Beta blockers are the last thing you should try to treat anxiety about public speaking

Sometimes I find an overenthusiastic, poorly researched, cheerleading article touting a product as the greatest thing since sliced bread. On June 5, 2019 there was such an article by Zara Stone at Ozy titled This startup wants to make you a better public speaker. It described Kick, which was peddling internet (telemedicine) prescriptions for a beta blocker pill, propranolol.

First, what is a beta blocker? A Mayo Clinic web page explains that:

“Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, your heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow.”

Another web page at Medline Plus discusses why propranolol is prescribed, precautions, and its side effects.

Zara Stone’s Ozy article claims that:

“Public speaking tops the most-feared list for many in America, affecting 26 percent, according to a 2018 Chapman University survey — that’s higher than the fear of flying, clowns and animals combined.”

But if you look at the Chapman article listing the fears for 2018 (for which no link was provided in her article) you will find Corrupt government officials are ranked as  #1 (73.6%) while Public speaking is way down at #60 (26.2%).

She also discussed the Musicians Health Survey that according to her found:

“66 percent of classical musicians said beta blockers improved their performance”

But the survey really said that 72 percent tried them, while 6% tried but found them not effective. Of those 66%, 37% tried and found them very effective, and 29% tried and found them just somewhat effective.

That survey also compared effectiveness for fifteen different treatments in a chart that followed immediately after the one with the 66 percent improvement statistic. I replotted it above. Note that while 92 percent found beta blockers effective - almost exactly as many, 91 percent, found that just experience (desensitization) was effective.  

Back on October 25, 2017 there was another far less rosy article about Kick by Rebecca Robbins at STAT titled Anxious about a big speech? This startup wants to calm you down – with a cardiac drug you pop like a mint. Her article notes that other drugs now are prescribed for social anxiety disorder, not just to block adrenaline. Rebecca quotes Boston University psychologist Stefan Hoffman as bemoaning:

“Bringing up propranolol is resurrecting a dead body.” and “That’s a horrible idea. It’s a horrible idea.”

An earlier article from 2011 at the Consumer Reports web site titled How to treat stage fright quoted Franklin Schneier, M.D.:

“Taken an hour before a performance, beta-blockers will reliably decrease symptoms like a pounding heart and a trembling voice or hands…But a moderate level of anxiety energizes a performance, so beta-blockers may actually reduce performance quality in people who are not very anxious. Also, people often become psychologically dependent on them and feel they need them and feel they need one before every performance, rather than learning skills to manage their anxiety.”

At Slate on June 25, 2019 there was still another article by Shannon Palus with the cautionary title Beta blockers were a miracle cure for my stage fright (then they took over my life).

Yet another article by Daniel McGinn on August 4, 2017 in The Atlantic titled Can this drug cure performance anxiety? included a story about his having told a friend about beta blockers. That friend wanted to borrow some of his, but Daniel instead supplied him with some vitamin B12 pills. His friend then raved that the pills were magic - although they really just were a placebo.

On April 16, 2018 at his Public Words blog Nick Morgan posted about What to do about public speaking fear when nothing else works, and mentioned beta blockers.

The image of sliced bread came from Timdogrulez at Wikimedia Commons.