Performance anxiety has become more and more common in medical practices in the past years.

What is performance anxiety?

Performance anxiety is, first of all, an anxiety for failing in a situation where you will be judged, for example, in an exam. Linked to this anxiety is almost always some form of avoiding behavior of such situations.

What therapy or approach cures performance anxiety?

Several forms of psychotherapy score well, providing that the patient does not quit before results are visible, and that the fear of fear which I described in another article is treated, too.

Short solution focused therapy for performance anxiety

The advantage of short solution focused therapy for performance anxiety, is that it is quick, elegant, and hardly confronting for the already tired and anxious patient. The most important advantage is that this type of therapy quickly increases the self-confidence of the anxious person in that they can solve heir own problems. The patient becomes away of which solutions they already are able to use in difficult moments, with the help of the solution focused questions of the treating doctor or therapist. This way, the confidence in own possibilities and solutions grows step by step.

Cognitive behavioral therapy (CBT) for performance anxiety

Cognitive behavioral therapy, too, has proven itself very efficient when dealing with performance anxiety. The therapist will help the client to discover which negative thoughts go through their mind just before the anxiety occurs. Together they will analyze these negative thoughts, and while doing so the anxious person will learn how to recognize and 'defuse' negative thoughts. Because this form of therapy is the oldest, working one, there are many studies which show its effects. The only disadvantage is that the finding of the negative thoughts can be confronting, meaning people stop going to therapy or even stay away from the consultations. For people who are scared of this confrontation, solution focused cognitive therapy, for example, can be a better way to go.

Rational emotive therapy (RET or REBT) by Albert Ellis for performance anxiety

RET was developed by the impressive New York therapist Albert Allis and has the same principles as CBT. They are likely to have a similar efficiency, while the prior school of therapy has invested more in research to make sure of this. Albert Ellis did this himself in a dramatically confronting manner, but with such amounts of love for his patient and his wonderful humor, that the person felt understood and got better. I have had the pleasure to meet Albert several times and see his work before his death several years ago, and I was impressed each time by his authentic, special working style!

EMDR therapy for performance anxiety

EMDR offers a completely different approach in the healing of performance anxiety, but is very efficient. The therapist will make you think of the places and situations in which you suffer from it, and will ask you to move your eyes back and forth during this visualisation. For reasons which are too complex to explain here, the anxiety slowly decreases until it becomes nearly impossible to feel it again.

Hypnosis therapy for performance anxiety

Medical hypnosis is another alternative for healing performance anxiety. It is very efficient in acute circumstances, for example if you have a seminar the next day where thousands of people will be listening. Hypnosis can offer a quick solution in such cases. The direct effect of a hypnotic session will last for about 48 hours. If you want to get rid of it in a long-term way, then  you will need several sessions to re-program the links and associations in your brain more thoroughly. Of course, you can also learn self-hypnotic exercises to complement your therapy.

Self-hypnosis for performance anxiety

The advantage of learing self-hypnosis exercises is that these self-hypnotic techniques will put you in control over yourself and your performance anxiety. During difficult moments, you will be able to take control.

Online Internet therapy for performance anxiety

Europe is a bit behind when compared to the United States when it comes to online internet therapy. You can sign up at an online internet therapy program which consists of daily self-help with weekly guidance by a therapist. A good program integrates the best elements from the different types of therapies, which were mentioned above.

Self-help for performance anxiety

And if you are motivated enough to help yourself, with proper guidance, then it is best to start a good online self-help program. If necessary, you can add additional guidance in case you find this necessary. Sometimes it is good to try to help yourself, first. What you need then, is a good system which contains knowledge of the best-used therapeutic concepts.

Self-test for performance anxiety

Would you like to know to what extent stress, tension, anxiety, or even depressed feelings play a role in your performance anxiety? Then easily test this by answering a short test with 21 questions.

Paul Koeck, MD