Is Public Speaking Fear an Anxiety Disorder?

Does public speaking make you nervous?

If so, you’re not alone. According to the National Comorbidity Survey (a large-scale epidiemiological study), public speaking is the most common fear, with 30.2% of people having experienced it over the course of their lives. In fact, when psychology researchers want to invoke stress and anxiety in their research subjects, they often assign them the task of impromptu speaking in front of strangers.

So, public speaking fear (also known as 'stagefright')  is really common. Which begs the question...

Is public speaking an anxiety disorder?

Technically speaking, yes. According to DSM-V (the “bible” of psychiatric diagnosis), it is a type of phobia. Which means it is a mental health condition and can be treated as such. Practically speaking, this means that many insurance plans (though not all of them) will cover treatment for public speaking fear. Research has shown cognitive-behavioral therapy (CBT) to be a highly effective method for treating it.

HOWEVER, stagefright alone doesn’t necessarily require CBT. There other ways to work with it as well, many of which incorporate cognitive-behavioral principles. To name a few:

  • Toastmasters. This is a great organization that is geared toward training and skills development, rather than just anxiety. (I’ve written about my experiences with them here)

  • Improv classes. These are not about public speaking per se. But they certainly do force you to confront your stagefright.

  • Virtual reality. VR is used in the treatment of various anxiety disorders (such as PTSD).  There is a Dutch program called Talk to Me that is currently in development, but it’s not clear whether it’s been made available to the public yet.

For many people, these other methods alone can be helpful enough. In fact, because interactive methods like Toastmasters require real actual practice in front of real live audiences, they could even be more effective than one-on-one CBT.

When is therapy necessary for public speaking?

Even though public speaking fear can be resolved a number of ways, it can lead to or indicate other anxiety problems that call for expert care.

You should probably consult a therapist if:

  • you have panic attacks during or after public speaking. In fact, many people report having had their first panic attack during a public speaking event. When this kicks off recurrent panic attacks, or if it leads to a persistent pattern of situational avoidance, it is known as panic disorder. It highly treatable through CBT, and well worth seeking treatment for.

  • your anxiety is not limited to public speaking alone, but rather, extends to other social or workplace situations. This could be indicative of social anxiety disorder, which involves persistent anxiety across different social situations.

  • you have symptoms of depression. Panic disorder and social anxiety disorder often lead people to restrict their lives. Less socializing, less healthy risk-taking, and less activity can all lead to depression.

  • you need alcohol or other medications to get through a talk. People sometimes cope with public speaking anxiety by drinking, or by taking prescription medications (such as Klonopin or propanolol). If you want to come off of these meds, it's best to consult with your prescribing physician before doing so.

In my opinion, the real shame of this problem is that public speaking can be one of the most enjoyable and potentially rewarding experiences possible--if you can push through the jitters. Which, of course, you can. You just have to take action.