Well today I thought I’d dive in and find out about arguably performing artists’ most common performance enhancing drug, Beta-blockers (often prescribed as propranolol). In studies of professional orchestral musicians beta blockers have a reported use rate of between 20-37% but more disturbingly, up to 70% sourced their beta blockers from a friend or family member rather than a medical practitioner.

In fact, in researching this podcast I found that beta blockers are used commonly by actors, dancers, public speakers, courtroom lawyers, surgeons and in golf, archery, snooker and shooting. Although if you want to keep your Olympic medal then it’s a no no. In 2008 Kim Jong-su lost both Bronze and Silver Shooting medals because of a positive test for beta blockers.

Today’s episode is not about passing judgement on whether using beta blockers to manage anxiety is advisable or not. It simply occurred to me, that given their pervasive use in the performing arts, as teachers we should understand a bit more about them.

So what are Beta-Blockers used for medically? 

Without getting overly technical, beta blockers are most commonly used to treat heart conditions, during heart surgery and can be prescribed for anxiety although this use is currently not approved by the FDA. Having said this, 25 years of studies indicates that they can help to reduce anxiety.

So how do beta blockers work? 

They lower the heart rate and reduce the pounding that many feel prior to performance. They also reduce tremors and sweaty palms. In essence stunting the effects of the fight of flight response triggered by performing in front of others. In their favour, beta blockers (propranolol) are short acting, non addictive and are clear of the blood stream within 12 hours.

I have personal experience of beta blockers being medically helpful as my daughter was prescribed propanolol for a medical condition (not anxiety) when she was seven years old and it assisted with remediating her issues without complications. 

However, as with all medications there can be side effects.

Side effects can include lethargy (not so good for strong performance), insufficient blood flow to the extremities (again not so good if your performance requires manual dexterity in the fingers) and dry mouth which isn’t so good for woodwind players, singers or actors. 

As the drug crosses the membrane into the brain, beta blockers can react with the central nervous system to produce light headedness, depression, visual disturbances, catatonia, hallucinations, vivid dreams, disorientation, emotional lability and mild confusion. None of which sound particularly conducive to strong performance. The list continues with potential gastrointestinal and respiratory complications which serve to remind us that any medication should be prescribed by your doctor. 

So why do so many performing artists take them. 

I encountered a number of newspaper articles in which performers glowingly described beta blockers as “a valuable tool, I wouldn’t hesitate to recommend them to anyone” ; “After the first time I tried it, I never looked back,”; “It’s fabulous to feel normal for a performance”; and “Before propranolol, I saw a lot of musicians using alcohol or Valium”.

Beta blockers reduce the physical manifestations of performance anxiety, which for some takes enough of the edge of their performance anxiety that they find them helpful. 

So should we be advising our anxious students see a doctor to get a script? 

Well thankfully that is your decision and not a blanket choice that anyone can make for you but before we finish there are a couple of things to note.

Beta blockers do not reduce the mental struggle many performers experience when trying to produce their best work in the spotlight. They will not stop overthinking nor will they help with intrusive thoughts such as those voiced by the performer’s inner critic and for many students it is these issues that are more debilitating. 

Students do not have the experience gained by professional performers of getting up and successfully performing time and time again. This leaves them arguably more full of self-doubt in their own expertise than a professional performer who is seeking to ease the physical manifestations of their anxiety.   

Use of beta blockers for exams as an indicator of mental health risk

I thought it worth mentioning that I found a 2017 study looking at use of beta blockers in adolescents for exam stress. The sample size for this study was robust with over 24,000 subjects and their conclusion is worth noting. 

“In healthy students, use of beta-blockers during the exam period was associated with an increased risk of psychiatric outcomes and might identify psychologically vulnerable students who need special attention.” 

So perhaps we should have our mental health antenna’s raised when interacting with students who might be seeking pharmaceutical help to manage anxiety.

This is not to say yes or no to beta blockers, that is a decision that is yours alone and particular to the student. Hopefully this podcast gives you a little more insight into how they may or may not help. 

 

Butt, J. H., Dalsgaard, S., Torp-Pedersen, C., Køber, L., Gislason, G. H., Kruuse, C., & Fosbøl, E. L. (2017). Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity. Journal of Child and Adolescent Psychopharmacology, 27(3), 266–273. https://doi.org/10.1089/cap.2016.0079
Mixed reviews for a stage-fright remedy, (2004). New York Times
Moira Farr. (1999). High anxiety solution: Beta blockers, drugs designed for heart patients, are becoming the remedy of choice for people stricken with stage fright: National Edition. National Post (Toronto).
Patson, T., & Loughlan, T. (2014). Playing with performance: the use and abuse of beta-blockers in the performing arts. Victorian Journal of Music Education, 1, 3-10.

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