Performance anxiety impacts the lives of many—not just professional athletes or performers. Often associated with “stage fright,” performance anxiety falls under the broader category of anxiety disorders, alongside conditions such as social anxiety (Cleveland Clinic). While it is commonly discussed in the context of sports, music, or public performance, performance anxiety can arise in everyday situations that involve pressure, evaluation, or the fear of failure.
For example, a student unexpectedly called on in class, a professional presenting a proposal at work, or someone taking an important exam may experience the same fear, dread, and physical symptoms that a performer feels before stepping onto a stage. Performance anxiety is ultimately less about the activity itself and more about the perceived stakes and the pressure to succeed.
What Causes Performance Anxiety?
Performance anxiety often emerges when an individual feels intense pressure to perform well or meet high expectations. Situations such as trying to ace an exam, pass a road test, make a strong first impression, land a new job, or compete in a championship can all trigger this response.
While a certain level of anxiety is both normal and adaptive, performance anxiety occurs when that stress response becomes overwhelming. In these moments, the body may enter a heightened fight-or-flight state. This response is driven by the sympathetic nervous system, which prepares the body to respond to perceived threats (Cleveland Clinic). When activated excessively, it can disrupt the body’s sense of balance and lead to intensified physical and emotional reactions—even when no real danger is present.
Signs and Symptoms of Performance Anxiety
It is completely normal to feel nervous before an important event. However, performance anxiety typically goes beyond ordinary jitters and may interfere with functioning or well-being.
Common signs of performance anxiety may include:
Physical symptoms
- Rapid heart rate
- Sweating or clamminess
- Shaking or trembling (voice, hands, or legs)
- Muscle tension or shivering
- Shortness of breath
- Nausea, stomach discomfort, or dry mouth
- Feeling cold or lightheaded
Cognitive and emotional symptoms
- Racing or intrusive thoughts
- Fear of failure or judgment
- Difficulty concentrating
- Feelings of dread, overwhelm, or panic
When these symptoms persist or significantly impact your ability to cope with stress or perform daily tasks, it may be a sign of performance anxiety. Paying attention to how your mind and body respond to stress—and reaching out for support when needed—can be an important first step toward relief.
Performance Anxiety on the World Stage: Simone Biles’ Story
One of the most visible examples of performance anxiety occurred on the world stage during the 2021 Olympic Games, when Simone Biles, one of the most accomplished gymnasts in history, withdrew from several events, including the women’s all around final, to prioritize her mental health.
Biles reported experiencing the “twisties,” a condition that disrupts spatial awareness and body control and can be extremely dangerous for gymnasts. Her decision sparked widespread discussion and controversy, but it also highlighted an essential truth: anxiety can manifest physically, and ignoring mental health concerns can place individuals at serious risk.
Biles later explained, “We have to protect our body and our mind… Whenever you get in a high-stress situation, you kind of freak out.” Her choice to step back underscored the importance of listening to one’s body and prioritizing well-being over external expectations. Since then, Biles has become a powerful advocate for mental health and has openly discussed the role therapy played in her return to elite competition, including her success at the 2024 Olympic Games in Paris.
Treatment and Interventions for Performance Anxiety
Performance anxiety is not limited to elite athletes—it can affect anyone, regardless of profession or experience level. Whether it shows up during public speaking, academic testing, or athletic competition, performance anxiety can feel deeply limiting. Fortunately, effective treatments are available.
Outside of therapy, strategies such as regular exercise, breathing techniques, grounding practices, and self-soothing exercises (such as butterfly hugs) can help regulate the nervous system. When these strategies are not enough, working with a mental health professional can be highly beneficial.
Evidence-based therapies shown to help with performance anxiety include:
- Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge unhelpful thought patterns, gradually face feared situations, and reduce avoidance behaviors through structured exposure and skill-building.
- Acceptance and Commitment Therapy (ACT): ACT focuses on accepting uncomfortable internal experiences while learning to act in alignment with personal values, rather than allowing anxiety to dictate behavior.
Mindfulness practices, visualization techniques, and breathwork are also commonly integrated into treatment and have been shown to reduce anxiety and improve performance over time.
Moving Forward
Performance anxiety can affect people in many different ways and at different stages of life. While some individuals are able to manage symptoms independently, many find that professional psychological care offers meaningful and lasting relief. Therapy can provide tools to better understand anxiety, strengthen emotional regulation, and rebuild confidence in high-pressure situations.
Even the world’s most accomplished athletes have shown us that seeking support is not a weakness—it is a powerful step toward growth, resilience, and authenticity. If performance anxiety is interfering with your daily life or goals, help is available, and recovery is absolutely possible.
If you are or someone you know is struggling with mental health concerns, contact us to connect with one of our therapists who can help you on your wellness journey.