As Jason Smoller prepared to graduate college and embark on a career as a classical musician in 2008, the prospect of auditioning for gigs and performing for paying customers was one that caused no small amount of anxiety.
During his more important college performances, the oboist would sometimes suffer from a quickened heartbeat, sweaty palms, and shaky hands — an especially damaging symptom given the precision needed to play his woodwind instrument.
One of his teachers suggested a series of mental preparation exercises, but the techniques gave Smoller no relief.
It was then that the teacher advised him to see a doctor about beta blockers, a type of drug that quells the body's physical reactions to anxiety and is popular not only with musicians and high-performance athletes, but increasingly with business executives, as well.
The next time Smoller performed with his college concerto, the sweats and the panic were gone, and today, he takes a beta blocker about once or twice a month before a big performance. He estimates that about 20% of the people he performs with do so, too.
"The best way to describe it is it feels like nothing," Smoller said. "It's just me, the same me that might be at a bar with my friends, but I happen to be doing something that is a high-pressure thing like playing an important solo with an orchestra or auditioning for a job I really want."
Beta blockers work by blocking the effects of adrenaline, the hormone that is released during the fight-or-flight response triggered by high-pressure situations. Primarily used to treat heart diseases and high blood pressure, the drugs became popular with musicians after a 1977 study suggested they could improve performance and calm stage fright.
Since then, the drugs have gained traction with athletes (a North Korean pistol shooter was stripped of two medals after testing positive at the 2008 Olympics) and professionals looking to nail a public speaking gig or key presentation.
Dr. John Worthington, who has worked at The Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital for 23 years, says he has prescribed the medication to salespeople who often spend weeks preparing for one high-stakes meeting with a prospective customer.
In fact, he noted that at an American Cardiology Association conference he attended, 15% of the speakers said they used a beta blocker beforehand.
Worthington said that unlike the selective serotonin re-uptake inhibitors (SSRI) class of anti-depressants, beta blockers don't need to be taken every day to have an impact, meaning that patients can use them selectively 15 minutes to an hour before a big event.
The most commonly used beta blocker for these kinds of situations is propranolol, a drug marketed in the United States under the brand name Inderal.
When Worthington prescribes it, he says he always makes sure patients have practice using it prior to their big performance. Otherwise, they could experience unwanted side effects like extreme drowsiness, dizziness, and light-headedness.
He also said that people tend to have a wide range of reactions to the drugs, so it's important to discuss them with your doctor before asking for a prescription.
"If you have your biggest job interview ever with Google, I wouldn't recommend taking it for the first time that morning," Worthington said.
Dr. Binoy Singh, associate chief of cardiology at Lenox Hill Hospital in New York, is even more cautious. He says he doesn't prescribe the drug at all because there has not yet been a long-term, randomized clinical trial proving its effectiveness at resolving anxiety (the 1977 study included just 24 musicians over the course of one evening).
Instead, Singh said he prefers to prescribe benzodiazepines, which directly influence the way the brain perceives anxiety as opposed to the way beta blockers affect the body's physical reaction to a high-pressure situation.
Still, he notes, benzodiazepines like Xanax can alter muscle tone, reaction times, and balance, which could be problematic for people hoping to remain sharp while they are performing for an audience.
"Anxiety is in part learning to cope with stress, so coping methods don't necessarily require medications," Singh said. "What this requires is multiple interventions over time about how one perceives themself and what it is they're responding to when they feel stressed or anxious." Nonetheless, Smoller says he is pleased with the results he has gotten from his occasional dose of propranolol, even if he remains unsure whether they stem from a placebo effect.
Last year, he auditioned for the New York Philharmonic's English horn section at Lincoln Center. But instead of freaking out about being alone on a big stage in front of New York's top oboists, he instead remained confident and played at what he says is the highest level he was capable of at the time.
"Rather than my mind racing or thinking, 'Oh my god, I missed a note,' it was just like, 'Look, you're making this sound and you get to be in the moment and enjoy what you're doing,'" he said.
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