One of my patients was a 42 year old successful software salesman in Washington D.C. He made a substantial six figure salary. He experienced public speaking anxiety. The first component of his treatment included education regarding the “physiology of performance”, which in essence, is an individual’s flow of adrenaline in a challenging or stressful situation. This is a component of the fight-flight response.

Many people have “autonomic hypersensitivity” which means their nervous system can be over-reactive; especially in a stressful situation. These individuals are susceptible to a dramatic surge or spike of adrenaline discharge.

This high achieving patient, before participating in treatment, thought that his spikes of adrenaline represented “a character disorder”.

This thinking led to substantial confusion, increased anxiety, moderate depression, and was a component in his overly enthusiastic relationship with alcohol.

The confusion regarding adrenaline discharge/ autonomic hypersensitivity and self- beliefs like “character disorder” or “personality flaw” impact countless numbers of individuals of all ages. Feelings of embarrassment and shame, coupled with confusion, often result in despair, hopelessness, and inaction.

Countless numbers of intelligent, high achieving, high-functioning individuals are obsessively driven to perfection. They have no tolerance, patience, or understanding of the adrenaline discharge that appears to be involuntary. This attitude makes the problem worse!

God forbid the person is noticeably nervous!

A patient in Boston, who worked in corporate middle management, took beta blockers before attending her toastmasters meetings. What was she accomplishing? An investment in image sickness perhaps.

The fear of being noticeably nervous can wreak havoc as the person puts his/her self-esteem on the line!

Another patient was a chief financial officer of a midwestern corporation. She was an obsessively driven career woman who “did not have the word can’t in her vocabulary”. One day she had to leave a business meeting because of a panic attack characterized by symptoms of blushing and sweating. From that moment on her anticipatory anxiety was over the top causing a substantial case of “burnout”. She expressed to me “there is no reason for this”. Indeed, the best of intention but a ton of confusion.

These cases are representative of an epidemic of performance anxiety which for the most part has rendered the psychotherapy and medical professions helpless. So many sufferers are locked into a mode of a lack of self acceptance they never seek real help. Many become the targets of clinically unproductive and damaging pharmaceutical use!

“Performance anxiety” is certainly resolvable. The characteristics you need to achieve a resolution are: “initiative”, motivation to change, willingness to be educated, expressive ability, and a developmental readiness to face fear.

I have “performed” on over 1500 shows; from “Oprah” to “Opie and Anthony”. Believe me; I have encountered my own stress and anxiety and turned these dynamics into productive energy. I can teach this process to you!!

For the person with these characteristics a resolution can be accomplished via the telephone.

jonathan berent, L.C.S.W.