Can This Drug Cure Performance Anxiety?

Beta-blockers, used primarily as a treatment for heart disease, may help calm the nerves of anxious orators.

Close-up of microphone and transparent lectern with audience seen in blurred background
Caiaimage / Paul Bradbury / Reuters

When we think about performance-enhancing drugs, our minds immediately turn to famous athletes using banned substances to build muscles and heal faster. Lance Armstrong, Mark McGwire, Marion Jones—the list of athletes whose legacies are tainted by alleged (or, in some cases, admitted) drug use seems to grow longer every year.

But athletes aren’t the only ones ingesting pharmaceuticals to do their work better.

For people whose jobs require public speaking or presentations, a class of drugs called beta-blockers can be a powerful tool to calm the nerves and reduce the jitters that detract from performance.

Beta-blockers were discovered by Scottish pharmacologist James Black in 1962 as a treatment for heart disease. The chemicals work by inhibiting the body’s response to adrenaline, lowering blood pressure and reducing the risk of heart attack. By the 1970s, doctors had begun using them to reduce performance anxiety, particularly in musicians. However, that remains a secondary use; beta-blockers are still used primarily to improve people’s circulatory systems. For his work, Black won the Nobel Prize, and upon his death in 2010, The New York Times credited him with “extending the lives of millions of people.”

I began hearing about their usefulness in public speaking from writer friends who found themselves anxious on book tours. “All of my bad things that usually happened when I’d speak—the sweating, the fast breathing—didn’t happen,” one best-selling author told me after trying the pills. “I don’t know if it’s psychosomatic or not, but the pills just tamp down all of the physical sensations.”

Another friend looks at beta-blockers as an insurance policy. He doesn’t think of himself as a nervous speaker, but occasionally he’ll suffer feelings of panic at the podium. “Beta-blockers just subtract the possibility that your body is going to rebel against you,” he says. “The medicine helps immeasurably, and I’ve become an evangelist for it. It’s improved my career by making me a more confident public speaker.”

So when I began working on a book about how people get psyched up to perform better at work, I decided to give beta-blockers a try.

On a winter evening, I’m sitting in the crowded waiting room of a medical office. I’m here to see a certified nurse specialist, to try to get a prescription for propranolol, the generic beta-blocker my friends have been using.

In her office, the nurse taps on an iPad, asking for my biographical information—name, address, employer, insurance.

She asks about my emotional well-being and professional life. I tell her that I spend most days writing and editing, but that my job does require occasional public speaking. In my last job, my employer asked me to make periodic appearances on television; although these opportunities have waned since I changed jobs, I still go on camera every once in a while. When I do, I experience the classic markers of performance anxiety: the dry mouth, the tight throat, and the rapid heartbeat. When my kids have seen me on TV, they’ve teased me about compulsive blinking. I tell the nurse about my friends who take beta-blockers before speeches. “They say it takes the physical signs of nervousness off the table, and it’s made a big difference in their careers,” I say.

The nurse nods approvingly. She’s had patients who’ve had great results with propranolol. In fact, she suddenly scowls and looks annoyed. Earlier that morning, she’d seen a patient who was distressed because she’d become extremely nervous during a job interview. In retrospect, the nurse says she wishes she’d recommended propranolol, and she makes a note to call the patient after I leave to discuss it. After a few more minutes of conversation, she electronically sends the prescription to CVS, where I pay a $7 co-pay for 30 tablets of propranolol, renewable three times.

A few weeks later, I’m scheduled to fly to California to moderate a panel discussion in front of an audience of 75 people. It’s a chance to try out my new pills, and I’m excited—but I inadvertently leave the bottle in my car at the airport. At the conference, I’m well prepared and not particularly nervous; I lead the discussion drug-free without a hitch.

While I wait for more chances to try the drug, a friend texts me in a panic. He’s recently taken a new job, and the next morning he has to make a one-on-one presentation to his firm’s CEO. He cuts to the chase. “You know those pills you were telling me about for performance anxiety? Can I grab some from you before I get on the plane?”

I say no, fearing it would be illegal to share them. He pressures me. I come up with a compromise. “Okay, I’ll drop some pills off late tonight,” I tell him. Then I drive to CVS, buy a bottle of vitamin B12, and leave five tablets in an envelope taped to his door. I text him careful instructions: Take one pill 90 minutes before the presentation, and another 15 minutes beforehand if he still feels nervous.

Later, he texts me from the plane: “What is this medication called?” “Propranolol,” I lie. He googles it and starts reading online reviews. “Wow, people really rave about this stuff,” he says.

After the meeting, I text him: “How did it go?” “Really well,” he replies. “Those pills are magic.”

My friend’s experience illustrates how hard it is to know how well these drugs really work: Because we want them to work, the odds of a placebo effect is high—and because the pills’ effect is signified by the absence of something, it’s difficult to know if the pills really kept you from feeling nervous. It’s similar to the flu vaccine: If you get the shot, and you don’t get the flu that year, can you say for certain that the immunization prevented the illness?

Placebo or not, I notice an effect when I start trying them. Although I don’t have any other public speaking opportunities in the weeks after I obtain the prescription, I take the pills a few times before important interviews at work. I tend not to get nervous during interviews ... except, occasionally and unpredictably, I’ll start sweating. I remain sweat-free while on beta-blockers, with no rapid heartbeat or shallow breathing—though it’s hard to say how much to credit the drug for that.

The beta-blockers have a more noticeable effect in an unlikely setting: a two-day, 20-man annual golf tournament I play in with friends each year. I’m the worst golfer in the group, but on the first day, I play poorly even by my low standards. The next morning, on the driving range, I pop a propranolol. On the first tee, I’m unusually calm. (There’s a reason the PGA bans players from taking beta-blockers.) I still post the day’s poorest score, but I play far better than I usually do. The lack of nervousness is especially noticeable on tee shots and important putts—and with my handicap giving me strokes against my opponents, I keep my match competitive until the 16th hole. By then the drugs have worn off, and as I stand over a putt, I feel the familiar jitteriness—one I hadn’t felt that morning. Nonetheless, even my opponents notice the difference. “Dan played out of his mind today,” one announced over drinks at the clubhouse after the round.

I can only hope the pills work that well at my next public speaking opportunity.

This article is adapted from McGinn’s recent book, Psyched Up: How the Science of Mental Preparation Can Help You Succeed.