What’s at the Root of Performance Anxiety?
How fear and anger become physical symptoms.
Updated April 16, 2025 | Reviewed by Abigail Fagan
By Julie Jaffee Nagel, Ph.D.
Many actors, politicians, athletes, public figures, and musicians suffer from performance anxiety also referred to as “ stage fright ”—Barbra Streisand, Beyonce, Adele, Emma Stone, David Beckham, Whoopi Goldberg, Oprah Winfrey, Thomas Jefferson, Warren Buffett, and Mahatma Gandhi, to name a few.
Those who are not famous struggle with performance anxiety too. These include business executives, writers, academics, lawyers, and even mental health professionals.
I struggled with stage fright as a student at Juilliard and suffered from self-doubt whenever I played piano in public. So I practiced harder. My mentors and teachers reassured me that I “should not worry”.
These reassurances did not help. I felt alone and confused. People did not want to talk about stage fright, acting as if it were contagious. I performed despite my anxiety, but the experience was exhausting, mystifying and unsettling.
Some Symptoms of Performance Anxiety
Today, performance anxiety is less stigmatized, but it continues to debilitate and demoralize many people. Performance anxiety has both physical and psychological symptoms such as
Fear Leads to "Fight or Flight"
When people are frightened and feel attacked, they try to defend themselves. Unfortunately, the fight can turn into an attack on the self. Forgetting what one knows, one believes the audience will not appreciate them or laugh at them.
Exemplifying flight, some performers procrastinate preparing to perform—and then say there was not enough time to get ready! Others stop performing altogether. How one approaches - or avoids a threat is important to understanding and managing performance anxiety. Psychoanalysts call defensive responses to anxiety “ego defenses” because the ego (or the self) is protecting itself from the perception of a dreaded disaster.
Lowering Your Anxiety
Cindy feared her audience would disapprove of her performances and frequently felt inhibited in expressing her musical ideas. She also suffered from cold hands. In therapy , she came to realize her fears and physical sensations had emotional significance in her life.
Her parents divorced when she was very young. Cindy could not understand her mother’s depression or her father’s disappearance. She assumed she played some role in their breakup and felt guilty and responsible.
Cindy felt her parents were aloof, non-responsive. They also had no idea of the impact their actions had on their daughter. She had been furious about her mother’s moods and her father’s absence but always tried to be a good and “perfect” daughter and performer to cover her anger .
Cindy used the following two ego defenses to protect herself from anxiety:
She denied her anger because she feared anger caused people to leave her.
She disconnected from her emotions, anger, and fear in particular, outside of the performance setting but became anxious when she was performing, fearing that an “imperfect” performance would cause an audience to disapprove of her.
As Cindy and I worked to understand the deeper roots of her cold hands, she discovered that her anxiety was a signal of an uncomfortable feeling, such as fear or anger. Once she realized this connection, Cindy could express herself through words and subsequently through her performances, which she anticipated with pleasure instead of dread and fear.
James became a cellist over the objections of his parents who believed musicians “wound up eating cat food in New York.” He persisted in his studies but developed a pain in his bow arm.
James sought the advice of many physicians who found nothing wrong physically. I posed the following question to him: “Let’s consider that the pain in your arm stems from some feelings inside you - inside your mind”. Although doubtful, he began to explore his emotional reactions as an important clue to his physical pain.
He came to understand how fear and anger informed his performance anxiety. He feared he would prove his parents right if he didn’t succeed. In fact, he was so angry at them for doubting his ability that he sometimes worried he would reach out his arm and hit them! Uncovering these feelings helped to eliminate his pain and enabled James to manage his performance anxiety.
How to Manage Performance Anxiety
Here are some important things to remember about performance anxiety:
Through therapy, Cindy and James learned to speak freely about their anger and fear. They began to understand that physical symptoms may stem from difficult-to-handle emotions. Once their emotions were expressed, the physical symptoms started to disappear.
About the Author: Julie Jaffee Nagel, Ph.D., has a private practice in Ann Arbor, Michigan, with a specialty in the management of performance anxiety.
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Kristen Beesley, Ph.D., a psychoanalyst in private practice in Detroit, is on faculty at the Michigan Psychoanalytic Institute.
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This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.