Adult Performance or Speech Anxiety Treatment (Performance Anxiety)
MD-only evaluation and situational beta blocker treatment by secure online video visit, $49 flat-fee, no insurance required.
Performance or speech anxiety is a common form of situational anxiety where physical symptoms like fast heartbeat, shaky hands, sweating, trembling voice, and nausea surge before a specific event such as public speaking, interviews, presentations, auditions, or exams. Many adults do not need daily medication and instead benefit from a targeted approach focused on the body’s stress response. When clinically appropriate, a short-acting beta blocker such as propranolol can reduce physical symptoms without being a controlled substance. TeleDirectMD physicians screen for medical contraindications, review your health history and current medications, and provide evidence-informed dosing guidance and safety monitoring expectations.
- $49 flat-fee adult visit
- MD-only care (no mid-levels)
- No insurance required
- Secure video visits in 25+ states
Last reviewed on January 21, 2026 by Parth Bhavsar, MD
Online MD-Only Performance Anxiety Care
- Adults 18+ with event-triggered anxiety and physical symptoms
- Situational beta blocker options such as propranolol when appropriate
- Medication safety screening, interaction checks, and dosing guidance
- Clear triage for chest pain, fainting, severe mood symptoms, or asthma concerns
Adults 18+ only. No controlled substances are prescribed through TeleDirectMD. Chest pain, fainting, severe shortness of breath, severe depression, mania, or thoughts of self-harm requires urgent in-person or emergency evaluation.
What Is Performance or Speech Anxiety?
Performance anxiety is a situational anxiety response that appears before a specific task or audience-facing event. It can cause prominent physical symptoms driven by adrenaline, including palpitations, tremor, sweating, flushing, and voice quiver. Many adults feel confident outside of these situations and do not need daily anxiety medication.
TeleDirectMD focuses on adult-only evaluation to confirm that symptoms fit a situational pattern, screen for medical causes that can mimic anxiety, and provide targeted treatment options when telehealth is safe. If your symptoms suggest a heart condition, thyroid issue, panic disorder needing broader treatment, or a mood disorder such as mania, in-person evaluation may be required.
Symptoms and Red Flags
Performance anxiety usually causes symptoms that cluster around a specific event. Red flags suggest a medical emergency, an underlying medical condition, or a mental health crisis that needs in-person evaluation.
| Symptom or situation | What it suggests | Telehealth appropriate? | Red flag requiring urgent in-person care |
|---|---|---|---|
| Anxiety and physical symptoms only around a specific event | Situational performance anxiety | Yes, often appropriate | No |
| Fast heartbeat, tremor, sweating, shaky voice before speaking | Adrenaline-driven symptoms | Yes | No |
| Symptoms occur at rest with no trigger or wake you from sleep | Possible medical cause or panic disorder | Sometimes, depends on details | Urgent evaluation if severe, recurrent, or with fainting |
| Chest pain, pressure, or severe shortness of breath | Possible heart or lung emergency | No | Emergency evaluation |
| Fainting, near-fainting, or irregular heartbeat sensation | Possible arrhythmia or low blood pressure | No | Urgent evaluation |
| Unintentional weight loss, heat intolerance, persistent tremor | Possible hyperthyroidism | Telehealth may triage | Needs timely in-person evaluation and labs |
| Wheezing or history of asthma with frequent symptoms | Beta blockers may be unsafe | Telehealth may triage | Urgent care for severe asthma symptoms |
| Severe depression, mania, psychosis, or thoughts of self-harm | Mental health emergency | No | Emergency evaluation immediately |
Differential Diagnosis
Several conditions can mimic or worsen performance anxiety symptoms. TeleDirectMD evaluates whether symptoms are situational and safe for targeted treatment, or whether a broader medical or psychiatric evaluation is needed.
Situational Anxiety Patterns
- Performance or speech anxiety
- Panic attacks triggered by specific situations
- Social anxiety with event-specific physical symptoms
Medical Contributors Considered
- Hyperthyroidism
- Arrhythmia or inappropriate sinus tachycardia
- Medication or stimulant effects (caffeine, decongestants, ADHD stimulants)
- Alcohol withdrawal or substance-related symptoms
- Hypoglycemia in diabetes treatment
When Is a Video Visit Appropriate?
When a Video Visit Is Appropriate
- Adult 18+ with anxiety and physical symptoms tied to a specific performance event
- No chest pain, fainting, or severe shortness of breath
- No uncontrolled asthma or frequent wheezing
- No history of severe bradycardia, heart block, or very low blood pressure
- Not seeking a controlled substance
Red Flags Requiring In-Person or ER Care
- Chest pain, fainting, severe shortness of breath, or irregular heartbeat
- Severe depression, mania, psychosis, or thoughts of self-harm
- Persistent symptoms not linked to a specific trigger
- Severe wheezing or uncontrolled asthma
- Possible intoxication, withdrawal, or unsafe substance use
If any red-flag symptoms are present, seek urgent in-person or emergency care. TeleDirectMD is not an emergency service.
Treatment Options
Treatment depends on whether symptoms are primarily physical, primarily cognitive, or both. Many adults benefit from skills-based strategies and a targeted medication option used only before the event.
Non-Medication Strategies That Often Help
- Practice exposure, rehearsal, and structured preparation
- Breathing techniques to reduce hyperventilation and tremor
- Sleep optimization and hydration before the event
- Limit caffeine and decongestants on the day of speaking
- Brief, realistic self-talk and focus cues during performance
Situational Beta Blocker Option
- Propranolol can reduce physical symptoms like tremor, palpitations, and voice quiver for some adults.
- It does not treat all forms of anxiety and is not appropriate for everyone.
- TeleDirectMD screens for asthma, bradycardia, heart block, hypotension, certain heart failure histories, and medication interactions.
- A test dose on a non-performance day is often recommended to understand how your body responds.
Common Medications Used for Performance or Speech Anxiety
TeleDirectMD may prescribe a situational beta blocker for adults when clinically appropriate. The table below provides common examples and typical usage patterns.
| Medication | Dose | Duration | When it is used |
|---|---|---|---|
| Propranolol 10 mg tablet | 10 mg by mouth 30 to 60 minutes before performance as directed | Single-event use | Lower starting dose for adults who are sensitive to beta blockers or want minimal effect |
| Propranolol 20 mg tablet | 20 mg by mouth 30 to 60 minutes before performance as directed | Single-event use | Common dose range for tremor, palpitations, and shaky voice in performance settings when appropriate |
| Propranolol 40 mg tablet | 40 mg by mouth 30 to 60 minutes before performance as directed | Single-event use | Sometimes used for larger physical symptom burden if medically appropriate |
These are example regimens only. Beta blockers can lower heart rate and blood pressure and may worsen asthma or cause dizziness. TeleDirectMD does not prescribe controlled substances for anxiety. If you have chest pain, fainting, wheezing, or severe mood symptoms, seek urgent in-person care.
Home Care and What to Expect
- Consider a test dose on a day without a major performance so you can assess fatigue, dizziness, or low heart rate symptoms.
- Avoid alcohol as a coping strategy, and avoid combining beta blockers with unsafe substances.
- On the day of the event, prioritize hydration and light meals and limit excess caffeine.
- If you feel faint, develop wheezing, or have chest pain, seek urgent evaluation.
- If anxiety is frequent, generalized, or impairing across many settings, longer-term therapy options may be more appropriate than situational medication.
TeleDirectMD Telehealth Disclaimer
TeleDirectMD provides MD-only virtual care for adults using secure video visits to evaluate performance or speech anxiety and prescribe non-controlled options such as situational beta blockers when clinically appropriate. Visits are $49 flat-fee with no insurance required and are available in 25+ states. TeleDirectMD is not an emergency service and does not replace comprehensive mental health care when needed.
Adult Performance or Speech Anxiety FAQs
Can TeleDirectMD prescribe propranolol for performance anxiety?
Yes, for many adults 18+ when the pattern fits situational performance or speech anxiety and there are no medical contraindications. Your MD reviews symptoms, health history, asthma risk, heart rate and blood pressure history, and medication interactions.
How does propranolol help with performance anxiety?
Propranolol is a beta blocker that can reduce the body’s adrenaline-driven symptoms such as tremor, palpitations, sweating, and shaky voice for some people. It does not eliminate all anxiety thoughts for everyone.
When should I take propranolol for a speech or presentation?
A common approach is taking it 30 to 60 minutes before the event, based on your individualized plan. Many adults benefit from a test dose on a non-performance day first.
What dose is typical for situational use?
Many adults use a range such as 10 mg to 40 mg before an event, depending on symptom burden and tolerance. Your MD will select a dose based on your history and safety screening.
Who should not take propranolol?
It may be unsafe for some people with asthma or frequent wheezing, very slow heart rate, certain heart conduction problems, very low blood pressure, or certain heart failure histories. Your MD will screen for these factors.
What side effects should I watch for?
Possible side effects include dizziness, fatigue, lightheadedness, low heart rate, low blood pressure symptoms, and breathing symptoms in people with asthma. Seek urgent care for chest pain, fainting, or severe shortness of breath.
Will propranolol affect exercise or stamina?
It can blunt heart rate response and may reduce peak exercise performance for some people, especially if taken close to intense activity. A test dose can help you understand your response.
Is propranolol a controlled substance?
No. Propranolol is not a controlled substance. TeleDirectMD does not prescribe controlled substances for anxiety.
Can this help if I have anxiety every day?
Situational beta blockers are best for event-triggered physical symptoms. If anxiety is frequent, generalized, or impairing across many settings, a broader evaluation and longer-term treatment plan may be more appropriate.
What makes TeleDirectMD different for performance anxiety care?
TeleDirectMD provides MD-only video visits for adults with a $49 flat-fee model in 25+ states. We focus on safety screening, medication interactions, and clear guidance on situational beta blocker use when appropriate.
Have a big presentation coming up?
$49 flat fee. Adult-only video visits. MD-only care. Targeted, non-controlled options like propranolol when appropriate, with safety screening and clear dosing guidance.