Public speaking and social anxiety

Why public speaking is so hard

When you give a talk, many people look at you at once, for minutes at a time, and you cannot leave. For many people this is the most frightening social situation of all.

For some, it is the only fear. This is sometimes called performance-only social anxiety, covered in performance anxiety. For others it is one fear among many. A large US survey found that fears of performing and fears of talking to people tend to go together, as parts of one problem.

The fear usually centres on the body: a shaking voice, trembling hands, blushing, going blank. You watch yourself closely for these signs, which makes them feel bigger and makes it harder to think. What keeps social anxiety going explains this loop.

Your audience sees much less than you feel. In a set of experiments, people believed their inner feelings showed much more than they really did. This is called the illusion of transparency. Your pounding heart is invisible from the back of the room.

What people with social anxiety often do

• Avoid presentations, or call in sick on the day.
• Write out every word and read it, never looking up.
• Speak very fast to get it over with.
• Hold the lectern tightly, or keep their hands in their pockets.
• Drink alcohol beforehand.

These are safety behaviours. They feel protective, but they stop you learning that you would cope without them. They can also make things worse: gripping something tightly can make shaking more visible, and an experiment found that safety behaviours and watching yourself are unhelpful in several ways.

Small steps to try

This is an example exposure ladder: steps you face on purpose, easiest first. Repeat each step until it feels easier, then move up.

1. Read a paragraph out loud, alone, standing up.
2. Record a two-minute talk on your phone and watch it. Compare how you felt with how you look.
3. Give the same talk to one person you trust.
4. Practise in front of a virtual audience, in VR or with an online practice tool, if you have access to one.
5. Make one planned point in a meeting or class.
6. Give a short talk to a small group, such as a team update or a toast at a family meal.
7. Join a speaking club such as Toastmasters, or take a public speaking class. They are not treatment, but they give regular, friendly practice.
8. Give a real presentation, using short notes instead of a script.

At each step, drop one safety behaviour. Look at faces in the audience. Let your hands move. Pause between points. Expect anxiety, and keep going anyway.

Practising in virtual reality

Public speaking is where virtual reality (VR) has the most evidence. In VR, you wear a headset and stand in front of a virtual room or audience. The audience can start small and friendly and get bigger or more bored. You can repeat the hard moment again and again.

• With a therapist, it works. In a US trial of 97 people whose main fear was public speaking, eight sessions of VR exposure helped as much as group therapy, and both were better than waiting. Gains held at a year.
• One session can help. In a Swedish trial of 50 people, one session of VR practice with a therapist cut fear of public speaking a lot compared with waiting. People also used a version at home, with good results, though that part was not compared with a separate group.
• The audience may matter less than speaking out loud. In a UK trial of 51 people, practising a talk in an empty virtual room also helped, not only practising in front of a virtual audience.

Be honest with yourself about the limits. Most trials are small, and many compare VR with waiting rather than with real-life practice. When VR is compared with real-life practice inside therapy, the two come out about even. VR is a good way to take the first steps, especially if you cannot easily find an audience. VR exposure therapy and VR at home have the details.

What about propranolol?

Propranolol is a beta-blocker: a heart medicine that blocks some of the body’s stress signals. Many people take it before talks. On Reddit, people often report that it calms the shaking and racing heart but “not the thoughts”. Some report tiredness or nausea.

The trial evidence for social anxiety disorder is thin. A review of the trials found only one small trial in social phobia, with 16 people, and said the evidence was not enough to support routine use. Propranolol is not safe for everyone. The NHS lists people with asthma, low blood pressure, a slow heart rate or diabetes among those who need to check with a doctor first. A doctor must prescribe it. See propranolol for more.

When to get more help

If fear of speaking is limiting your studies or career, or if it is part of a wider fear of social situations, get help. The best-tested therapy is cognitive therapy for social anxiety. It includes speaking practice, watching video of yourself and dropping safety behaviours.

If you rely on alcohol to get through talks, see alcohol and social anxiety. If you feel hopeless, crisis lines can help right now.