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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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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.

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Hacking Your Speaking Anxiety: How Lessons from Neuroscience Can Help You Communicate Confidently

In this podcast episode, we discuss actions you can take to reduce speaking anxiety and achieve your communication goals.

May 14, 2021

“There’s no difference between the physiological response to something that you’re excited about and something that you’re nervous about or dreading,” says Andrew Huberman , associate professor of neurobiology and ophthalmology at Stanford University.

In this podcast episode, Huberman talks with host and lecturer Matt Abrahams about his research on the autonomic continuum, a spectrum between states of high alertness or fear all the way down to deep sleep, and shares how to use the system to your advantage. “If people can conceptualize that the anxiety or stress response is the same as the excitement response, they feel different,” Huberman says.

Think Fast, Talk Smart is a podcast produced by Stanford Graduate School of Business. Each episode provides concrete, easy-to-implement tools and techniques to help you hone and enhance your communication skills.

Full Transcript: Hacking Your Speaking Anxiety

Matt Abrahams: Imagine what it would be like to be at your best every time you communicated: alert, focused, engaged, and with minimal fear. Today, using research from neuroscience we’ll explore how you can hack your communication to maximize your impact. I’m Matt Abrahams and I teach Strategic Communication at Stanford Graduate School of Business. Welcome to Think Fast, Talk Smart , the podcast. I am really looking forward to speaking with Andrew Huberman, who is a professor in the neurobiology department at Stanford University’s School of Medicine. Andrew’s research focuses on understanding the brain mechanisms controlling anxiety, cognition and performance under stress. Additionally, Andrew works diligently to bring neuroscience research to the public through his teaching, his videos, and his Huberman Lab podcast, which needs to be in everyone’s playlist. Thanks for being here, Andrew. Shall we get started?

Andrew Huberman: Delighted to be here.

Matt Abrahams: Like me, I know you’re fascinated by fear and its impact. As we all know, communicating in front of others in high stakes situations can certainly involve fear. From a neurologic point of view, what’s going on? What happens to our voice, our speech and our hand movements when we get nervous?

Andrew Huberman: Yeah. So when we get nervous, we are entering a state which is perfectly natural, but reflects one station along what’s called the autonomic continuum and really the autonomic continuum can be conceptualized as a continuum between states of very high alertness: think maximum excitement or fear all the way down to deep sleep, so that our states of mind and body are not discrete entities, they are along this continuum, this autonomic continuum. So when we are excited or we are nervous, we have a number of physiological responses that are purely autonomic, meaning they’re purely on an automatic.

The most important thing to realize is that it is a continuum. It has some features that are autonomic, meaning automatic, and that there’s no difference between the physiological response to something that you’re excited about and something that you’re nervous about or that you’re dreading. And so there’s an additional component there that we need to consider, but the most important thing above of all, and I guess if people are going to take away anything from our conversation today, it’s that despite these responses being automatic, there are direct control points through which we can control the autonomic nervous system, meaning that we can dial down the level of alertness or increase the level of calmness.

Those actually turn out to be two different things. So while it’s called the autonomic nervous system and the autonomic continuum, it’s a bit of a misnomer because there are two specific levers or entry points that we all have from birth that require essentially no learning. There’s you have to know what they are, but that will allow people to control voice level of alertness, level of shaking in their hands. So it’s a quite remarkable system in that it has this asymmetry — autonomic on the one hand, but with very powerful entry points for control on the other.

Matt Abrahams: I want to get back to the notion that you brought up about how we experience the physiological arousal that we get. You said in some cases it’s due to anxiety and fear. In other cases it’s due to excitement. You know, part of that I think, has to do with how we label what we’re experiencing and I know that there’s some research from my academic field that says one way to help manage anxiety is just to work on how you perceive the physiological symptoms that you’re having. So if you say, hey, even though my heart rate’s going up, I’m getting a little sweaty and shaky, it’s because I’m excited to share the information I’m sharing versus, oh, my goodness, everybody’s looking at me and I’m feeling nervous. So part of it, I think, has to do with how we frame the situation, does that ring true?

Andrew Huberman: Absolutely. When we are in a state of alertness, whether because of excitement or fear, the sympathetic division of the autonomic nervous system, let’s just call it the alertness system, deploys a hormone from our adrenal glands adrenaline and it deploys the equivalent chemical in the brain where it’s called epinephrine. It’s actually the same chemically identical structure, but called two different things, because neuroscientists and physiologists like to make things complicated. Not simple, but the role of adrenaline/epinephrine is to create agitation in the body and to create focus in the mind. And this is an important concept because that agitation makes it harder to be still, which is sort of a duh, right? That’s the definition of agitation, but it was designed to move us, to physically move us so that we would be biased toward ambulation or biased toward shifting from one position to a new one. And so one of the toughest things for many people is to tolerate that level of adrenaline or alertness when they have to be still.

The simplest example — I can give you this that I think most people will be familiar with, as if in the days where we congregated in person, this is this traditional practice of going around the room and introducing yourself and saying something about what you do and most people actually find that to be very stressful, especially if they toward the end of the line. Now, why would that be right? Most people know their name and can say their name. Most people know what they do and can say that — it’s anything but a high stress circumstance and occasionally there are some social pressure where someone’s very funny before us or they say something in a particularly nice way than we feel like some additional pressure to do that as well, but it really has more to do with the fact that when we’re in a room listening to somebody, we can we’re comfortable with the fact that we’re not going to speak or walk or do much and we could just sit there and write or listen or text or whatever it is we have to do. As we are called on to say something the reason it’s easier to do early in the line is because we are holding on to a reverberatory circuit. There are circuits in our brain that anticipate action and prepare us for action and the longer we keep that in check, the more challenging it becomes when we are trying to withhold action. But we’re preparing for action. There’s a lot of reverberating, excuse me, active activity in our nervous system and it feels like stress.

Getting ready to go up to the podium is tough. When we get up to the podium, many people, including myself, find that if we rock back and forth a little bit or we can engage some movement in our body, suddenly we start to relax and that’s because adrenaline/ epinephrine was designed to move us and it wasn’t designed to move us in response to incoming large predators. It was, but that’s not its primary function. Its primary function was to move us from whatever position we’re into a new position, sometimes towards things, sometimes away from things, depending on whether or not we want the experience or we want to avoid the experience. But the actual inner experience, what we call interception, our perception of our internal landscape, is identical for something that we want to approach versus we want to move away from; absolutely identical — below that from the neck down then.

Matt Abrahams: That is really interesting. So if you can reframe the physiological response, you can see it very differently. And I find it fascinating that when we see somebody who is nervous moving one way versus the other way, as an audience member, we have very different perceptions. So if somebody steps up on a stage and then takes a step back as they’re starting to speak, it looks like they’re retreating and therefore may be nervous or shy. But if somebody actually steps forward, we have a perception that they’re confident in stepping into the challenging situation. So it’s not only what we perceive, it’s how the audience perceives it as well.

Andrew Huberman: Absolutely. It might be useful for people to think about the fact that there’s only three responses we can have to any circumstance. One is to stay still. One is to move forward or one is to move back. Back in two-thousand eighteen a graduate student in the neurosciences program did her thesis with me Lindsays Tillet, and I published a paper in the journal Nature. Lindsay discovered a brain circuit that controls the movement toward threats. Now, this isn’t the kind of movement that will get you killed. This is the kind of movement toward an intelligent way, an adaptive way towards something that in this case, an animal or a person wants to do, but feels a tremendous amount of autonomic arousal, of stress and nervousness about.

And the take-home message is the following: forward movement under conditions of anxiety or high levels of alertness, a case, stress triggers the activation of a circuit deep in the brain that releases the neurochemical dopamine. Dopamine, of course, is a molecule that is most commonly associated with the sensation of reward and it is released when we achieve something that we want to achieve, but the other very interesting function of dopamine is to increase the probability that we will move toward similar types of goals in the future. So dopamine is not just the molecule reward, it’s the molecule of motivation and drive. And so Lindsay’s results have a number of different implications, but I think if people can just conceptualize that the anxiety or stress response is the same as the excitement response, they feel different because of some top down perception or verbiage that we introduced to it, but they’re actually identical physiologically. And that forward movement, provided it’s adaptive toward a goal, triggers the activation of chemicals in the brain and body that will make the subsequent pursuit of those same or similar goals more likely and more pleasurable.

Matt Abrahams: That’s really cool, so learning to take the stage and step forward, leaning in when you’re virtual can help and I believe in some of the work of yours that I read it doesn’t even… you don’t actually have to even physically move. If you simulate movement with your eyes, you can have a similar effect and I’d like for you to talk about that.

Andrew Huberman: Back in the early 80s, and someone actually in Palo Alto, a woman by the name of Francine Shapiro’s, a psychologist, developed a technique for it was actually developed for trauma treatment. She was a psychologist, did some work at Stanford, but also at a nearby clinic. And essentially she had found that taking walks was helpful for her anxiety and stress, something that everyone now I think says, OK, but we always thought that it was because of movement of the body, but she wanted to import some of that self-induced relaxation to her clinic. And she was clever enough to create this thing that they call EMDR Eye Movement Desensitization Reprocessing, which simply involves moving the eyes from side to side. It looks a little goofy if you see someone do it, but moving the eyes from side to side, not up or down, but side to side eye movement actually triggers, we now know, suppression of the amygdala, this fear center in the brain.

And for years people would ask me about EMDR because I’m a vision scientist and I work on stress and I thought it was totally kooky and crazy and I didn’t believe any of it and I my response was in my mind anyway, it was sort of like, okay, take your EMDR and your magic carpet and right and head down to Big Sur and let’s talk later if you want to talk science. But I really I was really quite wrong because a couple of years ago, there were no fewer than five papers published in very high quality journals, including Nature in Mice, Non-human Primates and Humans, showing that these laterized eye movements lead to suppression of this fear center in the brain. So it’s a quite long lasting effect. It’s I should just mention, if people are going to use it to deal with actual trauma, that should be done with a real trauma service.

Sure, it worked best for specific circumstances, like public speaking. It’s not great for sort of reducing your stress about your entire childhood or your entire divorce or your entire 2020. It’s best geared toward specific circumstances, but here’s how it works. You move your eyes from side to side for about 30 seconds, which is actually quite a long time. You don’t do this during the event. Right. But that creates a state of reduced alertness, a.k.a. stress. Not so much you fall asleep in your system and then you’re able to better approach things with more ease and with less alertness.

Matt Abrahams: I’ve heard you mention on your podcast that there are two approaches to addressing stress. Can you share those with us?

Andrew Huberman: The two approaches are you can either reduce your stress in real time, things like this, eye movements right before you go into a stressful event like up on stage or hard conversation or even if you’re just experiencing anxiety, there’s a breathing tool I’ll share with you in a moment that’s grounded deeply in physiology as well. Or you can raise your stress threshold. So things like ice baths running up steep mountains, exposure therapy, those are actually designed to increase your tolerance, your cognitive tolerance for high levels of agitation in your body, increasing the probability that you will stay still, not say the wrong thing, not strike anyone, not lose your cool. Right? So it’s sort of learning to be calm and storm or what is sometimes referred to as being comfortable, being uncomfortable.

That is a distinctly different set of practices then things like the eye movements I described or the second thing, which is a real time tool for calming oneself that my laboratory is working closely on with David Spiegels laboratory in the Department of Psychiatry, which is we asked the question, what breathing approach is the best way to calm oneself in real time? Because meditation is wonderful. TM is wonderful. If you know, if you’re of drinking age and you can tolerate it without going into a nice glass of wine is also another way to activate the person. Right? So is a massage. So is a dip in the hot tub or a sauna.

Matt Abrahams: Sounds like you’re describing a nice date.

Andrew Huberman: Right? Yeah, exactly. Or you know or remember, it’s called the Resting Digest System for a reason. One of the powerful ways to shift your autonomic nervous system to one of more calm is to feel your gut with food that then the digestion of your gut sends signals through the vagus nerve to a little set of neurons right behind your ear called the nodose ganglia, which projects into your brain gives you a little bit of a dopamine hit. This is, well, well-established, as well as activating areas of the brain that are involved in calming you down. And so, you know, there are a lot of ways to control the autonomic nervous system slowly and indirectly, massage hot tub, big meal, et cetera. We’re talking about real time control fast. So the best way that we know or that and this is work that’s still in progress is to use what are called physiological size. So these were discovered back in the thirties. It turns out that when you are stressed, you are breathing less deeply. Most common, the most common advice is to take a deep breath. It turns out that’s exactly the wrong advice.

Matt Abrahams: Oh, no.

Andrew Huberman: The exhale emphasized breathing leads to much more rapid activation of the calming arm of the nervous system. And it turns out you don’t just want to exhale. You want to do a double inhale. So inhale twice through the nose. So inhale through the nose. And then before you exhale, sneak in a little bit more air and then do a long exhale. And you do this just one to three times. So it’s you know, inhale. inhale again. Even if you just sneak the tiniest bit of air, ideally the emails are done through the nose and then exhale through the mouth. Now, why does this work? Turns out that your lungs are not just two big bags of air. They are billions of little tiny sacs called the alveoli of the lungs.

Matt Abrahams: Right.

Andrew Huberman: Those little sacs are or continue contiguous more or less with the vasculature, with the blood supply. So when you exhale, you offload carbon dioxide and a lot of the stress response is due to elevated carbon dioxide in the bloodstream. When, if you’ve ever been to a kid’s party and you’re asked to blow up a balloon and you blow in the balloon, sometimes it inflates right away, but if it doesn’t, you give to hard push pushes with air. One, two. And the same thing happens with the alveoli of the lungs. As we get stressed, they start to collapse, they flatten out and to reinflate the double inhale brings maximal air into the lungs and then you offload the maximum amount of carbon dioxide when you exhale. So this is very simple, very fast. You can actually do it during exercise as well. So if you ever find that your heart is pounding and you want to calm down, first thing is exhale, then maybe try the double inhale and then exhale. Follow.

Usually at least what we find in our studies is that within just one to three of those cycles, meaning within about five seconds, autonomic nervous system starts to shift more towards calmness. And then if you like, you can start using your eye movements or whatever cognitive reframing. But one of the things that I think will resonate with people, and I hope it does, is that it is very hard to control the mind with the mind. When you’re stepping up to the podium and you are nervous, you can say, oh, yeah, that nervousness is actually excitement and I think and this is a must be really agitated because I really want to do this and but, in that moment of stress, it’s very hard to control what’s going on. So under conditions where your mind is not where you want it, use the body to control the mind.

Matt Abrahams: So you’ve just shared techniques for what we can do when we’re directly experiencing anxiety, what can we do to prepare for anxiety and advance?

Andrew Huberman: The other thing to do is the stuff that you do away from the podium, away from the big event or the hard conversation. And that involves deliberately taking yourself into states of heightened alertness. As my colleague David Spiegel likes to say, it’s not just about the state you find yourself in. It’s how you got there and whether or not you had anything to do with it. And what he’s really saying is that when you drive your nervous system into a state of high alertness and you learn to be calm there, you achieve a certain kind of superpower such that when real life puts you into those states without any warning and very fast…you, it’s like driving in fog the first time you do it. It’s scary as heck. The fifth time you do it, it’s still scary, but you you’ve been there before and so you’re now a good driver. So the way you do this can be you know of different practices. But one of the best ones is a very cold shower and trying to stay calm for one to three minutes in a very cold shower.

Matt Abrahams: Wow.

Andrew Huberman: That’s not something that’s I like. It’s not very pleasant, which is…and there you use a protocol of breathing that involves taking twenty five to thirty deep inhales for reasons that now should be obvious to increase your heart rate. And then a big exhale.

Matt Abrahams: Hyperventilating like.

Andrew Huberman: You’re hyperventilating and by the twenty fifth one you will be very stressed. Now, I want to say that if people have our panic attack prone or anxiety attack prone this is I do not recommend this is very uncomfortable. But then what you do at the end of that twenty five abreast is you offload all your air, you empty your lungs and then you sit for about 15 to some people can go longer, 60 seconds or so, the lungs empty and you try and feel peaceful with that heightened level of adrenaline in your body. Now, never doing this in your water. I want to be really clear because there is this thing called shallow water. I don’t even do it in a puddle.

Andrew Huberman: Because I don’t want anyone injuring themselves or worse. But if you repeat that for two or three cycles, what you will find, it’s pretty remarkable. There are a lot of there’s some nuance to these practices, but they all kind of start and end with vision or breathing.

Matt Abrahams: Right. And I love how you make them simple for us to understand so that the things we can do in the moment are right out before the moment of the anxiety. And then there are things we can do to, in essence, desensitize ourselves in advance. Now, we are all communicating in this virtual world these days. Is there anything from your experience of how eyes work that that would indicate what we should do? For example, people often say you need to look at the camera. So it looks like you’re looking at the person on the other end. Any insight you have about this virtual communication? We all do, huh?

Andrew Huberman: Huh. OK, well, first of all, it’s a very unnatural time because most of all, because we are not used to seeing a little picture of ourselves moving while we look at other people. Everyone’s carrying a little mirror around on their shoulder for us now in this world — so turn that off or get it out of the way because it will interfere with your presence to the conversation and other people’s perception of how present you are. The other thing that’s really important is there’s a lot of research on gaze and eye contact and frequency of blinking. The most powerful way to connect with somebody through Zoom or just in person is actually not to stare directly at them the whole time is a combination of direct gaze, averting gaze and closing one’s eyes. That’s, you know, a real conversation involves moments where we are looking away, trying to, you know, like I’m doing right now. I’m trying to grab a concept and say it in a way that makes sense, but then also where we re-engage.

And so a conversation is actually a process of of looking directly at the other person and then breaking gaze and then coming back again. The other thing that works quite well, if people are experiencing eye fatigue from looking at screens up close and there’s a whole other conversation is one thing that works well is to see someone’s face at the beginning. Say hello, because faces are a powerful you know, it collects a lot of context for the brain saying hello, but then going into pure audio and then going back to visual before you part ways that may actually be a more effective form of Zoom communication than pretending we’re all in the same room and trying to stare at one another the entire time and sometimes see that reflection of ourselves.

Matt Abrahams: And that’s that’s advice that others on this podcast have given, that you don’t have to show your video the whole time. So before we end, Andrew, I’d like to ask you the same three questions I ask everybody who joins me on this podcast. Are you up for that?

Andrew Huberman: Definitely.

Matt Abrahams: If you were to capture the best communication advice you’ve ever received as a five to seven word presentation slide title, what would that be?

Andrew Huberman: Speak to inform and teach, not impress

Matt Abrahams: Oh I like that, so it’s about getting the information across and you are certainly a master at that and I encourage everybody to search out some of the work you’ve done. Your podcast is fantastic because you do such a nice job of something we talked about in an earlier podcast, how to make complex information accessible. You do a great job of that. You certainly don’t dumb it down, but you make it accessible as you’ve done for us today. Let me ask question number two, who is a communication that you admire and why?

Andrew Huberman: You know, I… there are two forms of communication that really appeal to me, and they will seem at odds with one another. I love poetry because really great poetry doesn’t really make sense at a cognitive level. It gets to a kind of what probably is some sort of deeper universal meaning, it probably is tapping into brain circuits that are more on an emotional level or that reside in the brain body connection. I really believe that. So that speaks to some sort of, quote unquote, truth. So I love poetry and I’m a big Wendell Berry fan. I’m also a big Joe Strummer fan you know, most famous for being the singer of The Clash for the things he said, not while he was on stage. So Joe Strummer was brilliant in terms of his offstage speech to people to check out some of the things that Joe said later in his life were really remarkable insights into human beings and humanity. There’s some real core truth there.

And the in the world of science, Claude Desplechin is a biology professor at NYU who studies insect vision and the only word that I can use to describe what it is to hear one of Claude’s lecture, whether or not you’re familiar with biology or not, is pure enchantment when he transports you into a world where, frankly, I don’t really care about dragonfly vision on a regular basis, but when I listen to Claude speak, I think about human vision, I think about love. He talks about the love spots of the dragonfly eyes that for pursuing mates and food and it’s just remarkable. And anyone that can do that for is incredible, but Claude is the world heavyweight champion of making biology fascinating and delightful.

Matt Abrahams: Well, I’m going to check his lectures out for sure. Last question for you. What are the first three ingredients that go into a successful communication recipe?

Andrew Huberman: Passion. The speaker has to love the topic in organizational logic there has to be a structure to the information that just can’t be bullet points and beginning, middle and kind of thing and clarity. If people if people walk away understanding more than they did at the beginning, then you you won. It gets back to the most important thing to do is to teach your audience, educate them.

Matt Abrahams: Passion, structure and clarity PSC, we’re going to add that as another acronym to your list of many acronyms I’ve heard you talk about. Andrew, it was fantastic to have you here. I’m taking a deep breath to calm myself down from all the exciting information that you shared. Thank you so much. It is my true hope that all of us listening in can apply some of these tools and hacks to optimize our communication. Thank you.

Andrew Huberman: Thanks so much for having me.

Matt Abrahams: Thank you for listening to Think Fast, Talk Smart , the podcast, a production of Stanford Graduate School of Business. To learn more, go to GSB.Stanford.edu. Please download other episodes wherever you find your podcasts.

For media inquiries, visit the Newsroom .

Explore More

Lose yourself: the secret to finding flow and being fully present, speak your truth: why authenticity leads to better communication, when words aren’t enough: how to excel at nonverbal communication, editor’s picks.

July 17, 2020 The Art of Negotiation: How to Get More of What You Want In this podcast episode, we discuss the common mistakes people make during high stakes communication and how to effectively approach these conversations.

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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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Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. Dysarthria often causes slurred or slow speech that can be difficult to understand.

Common causes of dysarthria include nervous system disorders and conditions that cause facial paralysis or tongue or throat muscle weakness. Certain medications also can cause dysarthria.

Treating the underlying cause of your dysarthria may improve your speech. You may also need speech therapy. For dysarthria caused by prescription medications, changing or discontinuing the medications may help.

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Signs and symptoms of dysarthria vary, depending on the underlying cause and the type of dysarthria. They may include:

• Slurred speech
• Slow speech
• Inability to speak louder than a whisper or speaking too loudly
• Rapid speech that is difficult to understand
• Nasal, raspy or strained voice
• Uneven or abnormal speech rhythm
• Uneven speech volume
• Monotone speech
• Difficulty moving your tongue or facial muscles

When to see a doctor

Dysarthria can be a sign of a serious condition. See your doctor if you have sudden or unexplained changes in your ability to speak.

In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. Conditions that may lead to dysarthria include:

• Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease)
• Brain injury
• Brain tumor
• Cerebral palsy
• Guillain-Barre syndrome
• Head injury
• Huntington's disease
• Lyme disease
• Multiple sclerosis
• Muscular dystrophy
• Myasthenia gravis
• Parkinson's disease
• Wilson's disease

Some medications, such as certain sedatives and seizure drugs, also can cause dysarthria.

Complications

Because of the communication problems dysarthria causes, complications can include:

• Social difficulty. Communication problems may affect your relationships with family and friends and make social situations challenging.
• Depression. In some people, dysarthria may lead to social isolation and depression.
• Daroff RB, et al., eds. Bradley's Neurology in Clinical Practice. 7th ed. Elsevier; 2016. https://www.clinicalkey.com. Accessed April 10, 2020.
• Dysarthria. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/dysarthria/. Accessed April 6, 2020.
• Maitin IB, et al., eds. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. Accessed April 10, 2020.
• Dysarthria in adults. American Speech-Language-Hearing Association. https://www.asha.org/PRPPrintTemplate.aspx?folderid=8589943481. Accessed April 6, 2020.
• Drugs that cause dysarthria. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 10, 2020.
• Lirani-Silva C, et al. Dysarthria and quality of life in neurologically healthy elderly and patients with Parkinson's disease. CoDAS. 2015; doi:10.1590/2317-1782/20152014083.
• Signs and symptoms of untreated Lyme disease. Centers for Disease Control and Prevention. https://www.cdc.gov/lyme/signs_symptoms/index.html. Accessed April 6, 2020.
• Neurological diagnostic tests and procedures fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. Accessed April 6, 2020.

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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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Speech & Language Difficulties

A dvanced Therapeutic Solutions for Anxiety offers speech and language therapy for those both with and without anxiety-related disorders that can impact communication. Licensed speech-language pathologists have expertise in many areas of communication and other specialties. Please see the below which further delineates the various components of speech and language, and further explains how a speech-language pathologist can help. 

Expressive and Receptive Language: Expressive language refers to verbal (e.g., speaking) and nonverbal (e.g., signing) communication. Receptive language refers to comprehension of spoken or signed language. Difficulties in expressing oneself and/or understanding others can impact social and academic success. Evaluation by a speech-language pathologist may be helpful if difficulty understanding directions or a limited repertoire of words is observed.

Stuttering: Stuttering is when typical speech patterns are disrupted with hesitations or repetitions, often referred to as disfluencies. At times, normal stages of development may result in temporary disfluencies that differ from the disfluencies observed in people who stutter. Evaluation by a speech-language pathologist may be helpful if repetition of the same words or sounds or a fast rate of speech is observed. 

Apraxia: Apraxia is a motor speech disorder that results in difficulties with the motor planning process of speech. The necessary articulators for speech do not receive messages properly from the brain in order to produce intelligible speech. Evaluation by a speech-language pathologist may be helpful if difficulties producing intentional speech but increased ease with more automatic speech (e.g., Happy Birthday) and/or difficulties with longer words is observed. 

Pragmatic Language: Communication not only involves understanding others and expressing oneself through language, there are also many social aspects to successful communication. The pragmatic components of communication allow us to express ourselves through both verbally and nonverbally. There are many aspects to social communication such as gestures, facial expression, interpreting and applying peer appropriate social rules, and conversation skills. Evaluation by a speech-language pathologist may be helpful if difficulties staying on topic, engaging in appropriate turn taking during play, and/or interpreting and applying social rules for communication. 

Articulation: As children develop spoken language, errors in speech sound production are to be expected. At various points in development, specific errors in articulation should resolve. In instances when these errors are not resolved by the time most peers are no longer demonstrating these errors, an evaluation by a speech-language pathologist may be helpful. 

Executive Function: Academic success is often impacted by executive function. This refers to concept such as impulse control, time management, attention, working memory, self regulation, and organization. Evaluation by a speech-language pathologist may be helpful when difficulties with the aforementioned skills are observed.

Reading and Writing: Reading and writing have their foundations in expressive language and auditory comprehension, and have a reciprocal relationship. Those with difficulties with expressive language and auditory comprehension, may also have difficulties in reading and writing. Evaluation by a speech-language pathologist may be helpful when difficulties in reading and writing are observed. Note, further collaboration with a reading specialist, outside of ATSA, may also be warranted 

Voice: Atypical vocal qualities can be secondary to a variety of diagnoses including infections, viruses, lack of vocal hygiene, allergies, neurological disorders, and voice misuse.  Evaluation by a speech-language pathologist may be helpful when difficulties with the aforementioned skills are observed.  ATSA does not currently offer services for voice therapy, however, please see our outside referral list for recommendations. 

Aural Rehabilitation: When a person has hearing loss, they may choose to be a member of the hearing community. During these instances, a speech-language pathologist may assist in the assessment and management of hearing loss on communication. ATSA does not currently offer services for aural rehabilitation, however, please see our outside referral list for recommendations. 

Feeding: Meal times can be difficult for developing children. Feeding therapy can assist children who face difficulties with eating and/or drinking. Many components can impact one’s ability to eat and drink including behavioral, sensory, and oral motor difficulties. Evaluation by a speech-language pathologist may be helpful if meal times are often stressful and rigid, there is a limited repertoire of foods consumed, and specific textures are avoided.  ATSA does not currently offer services for AAC, however, please see our outside referral list for recommendations. 

Alternative Augmentative Communication: When someone cannot communicate verbally, an alternative to this can be using Augmentative and Alternative Communication (AAC). There are a variety of types of AAC systems, from picture boards to iPads. Evaluation by a speech-language pathologist may be helpful when verbal output is limited. ATSA does not currently offer services for AAC, however, please see our outside referral list for recommendations.

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Interesting Fact : 33% of patients who are diagnosed with selective mutism are also in need of speech & language services!

How our speech and language services differ for those with selective mutism : Our speech-language pathologists have specialized training in the PCIT-SM protocol we utilize at ATSA to bolster verbal communication for those with selective mutism. When work on speech and language skills begins, these techniques will continue to be emplored to continue to foster verbal communication.

Clinical Procedures for Speech & Language Difficulties Evaluation and Outpatient Treatment

Evaluation of speech sound production.

A 30-60 min. diagnostic intake interview with the child’s parents to collect history, review of systems, differential diagnosis, review of prior records, review child functioning, parents’ and family histories, especially in regards to speech sound production.

CPT CODE: 92522

Evaluation of Speech Sound Production with Evaluation of Language Comprehension and Expression

A full diagnostic intake interview with the child’s parents to collect history, review of systems, differential diagnosis, review of prior records, review child functioning, parents’ and families histories, especially in regards to speech sound production, language comprehension, and expression.

CPT CODE: 92523

Behavioral and Qualitative Analysis of Voice and Resonance

A 60 min. session with the child and/or child's parents to assess voice and resonance.

CPT CODE: 92524

Speech Therapy

30 - 60 min. sessions working with your child on their specific speech and language goals. Treatment can be delivered in-person or via telehealth.

CPT CODE: 92507

Speech Group Therapy

60 min. speech therapy in a group setting. Each patient will be working on their own specific goals while practicing their speech and language with peers. 

CPT CODE: 92508

SLP Lead-in Session for Selective Mutism

60-min exposure sessions provided to help transfer treatment gains from the ATSA SM clinical therapist to the Speech and Language Pathologist. By nature of the disorder, SM symptoms occur selectively across environments. A SLP Lead-in session will assist with the transfer of treatment gains and help establish and maintain verbal behavior.

Parent Feedback Session

A 30-60 min. feedback session with parents is held which includes presenting diagnoses, symptom severity, diagnostic rule outs, and discussing the recommended treatment plan. Parents are asked for their specific goals for their child and what they hope to gain from treatment at ATSA. Parents will be provided guidance on the behavioral techniques to implement at home with their child, to help maintain and generalize treatment gains. Parents are provided feedback about their child’s challenges and gains from the initial assessment sessions, and the specific techniques that will be used to successfully help their child. Throughout treatment, parents are provided with additional feedback sessions to discuss next steps, including help with transfer of skills outside of the clinic setting.

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• Anxiety Guide
• Help & Advice

Behavioral Symptoms

Anxiety speech problems: trouble concentrating and swallowing while speaking, fact checked.

Micah Abraham, BSc

Last updated October 10, 2020

Speaking in a public setting, whether to a large group or simply to another person, can be a difficult, and even embarrassing, task when anxiety is involved. Many people with anxiety disorders experience speech problems including difficulty concentrating and feeling the need to swallow while they are speaking. These types of speaking problems can cause you to avoid speaking entirely, or to panic whenever you do speak.

If you are suffering from these symptoms of anxiety it can help to know exactly what is happening in your body when you experience these speech problems as well as what you can do to prevent them.

How Anxiety Can Make It Hard To Concentrate

Anxiety is a mentally and physically overwhelming condition. Your mind (and your brain) can only focus on a certain number of things at any given time. When you have anxiety, it takes up much of that space, making it considerably harder for you to concentrate on the tasks at hand. Indeed, not only does it take over your thoughts, but there is a great deal of evidence that anxiety can actually shut some parts of your brain down temporarily because it can't handle all of the work.

When you really need to concentrate, anxiety is right there to get in the way. Whether it is preventing you from applying your mind to a problem, crowding your mind with other problems, or refusing to let you rationalize your thoughts, anxiety can cause real difficulties when you are trying to speak well and make a good impression on others (for example, at a job interview, meeting someone you are attracted to, or making a presentation in front of a group). Speaking can involve unrealistic anxieties about the negative ways people may perceive you or irrational worries about your body malfunctioning while you speak. Additionally, having a speech impediment can make it even more difficult to speak in public.

Here are some of the effects that anxiety has which may stop you from concentrating when speaking:

• Deer in the Headlights Effect Anxiety, like fear, can cause your brain to freeze up (like a deer in the headlights). The thing that disturbs you becomes so overwhelming that your mind and body don't know what to do, tensing up and leaving you feeling unable to operate.
• Conflicting Concerns Having anxiety about other things, unrelated to speaking, can make it difficult to concentrate. If you are worrying about something going on in your life, something coming up in the future, or worrying about having a panic attack it will keep your mind from focusing on the task at hand.
• Negative Thought Spirals People who suffer from anxiety often find themselves caught in negative thoughts that spiral out of control. They may catastrophize the situation as well. For example: I can't speak because I'll sound like an idiot, if I sound like an idiot everyone will laugh at me, if everyone laughs at me people will lose respect for me, if they lose respect for me I'll be ostracized, and so on. Thought patterns such as this do not give you the headspace necessary for formulating ideas, much less trying to figure out how to articulate them clearly.
• Distracted by Others' Faces One symptom of social anxiety is often that you are too distracted by the faces of others because you're trying to see how they're interpreting you. That distraction means you are not concentrating on what you're about to say.
• Overthinking Another problem is actually overthinking. Many people with anxiety find that they try too hard to figure out what they should say next in order for it to be "perfect", only to find that they've lost their place and are unable formulate thoughts.

These experiences can lead to you doubt yourself, lose self esteem, and even increase your anxiety.

Swallowing While Speaking

Swallowing, like many bodily functions we never or rarely think about, becomes strange and challenging the moment we do focus on it. Overthinking simple physical acts such as swallowing, which are meant to happen unconsciously, may lead to hysterical reactions and socially inappropriate physical responses in attempting to compensate for the imagined problem.

Symptoms of this problem can include:

• Choking Swallowing while trying to speak can be too much for your body to process at once, which can lead to a feeling of choking. Choking is a frightening experience that can make you feel like you can't breathe properly and lead to further anxieties about suffocation and death.
• Gagging If your throat is triggered by saliva or by enough swallowing, it can result in gagging. Gagging is unpleasant to hear and to experience, as it is the result of signals in your brain suggesting that you may need to throw up, and may even result in feelings of nausea.
• Spitting Thinking too much about swallowing can actually prevent you from swallowing enough, which leads to excess saliva in the mouth and the unfortunate consequence of spitting unintentionally while speaking.
• Frequent Pauses During Speech If you are thinking about swallowing you may find yourself having to stop mid-speech to consciously do so, as you are interrupting your body's unconscious swallowing mechanisms (which controls how much saliva you produce and regulates when you need to swallow so it doesn't interfere with speech).
• Blushing The embarrassment caused by this problem can result in blushing uncontrollably. This can have the cyclical effect of causing further embarrassment which further stimulates blushing, and so on.

Being unable to concentrate can be mentally and socially uncomfortable, but difficulty swallowing can lead to physical consequences that can be even more unpleasant. Overcoming these barriers is crucial for people suffering from them to be able to live a normal and productive life. The list below will give you an idea of the types of mental exercises you can try in order to overcome them.

How to Defeat Your Public Speaking Anxiety Symptoms

The problem with anxiety is that it blows your fear of speaking and being judged out of proportion and makes you worry about things that just aren't realistic. You won't be ostracized for life if you stutter a little. You won't die from swallowing strangely. You won't lose friends simply because you lost your place in the conversation, and your life won't be over if you ever did lose a friend.

The fact is, most people get nervous when they have to speak publicly, and will usually be understanding of other people who feel the same way. Difficulty concentrating is a common experience for those who struggle with public speaking. And while difficulty swallowing may be less common, it is not something that should keep you from publicly speaking.

Here are some ways to calm your public speaking anxiety so that it stops getting in your way when you need to make yourself heard:

• Practice Speaking If you are preparing in advance for an event, read or review in your mind what you are going to say until saying it is practically second nature. To help you, you can come up with mnemonic cues to help you remember what you need to say if your mind suddenly goes blank. In situations that aren't as important (i.e., outside of a job interview or presentation), you can conscientiously practice your speech with others, trying to sound as natural and relaxed as possible.
• Pretend Your Audience Is Someone You Know Imagining your audience is a person you are comfortable talking to (a close friend, a grandmother, or maybe even yourself) can help get you in a more relaxed frame of mind. You won't worry so much about what they will think of you, and may even find yourself enjoying talking to them (when you are relaxed, you audience will react to you in a more comfortable and natural way).
• Think of Something Important to You Before speaking, you can relax yourself by calling to mind something you have a firm devotion to of belief in, like your family, your religion, or your ethical standpoint on an important issue. This will make you feel grounded and confident in yourself, which can help keep your mind from wandering in a state of uncertainty to unimportant things like monitoring your swallowing or obsessing about how you sound rather than focusing on what to say.
• Picture Yourself Succeeding When you vividly imagine everything going as well as you want it to (by imagining how comfortable your body will feel, how confidently you will speak, and how positively the audience will respond to you), your body will be prepared for that to happen rather than crippling you with the certainty that the opposite will happen.

Getting stuck on anxious thoughts and physical symptoms does not have to keep you from doing the important things in life that require you to speak with confidence and ease. Now that you are more informed about your body and have some strategies to cope with your speech anxieties, it is time to try them out and start making some positive impressions.

It is important to note that anxiety about public speaking often goes hand in hand with having other anxieties. The only way to truly cope with a fear of public speaking is to address your anxiety as a whole. While these strategies will help reduce your anxiety about public speaking, learning to manage your general anxiety is something that will take time and a commitment to treatment.

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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Can Stress Cause Speech Problems?

Picture this: you’re in an important meeting when suddenly as you’re speaking your speech goes from normal to slurred in a matter of moments. Or maybe you’re planning something with a friend only to find your words running together as you discuss the date and time. This can be a very upsetting, confusing, stressful, and frustrating experience. Understanding what caused your speech changes is important, and you may wonder if stress causes slurred speech. 

It is not widely known that stress and anxiety can cause speech problems. The brain and body react to stress in a variety of different ways, including increased tension in the muscles, scattered thoughts, and difficulty focusing on the task at hand, which in this case, is speaking. 

Speech therapy can be very helpful in supporting adults who may be struggling to communicate due to stress and anxiety. Get started with speech therapy through Great Speech by scheduling your free introductory call today!

How Does Stress & Anxiety Affect Speech?

It is very common for symptoms of anxiety to make the individual feel like there is something wrong with their brain. The brain is potentially the most important element of the human body, and those who struggle with anxiety often worry that their brain may fail, or that they have a serious medical condition such as a brain tumor or multiple sclerosis . This worry, on top of the anxiety they are experiencing, can increase feelings of stress, worry and anxiety.

Stress and anxiety can affect speech in the following ways: 

Increased Muscle Tension – Increased muscle tension due to stress and anxiety can affect the fluidity and clarity of speech.

Racing Thoughts – It is common for individuals with anxiety to feel like they can’t keep up with their thoughts, or that their thoughts are racing. This can make speaking clearly and effectively expressing thoughts and ideas difficult. 

Social Anxiety – Social anxiety can make speaking in front of others very difficult. An individual with social anxiety may struggle to communicate when in certain situations which can have significant effects on the individual’s ability to succeed in social, professional, and academic situations. 

Panic Attacks – Panic attacks can come on very suddenly and can make it very difficult or impossible for the individual to communicate. Panic attacks often cause shortness of breath, tightness in the chest, and difficulty thinking clearly, which can all have significant effects on speech. 

Dry Mouth – Stress and anxiety can cause the individual to experience frequent instances of dry mouth. A dry mouth can make speaking smoothly and fluidly difficult. 

Shaky Voice – Sometimes anxiety and stress can cause the voice to waver or sounds shaky. 

Difficulty Concentrating – Stress and anxiety can also make concentrating difficult. When an individual is experiencing significant stress or anxiety, they tend to focus on those feelings and what might be causing them. This can make focusing on the task at hand, speaking, for example, deeply challenging. 

Slurred Speech – Slurred speech (also referred to as dysarthria) is a common symptom of anxiety which can be quite frightening when it occurs. While it can be unnerving to experience, especially on top of feelings of anxiousness and worry, it usually is not an indication of the health of the brain. 

If you are struggling with communication problems related to stress and anxiety, speech therapy can be highly beneficial. Get started with speech therapy by scheduling your free introductory call today! 

What Causes Slurred Speech due to Stress?

Slurred speech can be caused by stress and anxiety due to the following effects:

Mouth Tension : As mentioned above, anxiety can result in significant muscle tension. This includes the muscles within the mouth, which can make it more difficult to clearly get the words out.

Hyperawareness : When anxiety is present, and the mind may be racing, some individuals become hyper-aware and may overthink the processes that would normally occur unconsciously. Such processes include walking, breathing, and of course, speaking. When an individual becomes too focused on getting the words out, speech can become slurred. 

Anxiety Medications : Many people who live with anxiety take medications to help them manage their symptoms and navigate their everyday life. Some of these medications act as muscle relaxants, which can make the mouth and facial muscles less reactive, resulting in slurred speech. 

How Can Speech Issues Due to Anxiety Be Reduced?

There are a few things that can help to reduce speech issues that are related to stress and anxiety. 

Prepare : If you are aware that you’ll be facing an important event or conversation, take some time to visualize yourself succeeding in that situation. Prepare your talking points ahead of time so you won’t add additional stress to yourself. 

Pacing : Work on speaking slowly and carefully, paying special attention to articulation. When you feel rushed, or your speech is rushed, speech can become slurred as a result. Allow your brain, and the required muscles, adequate time to efficiently produce speech. 

Deep breathing : Anxiety and worry can sometimes cause individuals to hold their breath. Practice taking some deep breaths before you encounter a potentially stressful situation. 

Slurred speech related to anxiety is usually a temporary condition and can last up to several hours, though it may also only last a matter of minutes. Anxiety impacts speech differently in each individual. In some cases, the slurring may last longer and can indicate an underlying health condition that should be addressed. 

How Can Speech Therapy Help with Speech Problems Related to Stress & Anxiety?

Our highly qualified and experienced speech and language pathologists work with individuals who are experiencing speech problems related to anxiety by improving and strengthening communication skills. This alone can help to reduce feelings of stress and anxiety in professional or social situations. Speech and language pathologists employ a variety of methods, exercises, and approaches to identify and treat communication problems related to anxiety and work collaboratively with the individual to achieve appropriate goals. Because stress and anxiety can affect speech in a wide variety of ways, every treatment plan varies between individuals. Contact us today for your free introductory call and get connected with a registered speech pathologist to start on your path to increased confidence and better communication.

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Selective mutism: symptoms, causes, and treatment

Posted: May 15, 2024 | Last updated: May 15, 2024

Selective mutism is best described as an anxiety disorder that causes a normally verbal person to be unable to speak when exposed to certain situations. While it is estimated to affect around one in 140 young children, awareness about selective mutism is relatively low. That said, there are certain misconceptions about the condition that have to be dispelled.

Check out this gallery to learn about selective mutism and what can be done about it.

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Introducing selective mutism

Selective mutism is a severe anxiety disorder that renders a person unable to speak in certain social situations, such as with schoolmates in the playground.

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Early beginnings

Selective mutism normally develops during childhood, and in certain cases it can continue into adulthood.

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Common misconception

It is important to recognize that a person who suffers from selective mutism does not simply decide not to speak in certain situations.

The freeze response

Rather, a freeze response is triggered in them with feelings of panic, and this renders speaking quite literally impossible.

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Common reaction

In many cases of selective mutism, the sufferer will learn to recognize situations in which they freeze, and try to avoid these situations at all costs.

Not mute all the time

However, a person with selective mutism is able to converse normally in other situations where they feel comfortable.

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We are still learning about selective mutism, and in fact it is more common than you might think. It is estimated to affect about one in 140 young children.

Affected groups

It is also more common in people who are learning a second language, such as people who have migrated from their country of origin.

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The onset of selective mutism normally happens between the ages of two and four. Often it is first picked up upon when a child begins to interact with people outside their family, such as schoolmates.

The main symptom of selective mutism is a marked contrast in the way a child interacts with different people.

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Sudden stillness

When expected to speak with someone outside their comfort zone, the child may react with a sudden stillness and frozen facial expression.

Temper tantrums

A child with selective mutism may avoid eye contact and appear otherwise socially awkward. They may be stubborn or aggressive and more prone to temper tantrums.

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Other means of communication

In some cases, an otherwise confident child with selective mutism may use other means of communication, such as hand gestures or body language.

In the majority of cases, however, children are severely affected and tend to avoid communication altogether. They may manage to respond with a few words, or in a whisper.

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Phobia of talking

Experts think of selective mutism as a phobia of talking to certain people. The exact cause is unclear, but it has been associated with anxiety.

General anxiety

Children who suffer from selective mutism generally have a tendency towards anxiety and may find it difficult to take everyday events in their stride.

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Separation from parents

Some children find it so distressing being separated from their parents that they are unable to speak, and they become selectively mute with the adults who try to settle them.

Speech and language problems

Others might have a speech and language disorder or a hearing problem, which can increase levels of anxiety and make it even more difficult to speak.

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There is no evidence to suggest that children with selective mutism are more likely to have experienced trauma or abuse.

No connection

There is also no evidence of a link between selective mutism and autism, although it is perfectly possible for a child to have both.

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If left untreated, selective mutism can lead to a host of other problems down the line. Thankfully, it is possible for children to overcome selective mutism if it is caught early enough.

Diagnosing children

If you suspect your child may have selective mutism and there is no help available at their school, seek a formal diagnosis from a speech and language therapist.

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Your child may not be able to speak during the consultation, but a professional will be prepared for this and will have other ways to help your child communicate.

Diagnosing adults

It is also possible, although arguably more difficult, for adults to overcome selective mutism with the help of a mental health professional who has the support of a speech and language therapist.

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Treating selective mutism does not focus on the speaking itself, but rather on reducing or even eliminating the anxiety associated with speaking in certain situations.

Types of treatment

There are two key types of treatment often used to treat selective mutism: cognitive behavioral therapy (CBT) and behavioral therapy.

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CBT encourages a person to focus on how they think about themselves, others, and the world around them, and how their perceptions of these things affect the way they think and feel.

As a general rule, CBT is more suitable for older children and adults who struggle with selective mutism.

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Behavioral treatment

Behavioral therapy, by contrast, focuses on working towards and reinforcing desired behaviors, while replacing bad habits with good ones.

Selective mutism is a complicated and tricky disorder to live with. However, with the right help and support, things can get better.

Sources: (NHS)

See also: Understanding developmental language disorder

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Why Is It So Hard to Hear That Your Child Has Difficulty?

Self-talk that can get you on the path to help..

Posted May 13, 2024 | Reviewed by Michelle Quirk

• A Parent's Role
• Find a family counsellor near me
• Many parents struggle with feeling embarrassment, guilt, and worry hearing their child should see a therapist.
• Seeking consultation with a therapist can be a great help offering guidance, perspective, and calm.
• Understanding your own feelings can help you talk to your child about the difficulty.

Alice left the meeting at school feeling scared and worried. Charlie’s teachers were concerned that he was not following the rules of school—he was resistant, uncooperative, and sometimes disruptive. They had even asked the school psychologist to observe Charlie in class and consult. Now they were all recommending that Alice and her husband Ray meet with a mental health professional to help them get a better understanding of what was underlying Charlie’s misbehavior. They were hopeful that the consultant could guide Alice and Ray to interventions that would help Charlie control himself better and comply with teachers.

Alice knew she had to follow up. She had wondered about this next step for some time and had discussed the idea with the pediatrician, but had never followed through. Now she felt guilty for her procrastination . She dreaded the conversation with Ray who was always a little uncomfortable with doctors, but she knew she could no longer delay.

Anticipation of a consultation with a psychologist, psychiatrist, social worker, or other mental health professional can bring up many feelings in a parent. For some, the feeling of getting help is one of relief. But for many, like Alice, the anticipation is unpleasant and they delay or never go at all. This can be an outgrowth of previous negative experiences. If you have not felt helped in the past, if you have felt judged or have been disappointed, then a referral for a consultation can feel like something you just do not want to do. Beyond trepidation and the anticipation of disappointment, it can feel like a mirror is being held up in which all their weaknesses, problems, and shortcomings are reflected. Feelings of failure, anxiety , shame , or anger can arise, just as guilty feelings did for Alice.

Here are three steps to help minimize your anticipatory distress:

• Think through any similar experiences that were upsetting to you. You are trying to close the gap between not wanting to do something and also expecting to feel badly if you do not do it. How did you handle this in the past? What was helpful?
• Note the differences between how you handled difficulties as a child and how you are able to address difficulties now as an adult. How have your life experiences added to your ability to keep things in proportion, broadened your perspective, and developed increased resilience ? How much better can you now think things through and solve problems?
• Recognize that there are different outcomes that are possible now. You can navigate a different path because you have awareness of your past experiences to serve as guidance and the expert is there to assist you in helping your child. This is a shared goal. Knowing that the consultant’s job was to help her and Ray help Charlie made it easier for Alice to move forward, even though Ray remained a bit uncomfortable.

A consultation can feel like a time when you and your child are being evaluated for the story that you are telling. The key here is that you are facing up to some truths that may be difficult, and at the same time you are hoping to find a partner in the expert you are meeting. Can they be someone who can help you and your child work through what is affecting your child’s behavior?

Here are three things to consider in these initial consultative sessions:

• Can you work with this particular professional? Do they listen attentively? Do they speak in a language you can understand and in a tone you can tolerate and, hopefully, feel better from? Does it feel like a good “fit” between you?
• What is their professional opinion of what is going on for your child? Do you understand how they see the issues, and does it make sense to you?
• What is the initial treatment plan they suggest for moving forward? Do you understand how they reached that plan? Do they want other professionals to add additional expertise, like a psychologist to do educational testing or a psychiatrist to evaluate the usefulness of medication , or do they feel that is unnecessary at this time? Do you agree with the plan and how they suggest you proceed?

You can expect that the professional you are consulting also will want to meet with your child. The ultimate treatment plan may or may not involve therapy sessions with your child, but it is usual for your consultant to meet with your child firsthand during this evaluative phase. Although Alice and Ray felt comfortable with the psychologist they met, they felt completely unprepared for introducing him to Charlie. They expected a lot of resistance and were not sure how to handle it. The psychologist discussed their concerns and helped Alice and Ray prepare to raise this with Charlie, even providing them with some words and an explanation that made it easier.

Introducing your child to the idea of meeting with a professional can range from a “breeze” to daunting. Although you should expect help from your consultant in breaching the idea to your child, here are three scenarios to consider:

• At a time when your child is upset with what is going on, mention that you, too, have been upset about this and have talked with someone, a professional, who you think can be very helpful.
• Explain to your somewhat resistant child that you want them to meet with a professional who specializes in helping children find out more about themselves and why things are going so hard for them. If your child balks, it is best to suspend the idea for a while, rather than taint it by pressuring the child. Interventions like therapy will not work if the child does not want to be there.
• When the child is required by the school to see a professional, explain that he does not have a choice, just like going to school is not a choice. Though difficult, it is important to use parental leverage to follow through on the requirement. You can explain that once he has met the professional and learned more about the plan to help him, he will have an opportunity to discuss it with you.

Consulting with a mental health professional is a big step. It is important to feel optimistic about the consultant, even if you feel pessimistic about the problems. Think of the consultation and therapy as helping your family get through a period when there are difficult but important issues to deal with. We have found that self-esteem , often at the root of many childhood issues, evolves once the child is engaged in doing the hard therapeutic parts and settling emotionally. Being able to look back on the struggle and the accomplishment can be strengthening and a source of well-deserved pride.

Elena Lister, MD, an Associate Professor of Psychiatry at Weill Cornell Medical Center, and Michael Schwartzman, Ph.D., a psychologist, are the co-authors of Giving Hope: Conversations with Children About Illness, Death and Loss .

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At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

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