, it’s this fountain of hair, but then if she gets excited, it can flex and straighten up. And so giving the animators the ability to suggest those timings to the sim department with this new rig, they were able to take that and make it real.”

The challenge with Anxiety was not making her seem like an unlikable villain, such as when she gets rid of Joy and the other emotions. The animators worked hard to make her appealing by making her impulsive and remorseful.

At the same time, Anxiety is also cunning in the way she thinks several steps ahead about all that could possibly go wrong. “This was very much in line with the research provided by the PhD consultants about what is anxiety and how it manifests itself,” Anderson told IndieWire.

Physically, there was plenty to play with, especially twitching, quick head moves, and shaking. Plus Hawke nailed the frantic quality with her vocal performance. “But we quickly realized that if we did that all the time, for every moment she was on screen, the audience would just be completely exhausted after a few minutes,” Anderson added. “So, finding her meant taking her to 11 where it made sense, but also being able to give her a range so that she’s not constantly at that level.”

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Dyspraxia vs Apraxia: what’s the difference?

Featured Image by David Cassolato, Pexels

This article will discuss the definitions of dyspraxia and apraxia, the main difference between them, and several aspects such as their nature, impact on speech, the severity of the condition, and the relationship between them. It is important to raise awareness about these conditions as they both affect the brain’s ability to plan movements needed to make speech sounds.

What exactly is dyspraxia?

The definition of dyspraxia may depend on the individual’s profession you are asking. Dyspraxia may have different definitions depending on different fields such as physiotherapy, speech and language therapy, teachers and so on. However, according to the Dyspraxia Foundation, it can be defined as “an impairment or immaturity of the organisation of movement. Associated with this there may be problems of language, perception, and thought”. In other words, it is about the brain’s immaturity to process information which affects the body’s responses. Moreover, the Greek etymology of the word means poor performance of movements.

What is apraxia?

Apraxia is used to define the impaired ability of performing a gesture, despite several brain functions being engaged in the action. This means that people have difficulties in performing certain movements, even though their muscles are normal. Being a neurological condition, milder forms of apraxia are defined as symptoms of dyspraxia. There are different forms of apraxia which affect different gestures or movements. For example, orofacial apraxia affects facial gestures such as lip licking or winking. Another form of apraxia is related to persons’ capacity to move their arms and legs. Moreover, apraxia of speech raises difficulties in persons’ lives when they have to move their mouth or tongue to speak. Additionally, apraxia of speech can be acquired in people of all ages, or it can be present from birth, affecting children’s ability to form sounds and words. Several symptoms of apraxia of speech may consist in difficulty in saying long or complicated words, omitting consonants at the beginning and end of words, distorting of vowels, speech inconsistencies, babbling during childhood, and so on. Usually, apraxia of speech in children can be observed along with other conditions such as grammatical issues, limited vocabulary, clumsiness, and having problems with chewing and swallowing.

What are the main differences between apraxia and dyspraxia?

Both terms, apraxia and dyspraxia, describe two disabilities which are closely related. For example, in children, when they have a difficulty in pronunciation, language therapists may diagnose them with Childhood apraxia of speech and verbal dyspraxia too. According to research, the term apraxia is used more by the American Speech Language-Hearing Association, and other professionals prefer to use the term verbal dyspraxia. However, one of the main differences between these conditions is related to their severity. Thus, apraxia is most severe because it refers to the complete inability of doing something, while dyspraxia refers to the partial inability of performing actions.

The nature of the disorder

The nature of the disorder is developmental by affecting individuals’ ability to process sounds, syllables, and words. As mentioned before, this neurological condition is not connected to muscle weakness or paralysis, it is just the brain’s inability to move different body parts that are needed for speech. It may occur as a result of a neurological impairment associated with complex neurobehavioral disorders. The Diagnostic and Statistical Manual of Mental Disorders-5 describes verbal dyspraxia as a disorder in which “other areas of motor coordination may be impaired as in developmental coordination disorder”. Therefore, the impairment of speech when neuromuscular deficits are not present is highlighted.

Impact on speech

According to the World Health Organization’s International Classification of Functioning, Disability and Health framework, some of the impacts on speech may be represented by impairments in body structure and function, limitations in activities and participation due to poor functional communication, difficulty in interpersonal communication with family members and friends, and learning difficulties. Moreover, the impact on speech can also affect environmental and personal factors such as poor communication abilities and communication impairments which affect the quality of life of the individuals.

The severity of the condition

Severity is usually referred to as mild, moderate, or severe. The level of severity of the condition is determined by the child’s response to tactile stimulation, and visual and auditory stimulation. It is important to keep in mind that not the child’s vocabulary determines the severity of the condition, because the number of words or sounds a child has will change over time. Therefore, they can have a limited vocabulary which can be misunderstood as a severe level, but in fact they may perform well to cueing in therapy, indicating a mild or moderate severity.

Can dyspraxia lead to apraxia?

As it has already been mentioned, these two conditions are very closely related, in that apraxia is a form of dyspraxia. However, dyspraxia is an umbrella term to describe muscle planning developmental abilities, while apraxia is most commonly used to describe muscle planning needed for speech. They can affect gross and fine motor skills, motor planning and the way movement is organised, speech and language, and the ability to perform your daily activities in a normal way. These conditions can be acquired, for example due to strokes or head injuries, or they can be associated with failures or delays of normal neurological functions. Therefore, dyspraxia and apraxia can influence the ability of individuals to perform daily tasks, influencing individuals to become apathetic or uninterested. These conditions may be often associated with anxiety, depression, attention deficit hyperactivity disorder, autism spectrum disorders, learning difficulties, and language impairments.

This article presented the definitions of dyspraxia and apraxia, discussing the differences between these two conditions, and explained the nature of the disorder, the impact it has on speech, how to understand the level of severity, and the relationship between these two.

Useful Links: What is Dyspraxia What is Verbal Dyspraxia

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Oana Gherasim

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Treatment and Intervention for Hearing Loss

• No single treatment or intervention for hearing loss is the answer for every child or family.
• Intervention plans will include close monitoring, follow-ups, and any changes needed along the way.
• There are many different options for children with hearing loss and their families.

Treatment and intervention overview

Treatment and intervention options for hearing loss in children include

• Working with a professional (or team) who can help a child and family learn to communicate.
• Getting a hearing device, such as a hearing aid.
• Joining support groups.
• Taking advantage of other resources available to children with a hearing loss and their families.

Early Hearing Detection and Intervention (EHDI) Programs

Every state has an EHDI program. EHDI works to identify infants and children with hearing loss. EHDI also promotes timely follow-up testing and intervention services for any family whose child has a hearing loss.

Important tip‎

Treatment and intervention types, intervention services, early intervention (0-3 years).

Hearing loss can affect a child's ability to develop speech, language, and social skills. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child's communication (speech or sign language) and social skills will reach their full potential.

Early intervention program services help young children with hearing loss learn communication and other important skills. Research shows that early intervention services can greatly improve a child's development.

Babies who are diagnosed with hearing loss should begin to get intervention services as soon as possible, but no later than 6 months of age .

There are many services available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004). Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if your child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

Special Education (3-22 years)

Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities, or those who are experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.

Assistive Technology

Many people who are deaf or hard-of-hearing have some hearing. The amount of hearing a deaf or hard-of-hearing person has is called "residual hearing." Technology does not "cure" hearing loss but may help a child with hearing loss to make the most of their residual hearing. For those parents who choose to have their child use technology, there are many options, including

• Hearing aids
• Cochlear or brainstem implants
• Bone-anchored hearing aids
• Other assistive devices

Hearing Aids

Hearing aids make sounds louder. They can be worn by people of any age, including infants. Babies with hearing loss may understand sounds better using hearing aids. This may give them the chance to learn speech skills at a young age.

There are many styles of hearing aids. They can help many types of hearing losses. A young child is usually fitted with behind-the-ear style hearing aids because they are better suited to growing ears.

Cochlear and Auditory Brainstem Implants

A cochlear implant may help many children with severe to profound hearing loss—even very young children. It gives that child a way to hear when a hearing aid is not enough. Unlike a hearing aid, cochlear implants do not make sounds louder. A cochlear implant sends sound signals directly to the hearing nerve.

Persons with severe to profound hearing loss due to an absent or very small hearing nerve or severely abnormal inner ear (cochlea), may not benefit from a hearing aid or cochlear implant. Instead an auditory brainstem implant may provide some hearing. An auditory brainstem implant directly stimulates the hearing pathways in the brainstem, bypassing the inner ear and hearing nerve.

Both cochlear and brainstem implants have two main parts. There are the parts that are placed inside the inner ear, the cochlea, or base of the brain, the brainstem during surgery; and the parts outside the ear that send sounds to the parts inside the ear.

Bone-Anchored Hearing Aids

This type of hearing aid can be considered when a child has either a conductive, mixed, or unilateral hearing loss and is specifically suitable for children who cannot otherwise wear ‘in the ear’ or ‘behind the ear’ hearing aids.

Other Assistive Devices

Besides hearing aids, there are other devices that help people with hearing loss. Examples of other assistive devices include

Frequency Modulation (FM) System . An FM system is a device that helps people with hearing loss hear in background noise. FM is the same type of signal used for radios. These systems send sound from a microphone used by someone speaking to a person wearing the receiver. FM is sometimes used with hearing aids. An extra piece is attached to the hearing aid that works with the FM system.

Captioning. Many television programs, videos, and DVDs are captioned. Television sets made after 1993 are made to show the captioning. You don't have to buy anything special. Captions show the conversation spoken in soundtrack of a program on the bottom of the television screen.

Other devices. There are many other devices available for children with hearing loss. Some of these include

• Text messaging
• Telephone amplifiers
• Flashing and vibrating alarms
• Audio loop systems
• Infrared listening devices
• Portable sound amplifiers
• TTY (Text Telephone or teletypewriter)

Medications and Surgery

Medications or surgery may also help make the most of a person’s hearing. This is especially true for a conductive hearing loss, or one that involves a part of the outer or middle ear that is not working in the usual way.

One type of conductive hearing loss can be caused by a chronic ear infection. A chronic ear infection is a build-up of fluid behind the eardrum in the middle ear space. Most ear infections are managed with medication or careful monitoring. Infections that don't go away with medication can be treated with a simple surgery that involves putting a tiny tube into the eardrum to drain the fluid out.

Another type of conductive hearing loss is caused by either the outer and or middle ear not forming correctly while the baby was growing in the mother's womb. Both the outer and middle ear need to work together in order for sound to be sent correctly to the inner ear. If any of these parts did not form correctly, there might be a hearing loss in that ear. This problem may be improved and perhaps even corrected with surgery. An ear, nose, and throat doctor (otolaryngologist) is the health care professional who usually takes care of this problem.

Placing a cochlear implant, auditory brainstem implant, or bone-anchored hearing aid will also require a surgery.

Learning Language

Without extra help, children with hearing loss have problems learning language. These children can then be at risk for other delays. Families who have children with hearing loss often need to change their communication habits or learn special skills (such as sign language) to help their children learn language. These skills can be used together with hearing aids, cochlear or auditory brainstem implants, and other devices that help children hear.

Family Support Services

For many parents, their child's hearing loss is unexpected. Parents sometimes need time and support to adapt to the child's hearing loss.

Parents of children with recently identified hearing loss can seek different kinds of support. Support is anything that helps a family and may include advice, information, having the chance to get to know other parents that have a child with hearing loss, locating a deaf mentor, finding childcare or transportation, giving parents time for personal relaxation or just a supportive listener.

Hearing Loss in Children

Hearing loss can affect a child’s ability to develop communication, language, and social skills. The earlier children with hearing loss start getting services, the more likely they are to reach their full potential.

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How Normal People Beautifully Represents Grief, Anxiety And Depression Through Paul Mescal And Daisy Edgar-Jones' Performances

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In one of Hulu’s best shows , Normal People , we see the depiction of anxiety, grief and depression in a candid and real way that is rarely depicted on television.

In the series, Paul Mescal’s Connell is dealing with loneliness all season and he loses a friend to suicide which triggers his depression toward the end of the series. For Daisy Edgar-Jones’ Marianne, she is dealing with self-loathing and loneliness throughout the entire run. Both these characters are handling anxiety and depression in real and relatable ways, and it's through these two actors' emotional performances that we get such a beautiful and raw depiction of mental health.

Read More About Projects With Great Mental Health Representation

20 Honest Movies About Mental Illness

Toward the end of the show, both Connell and Marianne battle with their mental health, and they work really hard to not let their anxiety and/or depression consume them. However, the show also did not downplay the fact that even if they are doing better, their mental health is still something they need to prioritize and focus on.

In an opinion piece for NBC News , reporter Elena Hilton wrote that Normal People “doesn’t sugarcoat, but neither does it exaggerate.” She also candidly opened up about how the show mirrored her own journey with depression and anxiety, writing:

Well acquainted with depression and anxiety attacks in my own life, I found it difficult to watch some scenes, like when Connell admits to his therapist that he has trouble connecting with people or adjusting to new environments. That feeling of helplessness is all-encompassing and more common than people realize. It’s also valuable that Normal People focuses on Connell’s vulnerability; talking through the feelings of numbness and grief is a key component in his ability to move forward.

Along with this, there has been a lot of deserved praise for the story and Mescal’s treatment of it. He portrayed Connell in such a nuanced way. While his character was still functioning and going about life, he was more exhausted and shut down to those around them. Also, his tender conversations with his therapist gave us a candid look into what’s truly going on in his mind and his relatable confusion over it.

Back when Normal People came out, Mescal candidly told The Independent that this story was personal to him. Three people died by suicide at his school when he was young, so he understood what Connell was going through, saying “It’s not fictional to me, it’s real, and I was really nervous portraying it.” Well, his performance was lovely, and throughout the series, it was heartwrenching to see his character go through this difficult experience in a way that was so honest.

In the case of Marianne, she is dealing with bouts of self-loathing throughout the series, and toward the end, she is in a sexually abusive relationship. Both things crush her. However, in the final episodes, we see her take proactive steps toward healing. She establishes boundaries, and she understands what she needs in her life to be happy.

Daisy Edgar-Jones is so vulnerable in her characters’ low moments, and she’s able to add nuance to her scenes that allows the audience to understand the various levels of trauma and anxiety that are seriously impacting her.

While the undeniable chemistry between the stars and the sweeping romance help make Normal People one of Daisy Edgar-Jones' best works and one of Paul Mescal’s greatest projects , the representation of mental health is also a major reason why the show is still beloved years after it came out.

To go back and see the wonderful performances from these two powerhouse actors, you can stream Normal People with a Hulu subscription . Then, make sure to check out the 2024 movie schedule so you don’t miss Daisy Edgar-Jones’ and Paul Mescal’s upcoming work, which includes Twisters and Gladiator 2 , respectively.

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