February 3, 2026
Learn evidence-based strategies for managing performance nerves and when to seek professional help.
Performance nerves—often called stage fright or performance anxiety—describe the physical sensations, racing thoughts, and emotional unease people feel before or during public performance, presentations, auditions, competitions, or intimate interpersonal moments.
These experiences range from mild butterflies and focused energy to overwhelming panic that interferes with memory, voice, coordination, or the ability to engage. Recognizing that nervousness is a normal human response helps reduce shame and opens the door to practical management.
The body interprets evaluative situations as potentially threatening and activates the sympathetic nervous system. Adrenaline increases heart rate, respiration, and muscle tension, while cortisol can affect concentration and memory retrieval—changes that feel like “nerves” onstage.
Cognitive patterns—worry about judgment, perfectionistic standards, and catastrophic predictions—amplify physiological arousal. Attention shifts from the present moment to self-monitoring, which can disrupt automatic skills that were otherwise well-rehearsed.
For many people, nerves are manageable with preparation and techniques. For others, performance anxiety becomes persistent, disproportionate, or disabling. It can co-occur with or be intensified by mental health conditions.
Generalized or social anxiety can make evaluative situations trigger intense fear; our anxiety specialists work with people to reduce avoidance and build coping skills.
Major depression can lower energy, motivation, and cognitive flexibility, making preparation and concentration harder; our team treats depression alongside performance-related concerns.
Attention differences such as ADHD can affect practice habits, working memory, and sustained attention during performance; targeted strategies improve focus and task structure.
For performers with intrusive thoughts about mistakes, contamination, or checking behaviors, OCD may fuel avoidance or rituals that interfere with performance.
Past trauma or hyperarousal from PTSD can make high-stakes situations feel unsafe; trauma-informed approaches are essential.
Other conditions—bipolar disorder, eating disorders, and substance use—can all shape how nerves appear and how best to treat them.
Cognitive-behavioral therapy helps people identify unhelpful thoughts (e.g., “If I make a mistake I’ll be ruined”) and replace them with realistic appraisals. Behavioral experiments and graded exposure to performance situations reduce avoidance and build confidence.
For many performers, targeted work with a clinician—through psychotherapy—addresses core beliefs and creates a structured plan for practice and exposure.
Breathing exercises such as diaphragmatic breathing and tactical breath-counting reduce autonomic arousal. Progressive muscle relaxation and grounding exercises help regulate tension. Attention-training (mindfulness, present-focused cues) shifts focus from threat to sensory details, which supports flow states.
Deliberate practice with simulated performance conditions—audience exposure, timed runs, dress rehearsals, and recording—desensitizes the nervous system to evaluation. Skills training focuses on chunking, cueing, and retrieval under pressure.
For some people, short-term or ongoing medication can support symptom reduction when combined with psychotherapy. Our clinicians offer evidence-based medication management for anxiety, depression, OCD, and mood disorders to stabilize symptoms and enable effective therapy.
Preparation reduces uncertainty and builds mastery—both antidotes to nerves. Practical steps include:
These habits are especially helpful when combined with skills taught in therapy—cognitive restructuring, graded exposure, and emotion regulation techniques.
When performance nerves occur alongside conditions such as ADHD, depression, OCD, or PTSD, tailored interventions help. For example, ADHD strategies emphasize structure and external cues; OCD treatment focuses on reducing safety behaviors; trauma work targets hypervigilance and triggers.
Eating disorders and bipolar disorder may require integrated medical and psychiatric care; our multidisciplinary approach coordinates between therapists, prescribers, and other providers to prioritize safety and performance goals. Learn more about specialized care for eating disorders and bipolar disorder.
Consider reaching out if performance nerves cause avoidance, frequent panic, or interfere with work, school, or relationships. If symptoms co-occur with persistent low mood, intrusive thoughts, or trauma symptoms, coordinated clinical care is recommended.
Our team blends psychotherapy, skills-based coaching, and medication when appropriate. Find out more about what we offer on our psychotherapy and medication management pages, or contact us directly through our contact page.
At Integrative Psych we take a collaborative, evidence-informed approach. We assess how performance nerves interact with mood, attention, trauma history, or compulsive behaviors, then create a personalized plan emphasizing skills practice, exposure, and any needed medical supports.
Clinicians provide brief interventions for acute performance needs (e.g., auditions) and longer-term treatment for underlying conditions. We specialize in anxiety, OCD, anxiety, depression, ADHD, trauma-related disorders, and more. Learn about our team and philosophy on our about page.
Integrative Psych is a premier practice offering evidence-based psychotherapy and medication management in Chelsea, New York City, and Miami. We support performers, students, professionals, and anyone struggling with performance nerves through compassionate, individualized care. To schedule an appointment or ask about services in Chelsea or Miami, visit our contact page or learn more about our approach.
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