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Anxiety & Panic Disorders Health Center

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Conquering Fear of Public Speaking

The ABCs of giving presentations without palpitations.
WebMD Magazine - Feature

Steve Tingley’s promotion came with a new duty he dreaded. When the 52-year-old was appointed director of media services for a Madison, Wis., insurance company, he was expected to make presentations to other divisions and outside groups.

“I’d break out in a sweat, get very nervous, stutter on the stage. I’d lose my concentration, and it all fell apart,” he says.

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Most of us feel a little twinge at taking the podium, but for some, the anxiety is debilitating. Estimates suggest as many as 35% of Americans quiver at the prospect of public speaking, and as many as 13% have full-blown social anxiety disorder at some point.

Extreme embarrassment seems to be a case of ancient brain systems overreacting to modern life. When you see danger -- a poisonous snake or a room full of people -- the amygdala, an area of the brain that processes emotional reactions, goes into alert. It jolts the body with the stress hormones cortisol and adrenaline, energizing you to flee or stand and fight. This is what causes the sweats and shakes.

If there’s no escape, the prefrontal cortex, the part of the brain that plans and makes decisions, seems to switch off, and you “freeze” as a result. You go on autopilot, which can lead to speaking without making sense or becoming immobilized. Even though running through a PowerPoint isn’t life-threatening, these same reactions kick into gear.

You can learn to train your amygdala not to overreact with a process called extinction. By repeatedly putting yourself in the scary situation minus any negative consequences, the amygdala learns that fear isn’t appropriate. For short-term relief, beta-blocking drugs ease performance anxiety by blocking the effects of adrenaline. And researchers are testing a substance called D-cycloserine to enhance the extinction process for severe cases.

Tingley extinguished his fear by taking a public-speaking workshop with Doug Stevenson, head of Story Theater International, an organization that coaches business people on improving presentation skills. In the weekend seminar, Tingley had to act out personal stories onstage. “The workshop was really scary,” he says. “I was way out of my comfort zone.”

But that marathon weekend seminar helped. Tingley can now give a speech without having to wring out his shirt afterward

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