Takeaway
Performance anxiety is common, and healthcare providers are sometimes the first people patients turn to for help. Clinicians can normalize it, offer coping strategies, and refer when appropriate to reduce distress and improve well-being.
Lifelong Learning in Clinical Excellence | October 9, 2025 | 2 min read
By Sarah Radtke, PhD, Johns Hopkins Medicine
Comedian Jerry Seinfeld has famously joked: “According to most studies, people’s number one fear is public speaking. Number two is death . . . this means that at a funeral, many would rather be in the casket than giving the eulogy.”
Although dark, his joke is correct regarding the prevalence of performance anxiety. Because of this, primary care doctors and other healthcare professionals are likely to encounter patients asking for support. In many instances, providers may be the first person the patient has discussed their experiences and anxieties with.
Here are a few tips for talking with patients about performance anxiety:
1. Normalize and validate.
As noted above, this is a common concern! Providers don’t need to “fix” their patient’s anxiety in the moment. Being a validating, nonjudgemental listener can increase patients’ openness to further support.
2. Differentiate helpful versus unhelpful anxiety.
Anxiety isn’t inherently “bad,” and mild anxiety can sharpen focus, energy, and motivation. On the other hand, overwhelming anxiety can interfere with functioning and warrants support. Ask when and where the patient’s anxiety occurs (“When do you notice the anxiety?”), does it impact participation or cause significant distress (“How does it affect your daily life?”), and is it a part of a broader pattern of generalized or social anxiety (“Do you notice yourself feeling similarly in other situations?”).
3. Provide initial coping tools.
1) Slow belly breathing and grounding techniques that involve focusing on the senses are strategies that reduce physiological arousal. 2) Encourage patients to notice unhelpful thoughts (“I’m going to mess up and everyone will laugh”) and replace them with more neutral and realistic ones (“I’m comfortable with the presentation topic and have practiced a lot”). 3) Gradual, repeated practice in low-stakes settings can help patients build tolerance and confidence.
4. Consider the whole patient.
Sleep, nutrition, and physical activity all affect stress resilience. Encourage balanced schedules that allow for downtime and relaxation.
5. Identify when to refer.
Referrals to mental health services are warranted when the anxiety is persistent and impairing (e.g., significant distress, panic attacks, refusal to perform at school or work). Psychologists or therapists trained in Cognitive Behavioral Therapy can support the development of effective coping strategies and provide structured, gradual exposure.
5. Educate regarding medications.
Some patients may ask about medications (e.g., beta-blockers) to reduce their anxiety. While these medications can reduce the physical symptoms of anxiety (such as rapid heartbeat or trembling), they don’t address the underlying thoughts or avoidance behaviors. Providers should counsel patients that these medications may be helpful for situational use, but they are not a long-term solution.
Finally, for children and adolescents the above steps apply. However, young children may show anxiety through somatic complaints (e.g., stomachaches the morning of an oral presentation) rather than verbalizing their anxiety. It’s important to involve parents as well. Encourage them to be supportive without pressuring. Emphasize the importance of modeling calm coping strategies and not rescuing their child from anxiety-provoking situations (which can reinforce avoidance).
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.