Hi, I’m Dr. Cheryl Mathews. My doctorate is in Psychology (PsyD) and I specialize in Speaking Anxiety - a mix of Public Speaking Anxiety and Social Anxiety. I personally suffered with debilitating speaking anxiety in college and early career. AMA!...

I have this exact issue on occasion. Had a meeting the other day where I was put on the spot in an unexpected/unplanned way. Heart started beating so fast and I could barely speak. Had to excuse myself and leave the room.

Sometimes situations like this don’t bother me. If I can prepare for a presentation, I’ll often do great. I’m good at making a fun speech. Years ago I was voted one of the best speakers in a public speaking class of about 30 people.

But there are times, if I’m in a room with people I’m uncomfortable with, or put on the spot, that totally throw me off. I’ll check out your video.

In particular, I seem to be struggling with online video calls. I feel more comfortable and natural with in-person meetings. There’s something about a camera in my face and a bunch of faces on a computer screen that feels so weird.

What would you generally recommend to someone like me?

Yes, this is exactly the situation that is so bewildering. Why is this happening!

I would join a group that practices speaking on online video calls. I've seen them on Reddit and MeetUps. Or SpeakMeister Practice Clubs, UltraSpeaking, and Toastmasters. Full disclosure I run the SpeakMeister Clubs and they are focused on anxiety reduction, but it doesn't matter so much where you practice as long as you do the practice (find a group that feels safe)! Find what works for you. Make sure you practice in the medium range of anxiety - nothing overwhelming. Practicing in the high ranges of anxiety will only increase your anxiety. Tell the facilitator what you want to practice so you keep it in the medium range of anxiety.

I would also practice using virtual reality. See https://anxietyhub.org/vr-training-using-virtual-reality-overcome-anxiety/.

It's also important to go into these practice sessions with some new interpretations and self-talk. I'll add more about that in this AMA.

What would you generally recommend to someone like me?

Propranolol

You can’t just pop a pill if you’re put on the spot in a big meeting.

Exactly! Beta blockers and benzodiazepines are "take as needed" meds. You have to plan ahead and take 30-60 minutes before a speaking event. So beta blockers are not ideal for those "put on the spot" situations. But some people do take them every day.

The other options are "take every day" meds like SSRI's, etc.

The problem with meds is they have side effects and they are not a cure. They mask symptoms. When you go off the meds, you relapse.

That doesn't mean that meds are not helpful - sometimes they are what will keep you afloat.

The best approach in my opinion is to use meds temporarily if you need them WHILE you're working on the long-term cure. Do the gradual exposure work, and as that takes root, gradually wean yourself off the meds. With the long-term cure, you should see progress after a few weeks/months and more progress at 3, 6, 9, and 12 months. Keep at it and don't let up. Plan practicing speaking in a safe group for at least a year. The fear center needs time to trust the situation is safe. And if you don't keep at it, the fear will come back.

I had exactly the same. I used to speak at conferences with 200+ people in the audience and did great.

But a random call out on a call during the pandemic triggered a slippery slope. It got so bad I got panic attacks. And especially video calls like you say. I think it's because you're coming in cold to the discussion. Can't establish rapport beforehand. It was getting real bad for me where I dreaded any speaking appointments days and days in advance and couldn't sleep the night before.

What really helped was cognitive behaviour therapy.

I managed to recondition my body response away from flight. My therapist was fantastic. Main things she had me do was 1) establish a happy place in my head where I could go to in situations of anxiety 2) visualise my fear as something tangible - naturally my fear was embodied as the balrog 3) counter pre-speech anxiety days before with positive thoughts 4) write down fears and counter them 5) on public speaking day I would ground myself in the minutes leading up to it by going into my happy day 6) lastly, id say out loud to myself : I'm afraid but I'm doing it anyway! And if I felt fear coming up I'd picture it as the balrog and I turned into gandalf at the bridge and imagined screaming : you shall not pass

After all this prep, I had a speaking engagement in front of 50 people on video. And I didn't even feel any anxiety come up. It was like magic. Random call outs I handle much more relaxed now. If your company offers private healthcare I'd give CBT a go

Very good!

I'm a mumbler. Like a serious mumbler. I think I'm speaking at an acceptable level and when someone says to speak up I I actually feel like I'm shouting. Any ideas, pointers?

One thing that helps me with the speaking up part of this:

When you raise your voice to speak louder, do it from the bottom of your chest, not in your throat. You can hear the difference, and it makes you sound more confident. It also helps avoid that feeling like you're yelling. Just feels like louder talking, which is exactly what you want.

I hope that makes sense.

Yes, very good!

Study up on some basic singing techniques - seriously! You don’t actually have to sing, but the physical mechanisms that make you able to project your singing voice are the same ones that make you able to speak at a healthy level in front of people.

Source: studied opera for several years.

ETA: not just volume, but also diction and pronunciation are enormous in being heard clearly.

I was always good at singing which eventually led to music school which led to years of performing. As OP said all eyes are on you, but really what is coming at you is energy from the audience, the other musicians, the lights shining down on you, even the darkness that you are in when you can’t see the audience because of the lights. You have to learn how to manage and re-direct this energy, and realize that it is positive energy, very rarely will you be in a situation where the listeners don’t want you to succeed.

Speech class in college taught me how to eliminate things like saying “um, like, and you know” from public speaking, but performing music taught me how to deal with energy, and you do this not only through experience but through extensive preparation.

It can also be helpful to keep things in perspective, if I’m walking to work and a baby falls out of a window and I catch her, then she grows up to cure cancer, what was the real reason I even went to work that day was it to stress out over a speech or was it to catch the cancer curing baby?

Love all of it...and especially "You have to learn how to manage and re-direct this energy, and realize that it is positive energy, very rarely will you be in a situation where the listeners don’t want you to succeed."

That's good that you've gotten that feedback and you're aware of it. What's most important in communication is that people understand what you're saying. So if people are not understanding what you're saying, you're not able to express yourself clearly and have a voice. So I would definitely work on that. Get into a speaking practice group so you can get lots of feedback from others "like I didn't understand what you were saying, can you speak up or enunciate more so I can understand." When you go into speaking situations, throw yourself completely into your goal of being understood by others. Keep practicing that.

When you very intentionally focus on being understood, you take your attention off of yourself (internal focus which makes you self-conscious) and you redirect your attention externally. Tell yourself "my goal is to get my message across clearly good enough. It doesn't have to be perfect but people have to understand the key point I'm making." This redirects your attention to the present moment. Focusing on something manageable in the present takes your mind off of bad memories from the past and frightening imaginary "what if" scenarios in the future. Throw yourself completely into your message. Then give yourself feedback after you speak: I got my key point across clearly good enough - I was successful."

I tried to get over mine by taking a storytelling class in college and then again volunteering as a participant in a story slam last minute. I froze in front of 200 people, my mouth went completely dry, and when I could finally rasp out “I need water”, at least 5 minutes of silence had passed. It was bad.

I’ve also choked up at important meetings at work with customers - although I attribute this more to racing thoughts & ADHD.

Forcing myself into situations to practice hasn’t worked. I would love to be a good public speaker, and have a dream of someday doing a TED talk - but right now it’s not possible.

It’s confusing because I’m not shy, and do great in smaller groups. What do you suggest?

OMG I know that situation well! It's so painful. And it's so confusing.

So here's the thing. You'll never get better by throwing yourself in the deep end of the pool. You have to start at the shallow end of the pool and gradually (with self-compassion) over time work yourself up to the deep end. The fear center in your brain has to trust over time - sometimes over lots of time depending how much trauma there is - that the situation is safe...that you're not going to drown (with speaking, it's be humiliated in public).

I hear a lot of people say practice hasn't worked. But smart strategic practice does work. It has to be gradual. It has to be in the medium range of anxiety (manageable - not overwhelming). Think of ways you can approach the exposures in a very gradual way. Can you start by practicing in front of a video camera? Can you practice using virtual reality https://anxietyhub.org/vr-training-using-virtual-reality-overcome-anxiety/. Can you start a safe practice group on Reddit? What can you do to approach the fearful situation but do it using baby steps that keep your anxiety in the manageable range?

You also need to go into the practice situation with new interpretations of anxiety, yourself, your audience and the speaking situation. Those anxiety management techniques help you go into the practice situation in a new way so you'll have a different outcome.

I know you can get to that TED Talk! But I have to manage your expectations that it's not quick and easy. It takes a lot of work practicing in the right way and, when there has been trauma as you have experienced, it can take at least a year practicing 3-5 times per week. Each practice session does not need to be long and onerous. You could practice in front of a video camera once or twice a week (15 minutes), do a virtual reality practice once a week (15 minutes), practice with a safe group on Reddit once a week (1 hour)...something like this will start to build confidence. The fear center in your brain has to trust over time that it's safe. Focus on building a database of positive memories around public speaking.

Taking propranolol before a big presentation/speech/meeting etc. can be super helpful

Yes it does. A beta blocker is blood pressure medication. It slows your heart rate.

Typically, for those of us who have experienced speaking anxiety in the high ranges, when we feel our heart beat faster, that freaks us out more. That heart racing starts this dialogue in our heads "Holy crap I'm gonna go off the rails...things are not going well..I'm going to make a fool of myself...anxiety is going out of control."

So the beta blocker can way way reduce the volume on that. It doesn't get rid of it entirely, but it can put a monkey wrench in the escalation process. It can keep the anxiety from escalating. The other way to do this is to change the dialogue that's going on in your head in the first place. But that takes time. So beta blocker while you work on changing the dialogue in your head can be a helpful strategy.

Can anxiety be permanently cured?

Anxiety itself can never be cured or eradicated. But anxiety disorders can (anxiety that gets in the way of functioning and achieving life goals).

Think of anxiety like cold, hunger and fatigue. They are all bodily sensations. They are "programmed" in your biology. You can't get rid of them. But you can manage them. And you can keep them from getting in the way of your life goals.

Anxiety is very important for protecting us from real dangers. It gets in the way when we have anxiety in safe situations. When it's a false alarm.

Beautifully put. As a fellow psych it’s really nice to read your answers in this AMA.

I often love drawing upon the Yerkes Dodson “law” from sport psych to help clients grasp that our in built biological response is “just add stress and arousal to increase performance”. When it comes to simple, instinctive, survival-oriented, well-rehearsed or “bang-it-out tasks”, stress and arousal help us speed up and get it done quick and aggressively.

But when we’re doing something novel or complex requiring greater prefrontal cortical input (empathy, emotional regulation, foresight, thinking through and organising thoughts, decision making, etc), anything beyond moderate stress and arousal actually has the opposite impact on performance.

But guess which function we’re built for by default? Survival tends to win out and the amygdala responds with its “just add arousal” solution to dealing with threat. Great for survival, not great for public speaking!

Yes, love that! Thanks so much for adding that.

Another helpful insight from sports psychology is how to manage and reduce performance anxiety. How to manage escalating anxiety and panic attacks when speaking. People who have experienced high anxiety speaking are worried their anxiety will escalate out of control. (It makes sense because they’ve experienced very painful anxiety escalations). They are focused on the thought “what if I have a panic attack” and they imagine vividly that situation happening. Their focus is on horrifying “what if” future scenarios. (A panic attack speaking means that the anxiety is in the very high ranges (9’s and 10’s) where you have to leave the room to escape).

Here’s what we’ve learned from sport psych and mindfulness to deal with this.

Before a tennis player serves, they may bounce the tennis ball multiple times. They may do a mindfulness exercise where they examine the seams in the tennis ball intently and non-judgmentally. Then they serve. This focuses their mind on the present moment: What is really happening right now. This takes their focus away from the past and the future where performance anxiety lives. Shame and regret live in the past. Stress and worry live in the future. Shame, regret, stress and worry weigh us down. We can’t perform optimally with all that weight. In our example, the tennis player is not thinking “I just missed the last serve“ (past) or “what if I miss this serve“ (future). They’re intently focusing their attention on the present moment. The present moment is much lighter and allows us to perform to the best of our ability at that moment.

To prevent panic attacks with public speaking, keep your focus on the message you’re trying to get across (throw yourself entirely into that manageable task in the present moment). That keeps you in the present moment. Keep focused on your goal. If you want to communicate one key point (your goal), focus on that one key point and throw yourself into getting that message across as clearly as possible. Your goal is for your audience to understand what you’re trying to say (good enough - doesn’t have to be perfect). When your mind goes to “what if my anxiety escalates and what if I have a panic attack?” Say to yourself “that is not happening right now. If I focus on my message (instead of focusing on frightening “what if” future scenarios), my anxiety will temporarily go up at the beginning but it will come down quickly to a manageable level. I can function with an anxiety spike for 30-60 seconds and then I’ll get into my zone. That additional adrenaline spike at the beginning is extra energy that I can harness to engage my audience. The less I focus on the past and future, the faster my anxiety will go down to a manageable level.”

How was defending your thesis?

Haha! It sucked! In terms of anxiety I mean. I had to defend my dissertation early in my journey to overcome high speaking anxiety, but I felt that I had come far enough where I could do it. I got through it with a lot of preparation. I would not have been able to do it without the public speaking phobia program I attended. I could do it today with very low manageable anxiety.

College was another story. Took me 7 years to graduate cause I kept dropping classes that required class participation and/or a presentation.

I noticed in the recent years more and more people talking about diagnosed with Anxiety Disorder including myself, do you agree that more people these days suffered Anxiety Disorder? If so is there any reason why it happened?

Great question! We don't have 100% accurate scientific data on that but there are three factors that are happening at the same time. One is that we just went through a pandemic and lock downs and there's no doubt that significantly increased anxiety and anxiety disorders. People who were functioning adequately before, for a variety of reasons, are having more trouble functioning in career, school, relationships, life. Wars, trauma and other world events lead to more anxiety disorders. Two, as science advances, the field of mental health gets more adept at diagnosing and identifying anxiety disorders. Three, as society makes it more acceptable to admit you have an anxiety disorder and the stigma is reduced (the stigma should be removed completely), more people who have had anxiety disorders are now counted where they used to be hidden. These are just some thoughts to get the discussion going!

I'm 50 years old and I wasn't diagnosed with anxiety disorder until 3 years ago (thanks, Pandemic!) and started medication which helps a lot.

So for the first 47 years of my life I had anxiety disorder but didn't know it. I simply thought I was unconfident about public speaking and didn't realize there was an underlying cause. I still remember trying to give a speech for debate club in high school and I completely failed-- It was humiliating and influenced the rest of my life. I have mostly tried to avoid public speaking, which includes avoiding opportunities for advancement.

I think a lot of people just look at us and think we are weird or someone who just fails over and over to prepare for a speech.

As I said, taking general anxiety medication has helped. Also, while I work in academia where public speaking is required, I generally have a workplace that is supportive of neurodivergent folks. We're all nerds here.

:) People who operate in the low-medium range of speaking anxiety do not understand the experience in the high ranges of anxiety! I had people tell me "it's OK it's just some stage fright...everyone has stage fright." No this is not just a little stage fright! It's really different from that. I like what you said about neurodivergent! And nice to be with others who will be supportive.

I have trouble with the first few minutes but then I'm usually okay. Throat tightening/ voice catching. Sometimes I take a little propranolol to get through, but I'd rather not. Any suggestions? It doesn't always happen which is the tougher part

Having some anxiety speaking - especially at the beginning - is a normal pattern. Professional public speakers know that they will get some anxiety at the beginning and they come up with coping strategies like memorizing their intro or the first slide. They also interpret that anxiety as excitement (the adrenaline that goes in your body is actually energy). They harness that energy to make their talk more engaging. Because they have a database of positive speaking memories, the adrenaline spikes for a few seconds to a minute and then goes down.

If it's a low stakes event, the adrenaline might spike for a few seconds and then go down. If it's a high stakes event (like a TED Talk), the adrenaline might spike for a minute and then go down. The more adrenaline in your body, the longer it takes to dissipate and go back to homeostasis. The less adrenaline that goes into your body, the quicker your anxiety will go to a manageable level.

The key difference here is how long in your case before that adrenaline dissipates from your body. When you say a few minutes, is it like 2 minutes? Are you making it through the speaking situation without too much distress or is it distressing and you're afraid you may not be able to make it through?

Just based on what you said, it seems like you're feeling discomfort but that you're managing through it (you're not panicking). It sounds to me like some practice once a week in a safe group would be very helpful. Find or start a group on Reddit where you can practice in a safe way where the stakes are lower. Get really confident in that group and it will spill over into the other situations. This works only if your anxiety is more in the medium range and not the high range. If it's in the high range, it takes some re-education and some very gradual practice in a safe group.

That's the hardest thing about this type of anxiety is you don't know when it will take you by surprise. Gradual practice in the medium range of anxiety should reduce your anticipatory anxiety.

I had one experience where as a new employee I had to introduce myself (very brief - name, position, previous employer) in front of the head of HR and with 50 other new employees (we all had to do this). I had the usual for me full onset of shakes, sweat, tunnel vision, extremely high and strong pulse. I managed to stutter out the information. 30 minutes later the CEO showed up and we had to do this all over again. But this time, the symptoms were so mild that I was a little bit surprised and wondered if this was the normal butterflies in your stomach people had talked about. I have the suspicion that I had already used up most of the adrenaline, or something like that. :)

Great story.

As I was working on overcoming this anxiety, I always thought, if I could just do this several times a day, it would become much easier.

That's the Law of Habituation. See video https://youtu.be/9ctnT--dGv8 start at counter 0:47. That's what happened to you in that 30-60 minute period.

Habituation only works in the medium range of anxiety. It does not work when you practice in the high overwhelming ranges of anxiety. Do speaking tasks in the manageable anxiety range for you then repeat, repeat, repeat. It's like going to a gym - do the reps.

Weird thought — I’m a bit of a nervous flyer and I realized that, if I have a layover, the second flight is not as bad as the first in terms of my anxiety on takeoff and landing. Maybe the same kind of thing is happening?

Sounds like it to me. The fight or flight response only lasts a given time before you calm down (usually). Then the next time you enter the same situation, it usually peaks a little lower (you habituate). The problem is we usually escape or avoid* the anxiety inducing situation before our nervous system calms itself down, so we fail to habituate and it spikes to the same height again next time.

• when I say escape or avoid, this can be as subtle as distracting yourself with your phone. Often these avoidance strategies we use end up prolonging our anxiety over the long term in this way.

Spot on!

Exactly!

Bingo. Always have to practice. Get it down so you can just get into the flow.

Spot on!

Do you have any advice for people who suffer from severe stammers?

It's a great question. I would defer to someone who has a specialty in this area as I think there are exercises and programs designed specifically for this. What have you found when you explored ways to get help such as specialty clinics or organizations? Can you start a support group on Reddit where you meet once a week to practice speaking with each other in a safe group?

Stutterer here. I’ve been taught many circumvention and prevention methods if you would like me to share

Yes, please!

Does the fake it till you make it approach actually work?

Yes and no.

If you just fake it with nothing else it won't cure anything.

But if you understand some of the key mechanisms of fear (understand what the heck is happening), and you can approach the situation differently, and do gradual exposures...now you can project confidence even when you have some anxiety ("faking it").

Think about anxiety on a scale of 0-10 where zero is no anxiety and 10 is terrified. Most people who are looking at you speak don't know you are anxious when you're in the low-medium range of anxiety (1-6). They typically don't even know when you're in the 7-8 range. They do notice when you're in the 9-10 range (high anxiety and panic). You may feel turbulent inside at 5-8, but other people don't realize that's what's going on inside of you. Practice projecting confidence (faking it) in the 5-8 ranges.

I have social anxiety when in public, what can I do to help this?

One of the best things you can do is to find social situations that do not cause high anxiety for you and gradually go into those situations. The fear center in your brain has to trust over time that the situation is safe. So I would write on a piece of paper situations that cause high anxiety, medium anxiety and lower anxiety. Then go into the low to medium situations and build a database of positive memories.

Think about it like a swimming pool. When you get thrown into the deep end of the pool, you can re-traumatize yourself and your anxiety goes up. But when you start in the shallow end of the pool and work up, you can gradually build trust and confidence that the situation is safe.

I also recommend scrutiny exercises like these: https://youtu.be/FeRw4y0si6I.

You want to be very kind, gentle and compassionate with yourself.

Love the pool analogy. I've done exercises like those in the video before but I've noticed it becomes very stressful and difficult depending on location and setting. Is situational social anxiety a thing? I'm fine being more of the center of attention online, or in a store, but when it comes to being at college or a professional setting it is drastically different for me. Maybe this is because being judged in those places could have more perceived consequences compared to casual settings?

Yes, if you think there is a greater chance of being negatively judged, your anxiety goes up. Your anxiety goes down when there is less risk of being negatively judged as explained in this video https://youtu.be/Sucm-6cCL60.

The most important thing is to do only manageable scrutiny exercises. Write on a piece of paper which scrutiny exercises cause high anxiety, medium anxiety and low anxiety. Then start with the low anxiety exercises. Once you get comfortable and confident with those, go to the medium exercises. Then work your way up. The ultimate "scrutiny exercise" for social anxiety and public speaking anxiety is karaoke - so keep that one for the very end once you've worked your way up to it gradually (and with a lot of self-compassion).

It's probably worth seeing a doctor if it interferes with your daily life

Yes, absolutely! For social anxiety, I would look at the National Social Anxiety Center at http://nationalsocialanxietycenter.com/. This is a consortium of anxiety clinics in major cities across the US.

Also check out these anxiety treatment centers: https://anxietyhub.org/best-anxiety-treatment-centers/. These anxiety clinics often have programs specifically on social anxiety and other anxiety disorders.

Just my personal take. If I was dealing with Social Anxiety Disorder, and if I did not live near one of these clinics and had the money, I would pay for travel and hotel to attend their programs. You may lose a lot of career opportunities because of this anxiety, and these programs can be game changers.

You can also find a therapist using these tools: https://anxietyhub.org/anxiety-help-find/

What is it called when someone has social anxiety, but doesn’t have stage anxiety?

I’ve always had terrible anxiety in normal situations, but in situations where I have to speak publicly or be on stage, I become happy and euphoric.

People will often mistake me for being an extrovert, and are surprised when I become shy when I’m not on stage anymore.

When I did a Reddit AMA 5 years ago, I was amazed at how many people said the same thing (I think there were 30 questions in the same vein). No problem on stage, but high anxiety in certain social situations like conversations. I posted this video to answer that question: https://youtu.be/Sucm-6cCL60. In the comments under that video you'll see some of the similar questions.

So what you have is called social anxiety. If your social anxiety is high and gets in the way of your life goals, then we could say you have social anxiety disorder. Most people have some social anxiety (low to medium range where it might be uncomfortable but manageable). A smaller percentage of the population has social anxiety disorder where the anxiety gets in the way of functioning well in relationships, career, school, life.

In certain social situations, you think there is a high risk of being negatively judged so you have higher anxiety. When you're on stage, you don't feel that same risk of being negatively judged, so your anxiety is lower. You may have some bad experiences in some social situations where it was painful or embarrassing. On stage you probably have had very positive experiences.

I identify with this 100%. When I’m on a literal stage I’m fine, excited even. If I’m on the same level as other people I just start shaking and can’t find my breath.

Social anxiety.

did you have help to overcome it when you had it, or did you do it yourself?

Good question. I attended a public speaking phobia program that was a game changer (it no longer exists). Overcoming it does not happen overnight so it's been a journey with ups and downs. The phobia program gave me the initial boost I needed. I learned that I could actually do something about this and I learned what was in my control. Then I started practicing (gradual exposures) that helped me build confidence. I was so bewildered by this anxiety that I continually researched and studied what the heck was happening. Understanding the causes and how to get out of this trap was really helpful. I went on to become an executive in major corporations and tech startups where I continually faced high-pressure speaking situations. So to answer your question, I got a first boost with the phobia program and then I did a lot of smart exposures (gradual, nothing overwhelming), I changed my interpretations of anxiety itself (anxiety in the low-medium ranges is not bad, anxiety in the high ranges is bad) and I did a deep dive into the research to try to understand. Let me know if that answered your question...cause I could talk about that all day!

Which did you attend? Was it the Dr. Richards one?

I attended an anxiety clinic in Rockville Maryland in person (not online). It no longer exists.

I have seen the Dr. Richards website - it's been a while since I've looked at it. Do you have any experience with Dr. Richards and if so was the program helpful?

if I was looking for a social anxiety program, I would evaluate Dr. Richards' program and the National Social Anxiety Center (NSAC) http://nationalsocialanxietycenter.com. NASC is a consortium of social anxiety clinics and programs in major cities in the US. I would also look at some of these anxiety clinics in case they are located near you: https://anxietyhub.org/best-anxiety-treatment-centers/ (some of them have social anxiety groups and programs).

Dr. Richards had an in-person program, which I was never able to make it to, because it is/was in another state and I didn't have the time or ability to take off enough time from work to go for a couple weeks. But I heard that people had good results from attending it in person. They would do small group therapy, which I personally would find incredibly helpful if I could find one.

He also had a series of tapes (yes, it's that old) and then later CD's, called Overcoming Social Anxiety, Step By Step. I tried listening all the way through the series two different times, and working through all the worksheets and exercises that you are supposed to do. Ultimately, I didn't feel like it helped me overcome anxiety, but it did help by giving me some tools to work with. It's probably somewhat out of date now that more research has been done in the area of social anxiety and its treatments, but it was good when I couldn't find really much of anything that was specifically for social anxiety/speaking anxiety. He talked a lot about "ANTs", which he used as an acronym for "automatic negative thoughts", and wanted people to read out loud a bunch of statements that were kind of like affirmations, designed to help reshape the way that you view anxiety and to take away some of its power over you.

Thank you! I remember his outdated ”tapes.” But his content seemed sound. And so happy you had access to his content, because as you said, you needed some help to understand social anxiety. Thanks for that info.

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Yes, I know how frustrating that is. You can't express yourself the way you'd like. You want a voice. You want to be able to communicate things. And you come away kicking yourself. And you miss opportunities.

If I had to pick one thing to do, I would find or start a SAFE group on Reddit that practices speaking. I've seen them on Reddit and on MeetUp. Start practicing easy stuff and work up to medium/manageable stuff. As you build a new database of positive memories and confidence, keep working your way up. What was difficult at the beginning, becomes manageable as you gradually work up.

How do you feel about those affected by anxiety disorders are represented in the media? I’m thinking about two specific manga/anime series, Bocchi the Rock and Komi Can’t Communicate, where the main character wants to be more social but has difficulty doing so because of their anxiety.

I am so happy there are series/movies that represent people with anxiety disorders. The writers often have really good insights about the experience (and sometimes good insights about what to do about it).

What did you learn or get from Bocchi the Rock and Komi Can’t Communicate?

Mostly that it takes people close to you that are patient and understand how you feel and what you’re going through to act as an intermediary or “interpret” your desires.

Yes, support from safe people is precious. Unfortunately, not everyone has that. There is a lot of shame around anxiety disorders. We often try to keep it a secret. So we don’t get the support we need.

.Just in case this is helpful, this is a draft letter that can help to explain to friends and family what you’re going through when you have an anxiety disorder or phobia: https://anxietyhub.org/relationship-advice-tell-friends-family-anxiety-draft-letter/

Ho Dr. Matthews!

I'm currently sitting my MSc. in Applied Psychology and hoping to do my PhD soon after too. It's great to see such information being spread so thank you for doing this informative AMA.

I'm wondering if you see any similarities with therapies for speaking anxiety and other forms of anxiety?

The reason I ask this is because I was always a very non-anxious person for most of my life. But I very quickly, and unknowingly, started getting anxiety and panic attacks from air travel. Then this year, when giving some presentations on some of my work, I could feel the same feeling of anxiety creep in. I needed to nip it in the butt, but I find it interesting how two drastically different things can have such a similar effect.

The ironic thing is, I'm also a musician, and perform in front of hundreds of people every week. Not a lick of anxiety in any of those shows.

Thanks for taking the time to read the message!

Awesome, all the best as you complete your MSc and hopefully move on to your PhD!

Yes, huge similarities between all of the phobias. Typically there are two cognitive distortions at work:

1. Overestimating the probability something bad will happen.
2. Overestimating the cost if something bad does happen.

It makes sense that we do this because the fear center in our brain in on the lookout for any POSSIBLE danger. It is prone to false alarms. It is going to send a message to our nervous system JUST IN CASE there is a real danger. Our nervous system is then programmed to release adrenaline into our body JUST IN CASE we need that energy to run from the danger or fight the danger. As explained in this video https://youtu.be/_21jFnb-smo.

#1. With flying we have to remind ourselves that there is a 1 in 3.37 billion chance of dying in a commercial airline plane crash - if we're on a major airline with a good safety record. The probability of crashing is low. But in our heads, we're focusing on terrifying imaginary "what if" scenarios that are not happening right now and we're telling ourselves "I’m going to go down in a ball of fire and die a horrible painful death." The fear center does not know the difference between a real situation and an imaginary one. So it reacts as if that is really happening. The fight-or-flight response is triggered when we scare ourselves with frightening thoughts. So we have to engage the logical thinking brain and say "wait a minute, that frightening thing is not happening right now. The probability that it will happen is low. If it does happen, I'll be better able to handle the situation and make better decisions if I'm calm."

#2. In terms of the cost if something bad happened, 98.6% of crashes did not result in a fatality during 2012-2016 — Of the 140 plane accidents, only two involved fatalities (1.4%). So if I do crash, I may not die or be injured.

We can say the same thing with fear of dogs. Are all dogs mean and will bite you? Sure some do bite. But can we learn to manage that risk by asking the owner "is your dog friendly?" before we pet it. Can we manage the risk of something bad happening?

Sure bad things happen. But with phobias there is an overestimation of the probability and cost. With a fear of flying, that over-estimation might not allow us to visit family and friends easily or travel for our job. It might get in the way of our goals and functioning. So we need to be smart about managing risk. We can't escape risk - even if we stay home. We can't live life without some risk. So let's be smart about it. But let's not over-manage it to the detriment of our quality of life.

The serenity prayer - or parts of it that are meaningful to you - can be helpful: "...the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference, living one day at a time; enjoying one moment at a time; taking this world as it is and not as I would have it..." Reinhold Niebuhr

With speaking, the fear of having a panic attack or embarrassing ourselves is what keeps us stuck. The more we dwell on that possibility, the more it becomes a self-fulfilling prophecy and it happens. When you've had a panic attack, that gets seared in your memory, so it makes sense that we dwell on it. One of the tricks is to shift our focus away from those horrifying imaginary "what if" scenarios and focus on getting our message across as clearly as possible. Tell yourself "These imaginary scenarios are not happening right now. If I focus on horrifying imaginary "what if" scenarios they will happen so I'm going to shift my focus. I'm going to throw myself completely into the task at hand and I'm going to slow down and communicate my point as clearly as possible." You can't always do this in a real-life scenario right off the bat. You may need to go into a safe speaking practice group where you can practice this technique with low pressure. You can’t do it in a high-stakes situation. It takes time, but keep practicing it.

David Clark is a world-renowned clinician and researcher in Social Anxiety in the UK. He came up with Attention Shifting Training videos. You may want to try some of these exercises. Keep practicing shifting your attention from internal-focus to external-focus. This can help us move our focus from the imaginary what if scenarios that are not happening to the present moment and what we're trying to accomplish in this moment. Here is his playlist on YouTube: https://www.youtube.com/playlist?list=PLjGQ1qp_lGNW8OdES0K5plTPvz4pVPp0d. As you do some of these, let me know what you think and if helpful.

The reason you have fear speaking, but not performing as a musician, is explained in this video: https://youtu.be/Sucm-6cCL60. It goes back to over-estimating the probability and cost.

Why would anyone be interested with what i say in public? Why do i feel they are laughing at me when i look at the audience?

Generally people would be interested in what you have to say in public. Everyone has unique experiences to share, and you're a valuable person who deserves to have a voice.

You may want to think about two cognitive distortions that people with public speaking anxiety and social anxiety often fall into:

1. Filtering. We tend to focus on the negative and ignore the positive. We all do it. The important thing is just to become aware of it. Researchers staged an experiment where they had people with public speaking anxiety present to an audience. They staged the audience so that everyone was smiling and nodding except for one person who was frowning and looked bored. When the researchers interviewed the speakers, the speakers said that the audience was frowning. Somehow they focused on the one negative person and completely missed all of the positive feedback they were getting. Part of overcoming public speaking anxiety has to do with getting accurate feedback on your performance. We do a lot of filtering so we're never getting accurate feedback.
2. Overgeneralization. In this cognitive distortion, you come to a general conclusion based on a single incident or a single piece of evidence. Maybe someone laughed at you once or a few times in some situation, but that doesn't mean all people all the time are laughing at you. People with public speaking anxiety tend to think that others are more hostile and competitive than they really are. Sure there are hostile people out there. But most people are pretty friendly and supportive. They're more interested in authenticity than they are perfection. Start to think about your audience with that new perspective.

Get into a safe speaking practice group. Start getting accurate feedback. I'll bet you start to change the way you're thinking about the situation.

I had a stroke last September and was diagnosed with aphasia and apraxia. Through 3 months of speech therapy, I've regained enough functions that I doubt anyone would suspect that those were my diagnosis. However, the struggles I had in the meantime left me with some anxiety in starting and maintaining a conversation. In dealing with that, I've always seen it as a stroke-related issue and not an anxiety issue, even though I identified it as an anxiety. Still, there is probably an actual physical impairment involved (dead brain tissue, etc). Has there been an attempt to reconcile the physical and the psychological in treating that issue?

Congratulations on all of the hard work in speech therapy regaining enough functions.

I worked for a short time as a neuropsychological intern in a rehabilitation hospital. I worked with a team of medical doctors & neurologists, speech therapists, PTs, OTs, psychologists, and we worked with stroke, traumatic brain injury and many other neurological issues. That was many years ago and I’m not an expert. Many of these professionals who work in this area everyday would be better at answering this question. But I’ll give you my take.

I would expect you to have some anxiety when starting and maintaining a conversation and throughout your recovery. You’re adapting to change and you’re having to redevelop abilities that used to be automatic. You’re going to feel some uncertainty as you go through this and I would expect some stress and worry. But it sounds like the speaking anxiety is not stopping you from speaking and engaging with others. Is the anxiety significantly getting in the way of your functioning in your relationships and life?

Anxiety happens on a continuum. When speaking anxiety is in the low-medium range, it's not bad - it's normal and to be expected. You can function with some speaking anxiety. You can still have loving relationships and a happy successful life with some speaking anxiety and imperfect speech. You can function with it and keep engaging with others despite it.

You may also want to think about others as friendly and supportive (not everyone is but most are). They actually have lower standards than what you might think and they don't expect perfection. They're more interested in authenticity than perfection. Go into the speaking situation reminding yourself of this.

Thanks for the reply. I feel like my anxiety doesn't prevent me from doing what I do, but at the end of the day, I feel exhausted from doing what used to be effortless. Sometimes, that bleeds into the next morning where I feel disquieted about what I must do during the day. I know I'm complaining about what is really a minor disability, especially compared to others that have it much rougher. But no tragedy worse than your own, and all that...

My wife has been and continue to be my rock. And interestingly (and fittingly) I feel no anxiety in speaking to her. I'm about as fluent as I was when speaking to her. Same with my kids, so the anxiety hasn't affected me in the relationships I value the most. And I think it segues neatly into your advice, that let the anxiety happen. My wife and kids are so accepting that I almost can't feel anxious in front of them. I'll try to be more comfortable with anxiety in other situations. Thanks!

That’s beautiful! I love the unconditional love and support you’re getting from your family. Yes, in other situations, tolerate some manageable anxiety - it’s to be expected.

Hi Dr. Mathews. I'm a trans woman who has successfully voice trained to a feminine voice, but I lose the nerve to do it properly when speaking to someone in person (as opposed to reading, or talking to myself). This has led to the majority of people I meet asking me to repeat myself as I was too quiet/timid/fast. Any advice?

Yes, practice speaking with others in a safe group. Start a safe group of other trans women on Reddit who want to practice the same thing. Also, record yourself on video and listen to yourself and watch yourself and give yourself feedback. Ask yourself, was I clear? Did I get my message across clearly good enough? If you did, give yourself feedback that you were successful. You don't have to be perfect, you just have to get your message across clearly enough so people understand what you're saying. Let go of perfection and focus on the message you're trying to get across.

Lol that's sounds exactly like how I freeze up when I try to say something in another language.

There more risk of negative judgment from others, the higher our anxiety! The less risk of negative judgement, the lower anxiety. This video shows what I mean https://youtu.be/Sucm-6cCL60.

You have more fear of negative judgment when speaking in a foreign language.

Why does this need a new term, "speaking anxiety," when we have social anxiety and public speaking anxiety categories already?

Yea, it's interesting you bring that up. Whenever I say "public speaking anxiety" most people think presentations and speeches. When I say "social anxiety" it covers a lot of social situations but isn't laser focused on speaking in groups of 2 or more. When I say "go around a table and introduce yourself" or "read out loud in front of a class" that's when that population in the middle comes out and says "Yea, that's me!"

I've had people tell me "I don't have public speaking anxiety exactly - I have speaking anxiety." That's when this started evolving for me. I still think it's perfectly fine to describe this as public speaking anxiety and social anxiety. But it's tricky when you try to find keywords on Google that really describe and target this nuanced thing so people in the middle know it's about them.

The root cause of public speaking anxiety, speaking anxiety and social anxiety is fear of negative judgment by others. Officially in the Diagnostic & Statistical Manual of Mental Health Disorders (DSM - classification system), Public speaking anxiety is a type of social anxiety so they are all very connected. Each has different situations that trigger the anxiety.

This is evolving in my head and I'm still figuring it out. I'm looking for words that communicate as clearly as possible.

Not OP, but speaking anxiety feels like it pinpoints to the specific act of speaking on a variety of different social levels (1:1 to group to huge audience).

Social anxiety can manifest differently for many people and can have nothing to do with speaking at all. Public speaking anxiety is too specific to the large group scenario. Speaking anxiety seems to make the most sense for the way OP is describing their expertise

spot on!

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Yes, start small and work up gradually. Think about your goal "I want to be able to get on a stage and play/sing in front of a large audience." Now let's chunk it down into smaller steps that keep your anxiety in the manageable range.

Which one of these situations would keep you in the medium/manageable range of anxiety (not too easy and not overwhelming)? Start easy and work up - always stay in the manageable range of anxiety:

1. Virtual reality practice https://anxietyhub.org/vr-training-using-virtual-reality-overcome-anxiety/
2. Play in front of family or friends. Start with a small group and increase the size of the audience gradually over time.
3. Practice in the back of an empty room/auditorium
4. Practice in the front in an empty room/auditorium
5. Practice on a stage in an empty room/auditorium
6. Practice with one or two people in the audience
7. Practice with more people in the audience
8. Etc. baby steps to get to your goal

Brainstorm and get creative about the small steps you can take to approach your goal safely. Write the steps down on a piece of paper. That becomes your "exposure hierarchy." Then work down the list.

Don't do anything overwhelming - that will increase your anxiety and can cause trauma.

The fear center in your brain has to gradually trust that the situation is safe. So find ways to approach the fearful situation using baby steps. Approach it safely and always in the manageable range of anxiety.

Also see this post for more tips on how to use mindfulness (focusing your attention on the present moment non-judgmentally) to manage performance anxiety https://www.reddit.com/r/IAmA/comments/13bo8as/comment/jjqjsac/?utm_source=share&utm_medium=web2x&context=3

I wonder if what I’m going to describe is social anxiety or is related to it (I’ve always felt like it is, so I’d be curious to get your perspective).

I’m a very confident person, very comfortable public speaking, having all eyes on me etc. However, I personally feel that I really struggle to find words to express how I’m really feeling, in both my professional and personal life. This can often lead to me saying ‘something’ in a rush to try and express myself and then having to explain what I meant because what I said was either misconstrued or I didn’t mean what it sounds like I meant (if you follow?). Do you think this is related to social anxiety? Whether it is or it isn’t I’d welcome any advice you might have regarding this!

I’ll state the obvious just to get it out of the way….It’s not possible with a few sentences on Reddit to get the full picture of what’s happening. You would need to see a mental health professional for an evaluation. They can dig into examples and details of the dialogue you’re having at work and in your personal life to get a better picture. But I can give you some thoughts based on the info you provided.

This seems more related to the skill of expressing your feelings rather than social anxiety per se. Not being able to express your feelings can create some anxiety, but you can probably fix this by getting better at expressing your feelings. I learned this skill in my Psychology education and it has been invaluable to me throughout my life. This is a great skill to learn and practice. I don’t know of any courses that cover this exactly for people who are not in Psych programs. If anyone else knows of some courses or resources, please post!

If this was me, I would look for a few therapists using these tools https://anxietyhub.org/anxiety-help-find/. Once I narrowed the list down to 2-3 therapists, I would contact each one and say ‘Here’s what I’m looking for [explain as you did here]…can you help me learn and practice this skill? Is that something you would do in therapy? I’m assuming this would be a fairly short engagement like 3-5 weeks - let me know if that is what you’re assuming and your thoughts. I’m very specifically looking for education and role play practice”. Hopefully, you find someone who fits the bill. In addition to understanding your situation better, they will give you some education and role-play practice.

Does anyone else have ideas?

My issues all revolve around the fact that my face gets really red when I have to speak in from of others that I don’t know well. I can run a meeting with my group and that’s fine, but if we invite some guests and I have to introduce them or even share an update at a training, and I will immediately start to feel that familiar hear rushing up to my face. Then I can think of nothing else except that I am red and everyone can see it. That makes the rambling begin. Instead of ending it quickly, I will just prolong the suffering with verbal nonsense. Why does this happen? I now get nervous before public speaking just thinking about the face flushing part.

Yes, blushing is one of those irritating and annoying anxiety symptoms. Overcoming speaking anxiety is all about learning how to deal with the symptoms and learning how to keep them from escalating to unmanageable anxiety levels.

One of the core features of speaking anxiety is that we become very internally-focused.

1. We focus on our bodily symptoms continually scanning our body: ”uh oh, they’re starting…that’s bad…this should not be happening…I’m going to be embarrassed and look like a fool.” We’re continually monitoring to see if they’re getting worse. We’re also continually sending danger messages to the fear center in our brain (this is bad, this is not going to turn out well). When our fear center receives a danger message, it’s programmed to send a message to our nervous system to release adrenaline into our bodies. The adrenaline is what causes the symptoms. So the symptoms become more intense. Then we send more alarming danger messages to our fear center. Self-perpetuating, escalating cycle. It’s a trap that is hard to escape. Merely trying to think your way out does not work. It takes some new tools and experiential practice to get out.
2. We have a harsh internal monologue going in our heads. That continually sends danger messages to the fear center.

This internal focus makes us very self-conscious. We need to practice shifting our focus externally. Focus on the message “I need to deliver three points and if I get those points across good enough (doesn’t have to be perfect), I was successful.” That moves our focus externally, to the present moment (not the past or the future where anxiety lives) and reduces the danger messages. It gives us a concrete goal so we know whether we were successful or not.

The best way to change this is to have some re-education so you can go into the situation differently with some new tools. And then get into a safe practice group where you can practice these new anxiety management techniques. You need some new tools. Some new ways to interpret the symptoms, yourself, your audience, the situation.

One technique is to get into a safe practice group (where it’s OK to experiment with new techniques). Before you go into the group, put rouge all over your face. Then practice manageable speaking tasks in the medium/manageable range of anxiety. The more you’re able to desensitize to the red face, the more those symptoms will go away.

You can start by working on reducing that harsh internal monologue in your head that is continually sending danger messages to your fear center. But there are more tools…too much to go into here.

The other technique that I’ve heard some people talk about is the v-beam procedure. I don’t know much about it so you can google it. It does not cure the underlying root cause but it helps to alleviate some of the blushing symptoms. It can be a stop-gap measure to get you through your job while you do the re-education and desensitization work that is required to address the root cause.

I find when I am public speaking in front of a large group, my anxiety has my internal monologue go off script and as I'm regurgitating the words I need to say, in my head I'm going "yeah you got em right where you want them. They are all focused on you... staring at you. Oh no, now your not sure what you just said."

I can't help it, doesn't happen every time but enough I get worried if I ever have to give a speech. It's so distracting, like putting a branch in the spokes of the bike I'm riding.

Any tips to get those anxious intrusive thoughts to subside?

That is one of the hardest parts of overcoming high speaking anxiety.

If I tell you "don't think about a pink elephant" it will be very hard to just stop thinking about it. It's in your head.

You have to give yourself a substitute. A replacement. A new thought. A new focus.

People with speaking anxiety and social anxiety need Attention Shifting Training. We have to be able to shift from being internally-focused (on our symptoms and self-critical self-talk) to being externally-focused on our message. What is it that we're trying to communicate? What's our goal in this speaking situation? If our goal is to communicate one key point, we need to completely throw our focus and attention on communicating that one key point as clearly as possible. That shifts our attention out of our head. Focus on your audience. You have an important message to get across. Are they getting it? Ask them "does this make sense?" "was this clear or can i clarify anything?" Slow down when you're speaking so you can work on being clear. Slowing down also relaxes your nervous system.

David Clark is a world-renowned clinician and researcher in Social Anxiety. He came up with Attention Shifting Training videos. You may want to try some of these exercises. Keep practicing shifting your attention from internal-focus to external-focus. Here is his playlist on YouTube: https://www.youtube.com/playlist?list=PLjGQ1qp_lGNW8OdES0K5plTPvz4pVPp0d. As you do some of these, let me know what you think and if helpful.

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Thank you for this question! It's very important to identify the causes and get a correct diagnosis. The treatment will be different depending on the diagnosis. For those with PTSD, I would go to someone who specializes in PTSD. Same with the other issues you mentioned. Talk with that specialist about speaking anxiety so they can add that to the treatment plan and/or make a referral.

(I don't see introversion as an issue per se. There are many introverts who don't have an issue with speaking anxiety - it's not getting in the way of their functioning or quality of life.)

How do you feel about marijuana or CBD helping with anxiety?

I‘m not a medical doctor so this is not medical advice but this is how I think about it with regards to speaking anxiety. I think about CBD the way I would think about the pros and cons of meds.

See pros and cons of meds: https://www.reddit.com/r/IAmA/comments/13bo8as/comment/jjck71s/?utm_source=share&utm_medium=web2x&context=3.

One of the biggest disadvantages of meds is that you will attribute your success to the med instead of to yourself. So I think it’s important to get into a safe practice group where you can keep the exercises in the manageable range of anxiety and desensitize. Attribute the success to yourself and not some external factor,

I haven’t wrapped my brain around marijuana for speaking anxiety and I have some mixed thoughts about it. I personally would gravitate towards a beta blocker and perhaps CBD oil (without the THC in marijuana).

From my research into CBD, it seems that it relaxes some people and not other people. Everyone's biology is different so it makes sense that it won't work the same for everyone.

Like meds, Marijuana and CBD oil are not cures. They mask symptoms. But meds may be very important for recovery and improvement.

Some people need meds to stay afloat in their jobs/life WHILE they are on the natural desensitization path. The desensitization path takes time. Many people need a "flotation device" when they're thrown in the deep end of the pool in their jobs. It's important that they have some kind of "flotation device" in the deep end of the pool otherwise their anxiety will go up and may be re-traumatized. Some kind of meds may be a good stop-gap measure as they're working on the long-term solution. And most people I talk to are super motivated to gradually wean off as they improve.

How do you learn how to approach a group at a professional reception and mingle? That's where most of my anxiety stems from - how to know when it's okay to "crash" a conversation and when to leave it. Especially when there are no other individual stragglers who are similarly awkwardly looking to have a conversation...

That’s an awkward situation for most people. Especially when you’re the lone person without someone to talk to.

I personally would check out some books to get some tips. https://www.amazon.com/s?k=How+to+mingle&i=stripbooks&crid=1J2TCUFQ8TIC8&sprefix=how+to+mingle%2Cstripbooks%2C86&ref=nb_sb_noss

I've heard that the reason for this, from an evolutionary biology perspective, could be that in small groups earlier in humanity's history that the primary time outside of storytelling that you would have to do this was when you had to plead your case for preventing ostracism. I can't see how one could prove this. What are your thoughts on it?

Yes, very interesting. All of this is conjecture, but this is the way researchers in social anxiety think about it:

In our earlier human history, to be ostracized from the tribe was a death sentence. People needed other humans to survive. So a negative evaluation or negative judgment from others triggers a danger alarm in the fear center of our brain. It’s primal and “programmed“ in our biology. Our nervous system releases adrenaline in our body and our heart starts beating faster and we get other fear symptoms.

That’s why most people get some anxiety symptoms when speaking in groups or in social situations. We expect some anxiety. It becomes a problem when that anxiety escalates to high levels and prevents us from functioning and realizing our life goals.

As we’re overcoming public speaking anxiety, it’s important to accept that you might have some normal anxiety. Allow it to happen and don’t fight it. See it as a normal thing.

Thinking that you should have no anxiety in those situations, is what makes the anxiety escalate. You think something is wrong when actually it’s quite normal to have some anxiety. You can function with some anxiety. Expect it, allow it, accept it. Don’t fight it.

Most things do not bother me when it comes to speaking but back when I was in the military I had a meeting with pretty much all my high ranking superiors in my command and I was just an e3 at the time.

I've had faster heart beats before but this was weird, I had a RACING heart but also it was like I had these weird "hiccups" but it was like my vocal chords or something just would "give up". It's super hard to describe and it hasn't happened since. Weird.

Do you think that was maybe a panic attack or possibly just bad timing (maybe sleep deprived, hungry, stressed, ect)?

Yes, very interesting. I suspect this is what was going on: https://youtu.be/Sucm-6cCL60. You perceived a high risk of negative judgment with all of those high ranking superiors.

Your anxiety may have been higher and more easily triggered by sleep deprivation, and being hungry or stressed.

I have lived with this for years, and after receiving my PhD, have mostly given up on my academic career plans because of it. What would you say is the most effective treatment for this form of anxiety (e.g., psychotherapy, medication)?

So so sorry about dropping your academic career plans. This anxiety really gets in the way of career and educational plans.

In a nutshell:

1. Re-education/re-framing. Re-intepreting anxiety, yourself, your audience and the speaking situation. Aware of cognitive distortions that get in your way and practicing new self-talk..
2. Desensitization. Gradual exposures in the manageable/medium range of anxiety. Repeat, repeat, repeat.
3. Use meds (like a beta blocker) if you need them to stay afloat in the deep end of the pool while you’re working on #1 and 2.

Check out this AMA as it goes into detail on each of these.

Can you recommend any subreddits/Facebook groups/other groups that I can look to to start practicing? It’s very difficult for me as I’m in a project management position and get nervous even introducing myself on a call! Even though I’m a grown adult and fully capable of doing my job, AND I know it’s irrational. Funnily enough I’ll also be starting my PhD in clinical psychology this fall, and so I desperately want to get ahead of this before I have to defend, haha. Thanks for doing this AMA!

Awesome and good luck on your PhD in clinical psych!

This is one thread on a practice group: https://www.reddit.com/r/PublicSpeaking/comments/udu6jc/looking_for_a_public_speaking_club_online_and/.

Do you ever have trouble with people trying to eliminate their anxiety entirely? Like where they become anxious about having any anxiety whatsoever? I know a small level of anxiety is good when you need to perform (in whatever context). Yet, if you told someone suffering from GAD that, they might think you’re crazy off the cuff. Since to them, any anxiety might have become a threat to their day to day life.

"Do you ever have trouble with people trying to eliminate their anxiety entirely?"

That is what keeps people stuck. Many people with speaking anxiety and social anxiety make the mistake of thinking "I should have no anxiety in this situation. Something is wrong, I have some anxiety. I should be perfectly calm, cool and collected."

One of the most important "re-interpretations" we need to make is about anxiety itself. Yes, anxiety in the high ranges is bad - it gets in the way of our functioning, happiness and goals. But anxiety in the low-to-medium ranges is to be expected and normal. You can function with anxiety in that range. You can prove this to yourself in a safe practice group. The fear center in your brain needs to learn this experientially. It doesn't help to just talk about it - you have to experience it for yourself.

When we send the message to the fear center in our brain saying "something is wrong, I shouldn't be feeling any anxiety," that sends a danger message which triggers more adrenaline and intensifies the symptoms. It's a self-perpetuating cycle. Anxiety keeps escalating out of control. But if we say to ourselves "Some anxiety is normal and fine. I can function with some anxiety. People don't notice anxiety in the low to medium ranges so i don't have to be afraid of people seeing my anxiety" that keeps the anxiety from escalating.

Anxiety happens on a continuum. It's not all or nothing. We need to accept, allow and expect anxiety in the low to medium ranges. Don't fight the symptoms when you experience it in that range. If you don't fight the symptoms, just let them happen, your anxiety won't escalate and become a self-fulfilling prophecy.

Thanks for the long form explanation. I recently wrote a school paper on insomnia and how it relates to other disorders (which you probably know sleep-wake disorders are both caused by everything and cause everything). But anxiety comes up a lot in research, sometimes beyond what I would have thought. That something like 1/3 of CBT-I exercises directly involve lowering anxiety about sleeping would have gone over my head a year ago.

I didn’t think about the whole “person develops a sleep disorder, gets anxiety about sleeping, associates bed with sleep, which raises their anxiety, which in turn prevents them from sleeping.” But as soon as I had read it, I could see how it can be learned behavior just from any point in life.

I said it in a long, drawn out way, but I can see the parallels in my recent paper and your area of expertise where anxiety builds from essentially fear of anxiety.

Yes, exactly!

Hi! I haven't suffered fear of public speaking to the degree that you concern your work with, but most people I know have that fear to some degree. I got over mine when I waited tables in college. I remember how terrifying it was to even consider walking up to a table of strangers at first, but with time I became comfortable with it.

I have recently run into several people who, when they learn I was a waiter, they say "omigod, I couldn't do that I am scared to talk to people".

My question is, isn't it helpful for most people to be pushed to overcome this fear?

Yes, people have to find SAFE ways to approach this fear gradually in the medium-range of anxiety.

Everyone has different anxiety triggers. What causes high anxiety for one person causes low anxiety for another person. So you have to design a tailored "exposure hierarchy" to each person individually.

Each person should write on a piece of paper what situations cause high anxiety, medium anxiety and low anxiety. Brainstorm how to break these up into manageable baby steps so the person can approach the situation over time in a safe way with manageable anxiety. If their anxiety is too high, they will probably abandon the exercise and that approach actually makes the anxiety go up.

So I would encourage people to find exercises they can do in the manageable range of anxiety for them. But I would not push them to jump into the deep end of the pool and re-traumatize themselves.

Ever think of writing a book?

I prefer Reddit, youtube and blogs. Feels more creative, dynamic and exciting for me.

HELP with teenage daughter? Ok first off she's an amazing kid. She's 14 years old and you couldask for a more polite well behaved teenage daughter lol! But her social anxiety is borderline debilitating. At home with my wife and myself she talks to us and jokes around and seems perfectly normal. Shes technically my step daughter but I am dad to her and I love the kid with all my heart. We are close and she'll come to me more often than mom when she needs to talk. But the real problem is when she's at school or in public. At 14 she will break down crying or just lock up and not speak at all in certain situations. Like having a class presentation, tried a psychologist once and she would say a word. She had a counselor at school she would talk to and our school district had a psychologist that she would talk to. She gets home and will literally sit with me and talk my head off. I'll sit and just let her talk about whatever for as long as she wants because she doesn't talk to many people outside the hone. She does have a couple if friends but seems so desperate for their attention and acceptance I'm afraid later on in high schooland later this habit may get her into trouble or in situations she was scared to say no to. The school psychologist did her best hut now we want to see if we can find someone to help her, I guess to be more confident, to be able to talk to people. She's told me she gets scared to upset people. No matter what I say or advice I give it doesn't really help. I'm glad it helps her feel better to talk to me but us there a type of special children's psychologist we can send her to? Someone willing to be patient with her in case she just locks up and won't speak thev1st tine she goes? I just want my girl happy and to be able to communicate her feelings, opinions, and thoughts in a healthy and nor.al way so she's no longer scared to try and make new friends and live her life.

Edit: please forgive my grammer and awful spelling! Big thumbs trying to type fast on this little phone lol

Thanks for posting this. Can you tell me what city you live in (feel free to PM me)? There are definitely Psychologists and Anxiety Clinics that fit what you’re looking for and could really help her.

Thanks for your question. To find a child psychologist I would do some exploratory research at:

1. Anxiety and Depression Association of America (ADAA) at https://adaa.org/find-help/by-demographics/children/children-teens and Selective Mutism Association: https://www.selectivemutism.org/ and https://www.asha.org/public/speech/disorders/selective-mutism/.
2. Contact some anxiety clinics that specialize in Selective Mutism, Social Anxiety and Child Psychological services in general. If you are not located near that clinic, ask them if they know of a child psychologist or professional that they can recommend near you. Or what ideas they might have. For example, https://childmind.org/care/areas-of-expertise/anxiety-disorders-center/social-anxiety-groups/ and https://childmind.org/care/areas-of-expertise/anxiety-disorders-center/selective-mutism-service/ and https://selectivemutismcenter.org/whatisselectivemutism
3. You can also look for a child psychologist using these search tools: https://anxietyhub.org/anxiety-help-find/. When I did a search on social anxiety and on selective mutism (without a location), quite a few professionals came up. It will take some phone calls and due diligence to narrow down the list.
4. Once you find a professional, have them evaluate and diagnose your child and develop a tailored treatment plan.

I hope this helps.

I had severe anxiety. I was unable to speak to strangers or even order pizza. Then my family mostly died months from each other. I got depressed and it went away. I could get in front of an audience naked and talk about anything. Zero anxiety.

For me it was cured because compared to what happened worrying what others think of me was trivial.

My kids though, they also have anxiety and I don't know how to help them. I mean trauma as therapy was wildly successful for me, which led me to be kind of like just go fail you'll be fine. How do you balance forcing kids to face their anxiety fears and making them worse? Like at a certain point, won't just doing it anyway get you past the anxiety? It's been so long that I can't remember what is like to be afraid.

Wow thank you for that story.

How do you balance forcing kids to face their anxiety fears and making them worse? Someone asked a similar question: https://www.reddit.com/r/IAmA/comments/13bo8as/comment/jjgja79/?utm_source=share&utm_medium=web2x&context=3

Hello! Thank you for sharing your experiences and knowledge!

My son’s pediatrician called similar symptoms in my son “select mutism.” My son wouldn’t answer simple questions when we went for his medication management appointment a few months ago. My son was staring into space and when I asked him something, you could see him come back to reality with a look of confusion on his face. He looked like he was scared or worried but also like he wasn’t sure what was going on. He recommended speech therapy through his school’s SpED program since we have accommodations in place for his ADHD. When I brought it up to at our IEP meeting, they said they didn’t notice any of those symptoms and didn’t think he needs speech therapy.

Can you explain the differences between speaking anxiety and select mutism?

Thank you in advance.

I defer to professionals who work with children and specialize in selective mutism. It's a very specialized field (with specialized treatment techniques that may include speech therapy) and I don't have experience in that area. There are clear connections with speaking anxiety and social anxiety and some of the treatment techniques overlap.

To find a child psychologist I would do some exploratory research at:

1. Anxiety and Depression Association of America (ADAA) at https://adaa.org/find-help/by-demographics/children/children-teens and Selective Mutism Association: https://www.selectivemutism.org/ and https://www.asha.org/public/speech/disorders/selective-mutism/.
2. Contact some anxiety clinics that specialize in Selective Mutism, Social Anxiety and Child Psychological services in general. If you are not located near that clinic, ask them if they know of a child psychologist or professional that they can recommend near you. Or what ideas they might have. For example, https://childmind.org/care/areas-of-expertise/anxiety-disorders-center/social-anxiety-groups/ and https://childmind.org/care/areas-of-expertise/anxiety-disorders-center/selective-mutism-service/ and https://selectivemutismcenter.org/whatisselectivemutism
3. You can also look for a child psychologist using these search tools: https://anxietyhub.org/anxiety-help-find/. When I did a search on social anxiety and on selective mutism (without a location), quite a few professionals came up. It will take some phone calls and due diligence to narrow down the list.
4. Once you find a professional, have them evaluate and diagnose your child and develop a tailored treatment plan.

I hope this helps.

As someone with social anxiety, for some reason I don't have this issue with public speaking or acting, I actually find myself quite comfortable. However it's in small groups that I have issues. I've heard this is relatively common, so why does this take place?

I suspect this is what is going on: https://youtu.be/Sucm-6cCL60. You think there is a higher risk of negative judgement by others in the small groups.

[deleted]

Not OP, but I’m so sorry you lost your daughter. Hugs from an internet stranger. I was diagnosed with general anxiety disorder, depression and ADHD. In and out of therapy my whole life. Mental health issues run in my family but I had a good stable childhood as my parents didn’t have the issues my relatives did.

However. I went through two bad car accidents, was a caregiver for a family member who passed away, have second hand trauma from a prior career, and I have medical trauma. All this coupled with my family history has really made life really difficult at times.

I used to take Xanax here and there and then ended up on Klonopin daily which really caused severe side effects and major issues trying to come off of it. It was scary to say the least. I was also on Lexapro for a few years at a time.

After years of thinking I could be on meds for sometime and then get off them, I have finally committed to staying on Lexapro, a SSRI for the rest of my life. Meds can delude us into thinking we are well and cured. So we want to stop them, when this is the exact opposite of what we should be doing.

Going on something long term is something to consider but I know you lack insurance. I also work on controlled breathing when I feel anxious and do guided meditation. Dr. Mao makes a good album I use.

Edit to add I found out he has YouTube and here is one of his guided meditations. https://youtu.be/V-9DPljP9Lc

Thank you internet stranger for reaching out and sharing your experiences!

To the person who posted, sorry for the delay answering your question. If you’re still reading, I wanted to say: I am so sorry for your devastating loss and so sorry to hear everything you’re dealing with. I’m grateful to the kind Internet stranger who reached out to you here and has many relevant personal experiences to share.

Because what you brought up is complex and broader than speaking anxiety, I would recommend an anxiety treatment center that specializes in panic attacks and one that can evaluate, diagnose and treat other comorbidities. I realize you don’t have insurance but perhaps you can work with someone on a sliding scale. There are some mental health professionals who will lower fees based on need (income, lack of insurance). You can use these tools to look for a therapist who specializes in panic attacks in your area and ask them if they use a sliding scale: https://anxietyhub.org/anxiety-help-find/. You can also check these anxiety treatment clinics if they are located near you https://anxietyhub.org/best-anxiety-treatment-centers/.

In the meantime, these books may answer some of the specific questions you raised regarding panic attacks:

Panic Attacks Workbook: Second Edition: A Guided Program for Beating the Panic Trick: https://www.amazon.com/Panic-Attacks-Workbook-Program-Beating/dp/1646043332/ref=sr_1_5?crid=EES633VVW2AB&keywords=panic+attacks&qid=1683820995&s=books&sprefix=panic+attacks%2Cstripbooks%2C71&sr=1-5.

The author, David Carbonell PhD also has a good website at https://www.anxietycoach.com/.

When Panic Attacks: The New, Drug-Free Anxiety Therapy That Can Change Your Life: https://www.amazon.com/When-Panic-Attacks-audiobook/dp/B06XCNYQ8V/ref=sr_1_4?crid=EES633VVW2AB&keywords=panic+attacks&qid=1683821800&s=books&sprefix=panic+attacks%2Cstripbooks%2C71&sr=1-4

I misread the title as Cerys Matthews.. has anyone ever accidentally booked you instead of a welsh singer?

LMAO!

How many people suffer from speech anxiety?

That's a great question! We have some scientific data but not enough. Here's what I mean.

There is low, medium and high speaking anxiety. Low means there may be some anxiety (mild symptoms) but the speaking task is fairly comfortable. Medium means the symptoms are getting more uncomfortable and may be getting in the way of your ability to speak as effectively as you’d like but you can do it. High anxiety is where your anxious thoughts and symptoms are intense, distressing and are getting in the way of speaking (losing your train of thought, breathlessness, etc.). The majority of the population has low-to-medium anxiety. A smaller unknown percentage of the population has high speaking anxiety that significantly gets in the way of their functioning. There is a lack of research in this area so my best guess is 6-10% of the population has high speaking anxiety (disorder).

Even for people in the low-medium anxiety range, in high stakes situations, their anxiety will be higher. In lower stakes situations, their anxiety will be lower. The level of anxiety you feel depends on how much perceived risk there is of negative judgment: https://youtu.be/Sucm-6cCL60.

We need more research on the speaking anxiety spectrum (low, medium, high). (If there are any doctoral students or researchers out there who want to partner on some research, PM me).

Any suggestions for flushing when feeling self conscious?

I feel that when I try to make sure that I am understood or caught off guard while speaking I will start to feel an itch and will have redness that starts on my chest working up to my face.

Check out this post with a similar question: https://www.reddit.com/r/IAmA/comments/13bo8as/comment/jjlojyh/?utm_source=share&utm_medium=web2x&context=3.

What do you think about how the psyd has been “obsoleted” first by the MSW and now by the LMHC, with a growing share of mental health care being provided by “addiction counselors” with basically no education requirements at all?

I find this really troubling myself. When I was an undergraduate psych student at the turn of the century, the PsyD was presented as a more streamlined alternative to the PhD that would allow clinicians to get to work without taking a detour through research. But now it seems like the focus is just on driving down costs without much concern for quality of care. People on the internet love to tell each other to just get a better therapist with the right specialization, when the reality is that more and more mental health providers are about as sophisticated as a rogerian computer script.

Interesting. I haven’t felt this way to the extent that you’ve described it.

Which is the best cure for anxiety? Pills, therapy, or something else?

Good question. Pills don't cure anxiety. They just mask symptoms. That doesn't mean they can't be useful in recovery, and sometimes they're a critical part of getting better. When you're thrown into the deep end of the pool, pills can be your flotation device. But I like to think about pills as a stop-gap measure WHILE you're doing the natural desensitization work and cognitive reframing (the real cure). Desensitization (gradual exposures) take time so you may need something that keeps you afloat at work (we don't want you to risk your job) until your desensitization work starts to take root.

Cognitive-behavioral therapy (CBT) or some of it's different flavors are extremely helpful (as long as you find a (1) well-trained therapist who (2) specializes in the anxiety you have and that (3) you connect well with them https://anxietyhub.org/anxiety-help-find. People with high anxiety can usually benefit from thinking differently about themselves, their anxiety, the audience and the speaking situation. It helps to understand cognitive distortions and to work on approaching situations more accurately and logically. CBT helps you do that. It helps you go into the fearful situations differently so you can have a different outcome. So yes I think therapy can be helpful. But just talking with a therapist won’t get you over this thing. You have to do the exposures (safe gradual practice). The fear center in your brain learns experientially that the situation is safe. You have to experience it for yourself. You can’t talk your way out or think your way out. You have to think your way out and experience the situation as safe.

Ultimately, (#1) smart strategic exposures with some CBT reframing is what helps. Do the (#2) meds if you need them as a stop gap measure while you're working on (#1). With speaking anxiety the med can be a beta blocker (most often used). Beta blockers are used "as needed" so you don't have to take them every day. You take them 30-60 minutes before an event. You have to plan ahead so they don't work well for impromptu situations where you're not expecting to be called on to speak. That's especially where you need the desensitization work.

Would you post to /r/stutter ? I'm sure they would be great full

Thanks kobie, I contacted Mods to see if they will crosspost the AMA.

What’s the term for speaking in public and loving it?

Not sure! Glossophobia is the opposite. Maybe Glossoeros!

Give some simple tips to controll self while get striken with nervous breakdown?

Nervous breakdown is very broad and can mean many things. Not sure how to answer that without more specifics on what is happening. What’s the experience?

Every time I speak publicly or in a unit meeting at work I get that thing in my throat where I have to constantly swallow. Even if I’m not feeling too nervous or getting FOF response. Any tips for this?

Yea, I used to get that all the time. Couldn't finish my sentence without swallowing, swallowing. It's not an overnight fix. Takes time.

Swallowing is one of those irritating, annoying bodily symptoms that is triggered by the flight-or-flight response (muscles and throat tightening). This is what causes the fight-or-flight response: https://youtu.be/_21jFnb-smo. When the fear center in our brain (amygdala) detects a risk of danger (I might be negatively judged by others), it sends a message to our nervous system which gives our body a shot of adrenaline. When the fear center detects a HIGH DANGER RISK, it sends a message to our nervous system to release a large dose of adrenaline into our bodies. The more adrenaline, the more intense our symptoms.

Very simply, the way to stop this is for your fear center to stop sending danger risk messages to your nervous system. The only way to train your fear center is experientially: You have to repeatedly go into the fearful situation safely and successfully and build a database of positive memories with that situation. It's all about keeping the amount of adrenaline in your body to a minimum (to a manageable level). You can speak when the adrenaline is at a manageable level, but the adrenaline completely hijacks you when it's at higher levels.

Get into a safe speaking practice group. Find one or start one on Reddit. Start practicing things that are in the manageable range of anxiety for you. Then work up.

Also, do progressive muscle relaxation before you speak. That will loosen up the muscles in your chest and throat. See Johns Hopkins video on how to do it https://youtu.be/ClqPtWzozXs. I always squeeze my fists and release before I speak (I can do it in my chair before I'm about to speak).

Also, always have water handy. Give yourself permission to stop and drink some water before you start speaking and during.

Slow your speaking pace down - this relaxes your nervous system. If it creates more anxiety at first, just keep practicing it in front of a video camera. Learn to tolerate slowing down and pausing.

This is tangential, but I figured out that I was allergic to milk and cheese. Once I cut those out, I was able to get a handle on this symptom. What used to happen is that the swallowing was severe and that symptom would freak me out "Crap, I'm about to have a panic attack..things are going to go off the rails..). So when I was able to reduce the intensity of that symptom by avoiding some dairy, I was able to stop the anxiety from escalating out of control. Hope that makes sense! But really getting rid of this was a confluence of several things and several years: Safe practice in groups and re-interpreting anxiety, myself, the audience and the speaking situation.

Isn’t it ‘dehabilitating’? Google is telling me that my spelling doesn’t exist and I feel like I’m going insane. Pls help

Not OP, but it is "debilitating".

Damn, thanks. I actually work as a writer and proofreader so don’t often come across something like this. I have 100% been spelling that wrong my whole life.

LMAO! I've been there.

I had to scroll up and make sure I spelled it correctly!

You ever used the Dr. title pretending to be a real doctor?

She has a doctorate which makes her a real doctor compared to someone who got Dr by completing a medical degree and not completing their doctorate

Yup! Not a medical doctor (MD). Doctor of Psychology (PsyD).