image An estimated 85% of Americans suffer from the fear of public speaking, a social phobia known as glossophobia. Characterized by an intense fear of social or performance situations, social phobias can physically manifest themselves through palpitations, tremors, sweating, ]]>diarrhea]]> , confusion, and blushing, according to the Anxiety Disorders Association of America (ADAA).

What Causes Performance Anxiety?

While researchers work at pinpointing the cause of public-speaking fear and other social phobias, some investigators suggest the trigger may be a small structure in the brain called the amygdala, which is the central site in the brain that controls fear responses.

The National Institute of Mental Health (NIMH) reports social phobias may also be inherited, with researchers recently identifying the site of a gene in mice which affects learned fearfulness. Scientists are also exploring a biochemical basis for the disorder, with the idea that heightened sensitivity to disapproval may be hormonally or physiologically based.

Social phobias may also be fueled by environmental factors. For instance, a fear of public speaking may be acquired from observing the fear in others, a process called observational learning or social modeling.


Classified by the American Psychiatric Association as the top social phobia in the United States, the fear of public speaking is being successfully treated by cognitive-behavior therapy.

During cognitive therapy, glossophobics gradually confront audiences under the supervision of a trained therapist. Instead of fleeing from their fear, individuals confront their anxiety with a goal of steadily reducing the dread they once felt.

Therapy may also include anxiety management techniques such as deep breathing; cognitive restructuring to help individuals develop more realistic expectations of public-speaking dangers; and group, couples, or family therapy.

Antidepressants—primarily selective serotonin reuptake inhibitors (SSRIs), and rarely monoamine oxidase inhibitors (MAOIs)—are also being used to treat the fear of public speaking. Doctors do not yet know whether the combination of cognitive therapy and drugs might lead to better outcomes than either treatment alone. However, the FDA now requires manufacturers of most SSRIs to warn doctors and patients about an apparent risk for suicide among depressed children and adolescents treated with these drugs. It is unknown whether SSRI treatment for anxiety disorders could also lead to increased suicidal risk.

Stage Fright Tips

Toastmasters International (whose members meet regularly to practice public speaking in a supportive environment) offers these ten tips for speaking success:

  • Know your material. Pick a topic you’re interested in, using personal stories and conversational language to minimize chances of forgetting your speech.
  • Practice beforehand by rehearsing out loud.
  • Know you audience. Begin by greeting people as they arrive.
  • Familiarize yourself with the room by arriving early; practice using the microphone and other visual aids.
  • Picture yourself giving your talk in a clear and confident voice and manner. Imagine the audience clapping and how their positive response will boost your confidence.
  • Realize everyone is rooting for you. Audiences want you to be interesting, entertaining, and informative.
  • Don’t apologize for problems or nervousness—which attendees likely don’t notice anyway.
  • Focus on your message and the audience, rather than your anxieties.
  • Gain experiences to further build your confidence.