No shame in beta-blocker use?

Challenging the stigma of performance anxiety medication



I used to start shaking before I went on stage. My palms would sweat and I’d feel sick to my stomach.

When I was in year 11, I started thinking more seriously about performance anxiety. That was the year I tried my first beta-blocker.

I would like to share my story with you.

I have been singing in choirs for what seems like forever, and I started learning the cello when I was seven. By 13, I was accepted into the Marryatville High School Special Interest Music Program. As a total music nerd, I was so excited to go to high school and have 10 music lessons per week, and hopefully meet some fellow nerds. And my excitement was totally justified: it was an incredible music education (and all at a public school! Represent!). So many of my fellow nerd friends from that initial group – the Music-Two class – are still great friends today, doing inspiring things in their musical lives.

I joined the orchestra, string orchestra, string quartet (The Clef Hangers); basically, any ensemble I could squeeze into my schedule, I joined. My choir nerdiness was also greatly enhanced at school, and I think there was a moment around year 10 when I was in five school choirs at once.

There was just one thing that I wasn’t prepared for, and that was the dreaded Concert Practice class. This was the weekly class in which we were scheduled to play a solo in front of everyone, once or twice per term.

At first, I think I was quite excited by the concept of this class, and hearing everyone play their own solos. I was among a very supportive, uncompetitive group of people, and I thought: ‘Yes, I can do this, this will be fun’.

However, my Concert Practice performances never went as well as I’d planned.

It didn’t matter how well prepared I was, how much I loved the piece I was playing, or how good I felt on the day of my scheduled performance. Whenever I went down those stairs from the warm-up room, and waited by the door to walk on and introduce my piece, the nerves would kick in. I am talking about the physical symptoms of anxiety: shakiness, sweaty palms, stomach troubles.

There were even occasions when I felt fine while I was waiting by the door. I felt fine while I was walking on. I still felt totally fine while I was introducing the piece. But then, the moment I sat down to tune, my bow arm would just not stop shaking.

I came to dread whenever it was my turn to play

Over the years, the situation didn’t improve, and I came to dread whenever it was my turn to play. The knowledge that my arm would shake no matter how I felt within myself – and there was seemingly nothing I could do about it – created an even greater cycle of anxiety.

It wasn’t until year 11 that I had a conversation with a professional musician of many decades about a possible and widely used medical solution: beta-blockers. That conversation changed my life.

I remember having a particularly angsty moment leading up to a Concert Practice performance and lamenting my uncontrollably shaky arm. ‘It doesn’t matter how confident I feel about the performance, I just can never stop shaking!’ I said. I remember these words exactly: ‘Well, you know, there is a way to deal with that’.

I was confused and intrigued by this comment. It was then revealed to me that medication existed which performers could take to overcome the effects of nerves. The basics were explained: that beta-blockers work by somehow blocking the symptoms caused by the adrenaline-fuelled fight-or-flight response when you are nervous.

This was a total revelation. There was actually something I could take that might completely solve my shaky bow problem?! With the support of my family and GP, I organised to test out my new beta-blocker prescription at my next Concert Practice. Half an hour before I was due to play, I took a tablet. I went up to the practice room to warm up, walked down the stairs, waited for the time to come for me to walk on stage and introduce my piece…and I still felt the familiar dread. What if this doesn’t work? What if nothing ever helps? What if I am doomed never to be able to share my music in public?!

I sat down to tune. No shaking.

I began to play. No shaking! Not even at the end of a slow, soft, down bow. The feeling was incredible, and I have never looked back.

This is not to say that I am dependent on beta-blockers. But they are certainly an integral part of my life as a working musician. I have never had a problem with the physical symptoms of performance nerves when singing with choirs or playing cello in large ensembles. As a composer, when I am in the situation of listening to a performance of my work, I will often be shaky and sweaty – but if I am in the audience rather than on stage, it doesn’t matter. When I am in a pressured, small ensemble, solo performance, or audition situation, though, I will not hesitate to take a beta-blocker.

And there should be no shame in that. 

Even though I have had such a positive personal experience, I often feel that beta-blocker use is an unacceptable topic to discuss openly among colleagues. I never mentioned it at school, and it is only recently that I’ve managed to have some good discussions about it with fellow musicians.

I think there are some fundamental misunderstandings that exist surrounding the use of beta-blockers to aid musicians who experience these ‘stage fright’ symptoms. It is important to make the distinction between performance-enhancing (for example, athletes taking steroids) and performance-enabling. Beta-blockers are not going to alter your mind or body to make you a stronger/faster/better musician. They are a medical treatment to enable a performance without debilitating anxiety symptoms.

This leads into a broader discussion surrounding other forms of medication-shaming. As someone who is currently medicated for Persistent Depressive Disorder, I tend to get pretty frustrated when, for example, friends share articles on Facebook with titles such as: Group drumming more effective than antidepressants. People have an extremely wide range of individual needs when it comes to managing symptoms for any health or wellbeing issue, including performance anxiety. A combination of treatments may provide the greatest relief: medication, taking therapies, hypnosis, natural therapies, diet and exercise changes… the list goes on forever! The use of medication as a treatment for performance anxiety must be destigmatised.

Beta-blockers do not affect my mental state; they do not make me feel any different within myself. These days, when I’m waiting side-stage to perform, I will still be having many unhelpful thoughts! However, my medication provides me with much needed assistance in managing my performance anxiety, and I will never be ashamed or apologetic about it.

Rachel Bruerville challenges our approach to performance anxiety treatments

It is important to emphasise that individual needs and personal experiences will vary, and that this blog does not constitute medical advice. If you would like to explore performance anxiety treatments, you must be in consultation with your doctor to find treatments and dosages appropriate for you alone. 

CutCommon encourages healthy discussion surrounding health and wellbeing in classical music. We are a proud member of the Arts Wellbeing Collective, where you can find out more about health in the Australian arts industry. For youth mental health support, visit headspace.

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Featured image credit NIAID (modified by CutCommon); tiled image Practical Cures (modified by CutCommon): Flickr CC-BY-SA-22.0.

Disclaimer: The views found in this blog reflect those of the writer and not necessarily the publication.

Listen up!

6 Comments on No shame in beta-blocker use?

  1. You are right Rachel, there should be no shame in using Beta-blockers. I have been on them for over a year now, due to a heart condition. Some of the side effects are pretty bad though, the main one for me, being blurred vision.

    There are a few types, if this happens, talk to your GP and see what can be done. There is a lot written about performance anxiety, and there are a lot or alternates to drugs that might work. Yoga being one, but I’ve found special breathing techniques work for me.

    I was skeptical of these working and never tried them for years. I was quite amazed how much it relaxed me. This is what I do, breath in deep through the nose, hold it for two seconds, and slowly let it out through the your mouth like you are singing the vowel U. Do this six times and monitor the difference. It works for me.

    • Thanks for the feedback, Rob – blurred vision would indeed be a debilitating side effect! I have been fortunate to have never had that experience. I also find that deep, conscious breathing is very helpful for focussing the mind and keeping unhelpful thoughts at bay, in tandem with medication specifically for physical symptoms. I’m so glad you’ve found something that works for you.

      Thanks again for reading 🙂

  2. I disagree entirely. As an orchestral musician I rely on my colleagues being at the best of their ability so we can achieve the best collectively. Beta blockers cause emotions dullness and robotic playing in all the cases I know of.

    Simply put, if you can’t play without them, playing with them will only give you satisfaction, not your colleagues or audiences. Perhaps you should look at the multitude of reasons that make you need these, rather then take the easy way out.

    • I have to call you out on that one, mate. You probably have no idea how many of your colleagues take them, and probably think many of the confident, expressive, and outstanding musicians in your circle don’t take them because they’re beautiful, emotive, and expressive musicians. Beta Blockers in no way affect ones ability to express emotions. They literally affect only the physiological symptoms of anxiety (note: not the psychological ones). It sounds to me like you probably don’t experience the physical symptoms of anxiety to the point where you need medication, and that’s awesome for you, but please don’t make judgements about those that do because you donny understand how the medication works.

    • Hi Billy, thanks for reading, but it won’t surprise you that I feel like I must respond and call you out on your medication-shaming comments. As “Violinist” has said, and as I have clearly articulated in my article, the whole point of the medication is to block the debilitating physical symptoms of anxiety – specifically, shaking. It’s true that some people will experience negative side-effects, and that beta-blockers won’t be the solution for everyone. But it perpetuates stigma to suggest they cause “emotions dullness and robotic playing”, when many who are using beta-blockers will tell you this is simply not the case.

      More broadly, viewing taking medication as as taking “the easy way out”, is an incredibly dangerous viewpoint. Personally I have found that I need to take beta-blockers less and less as my career moves forward, and as I do more work on my generalised anxiety and depression through various other therapies. But this is a personal thing. Only the individual and their health professionals who they have direct contact with will know what is best for them.

  3. “As an orchestral musician I rely on my colleagues being at the best of their ability so we can achieve the best collectively.” Sounds like a good argument for using beta-blockers if that allows you to perform to the best of your ability.

    A medical model of care uses a psycho/social/biological approach. All facets of this model are equally important, and there should be no shame/stigma in what works for one person (with medical consultation of course), and what doesn’t for somebody else.

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