You can’t spell “Propranolol” without “LOL”

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My shoulders and rib cage tighten.
My breaths become shallow.
My mouth goes dry. 
My arms, hands, and legs shake.

Not only am I describing the minutes preceding a first date, but I’m also talking about what happens to my body when I’m playing a performance that makes me nervous. The symptoms I’ve listed are examples of psychological stress that manifests itself physiologically. The Fight-or-Flight Response, as it were.

Playing a brass instrument with shallow breaths and shaking limbs is…shall we say, not ideal.

And sometimes it isn’t the actual music at hand that makes me nervous. Rather, I get nervous about the prospect of being nervous. And then the symptoms settle in. And then I freak out about it. And then the symptoms get worse. And then I freak out some more. And then…

A faun pug with his tongue sticking out the left side of his mouth. There are two silver metal bowls to his right on top of a brown bowl mat, and a clear container of dog food to his left. He's sitting on a black and white tile kitchen.

The world of Performance Psychology has given us musicians a ceaseless variety of ways to deal with this stuff. As I’ve mentioned in previous articles, I greatly admire the work of Dr. Don Greene and Dr. Noa Kageyama. I also cannot overstate how helpful seeing a therapist has been for my career. (And my whole life in general.)

While I’m basically a worshipper of these resources, sometimes it feels as though I would be better able to execute their methods if I didn’t have such intense physiological battles.

There is an occassionally-controversial answer that I sometimes use for this: Beta Blockers. Medicine that reduces the amount adrenalin that reaches your heart, thereby mitigating Fight-or-Flight symptoms. To the best of my knowledge, the most common prescription beta blocker is called Propranolol (aka Inderal).

Before I go any further here, I need to give two disclaimers.

First, this article is not a scientific resource. Even thought my initials are “DR”, I am not qualified to give medical advice. Second, if you’re thinking about trying prescription beta blockers, do NOT swallow a single pill before seeing your doctor. This is heart medicine, and without his/her blessing, you won’t know if it could lead to unwanted side effects.

Right around the time when I graduated college, I recall a good deal of beta blocker stigma amongst professional musicians. For example, that taking beta blockers somehow made you weak, or that you were carrying out your passion insincerely.

Of course, this is ridiculous. Medical decisions are personal and should never be a source for shame or shaming. Ever. And any musician who has tried beta blockers will be the first to say that they don’t magically make you play any better than you do in the practice room.

Character attacks aside, there are a few understandable concerns associated with beta blockers.

While these aren’t mind-altering medications, they are used for mind-related reasons. (e.g. mitigating Fight-or-Flight symptoms) Truth be told, I’m not 100% comfortable with this, as I do wonder if this opens the door for some kind of drug dependency in the future. Again, I’m no doctor claiming this to be true; it’s merely suspicion. (Does anybody have data supporting or refuting this?)

Whether or not I’ve just started some #FakeNews, I will say that I’m glad I waited until age 25 to try beta blockers. Allowing myself to be nervous throughout my years in college and training orchestras made me a more tenacious performer.

I learned what performance anxiety feels like in its rawest forms. I experienced what it means to power through treacherous moments. It motivated me to be more thorough in my practice sessions. And it made me more empathetic to other people who go through live performances of any kind, from wedding toasts to political speeches.

I’m grateful for these things, because beta blockers only lower the physical symptoms. They don’t get rid of nerves altogether.

So, what’s my objective here?

First, it’s to contribute to the reduction of stigma, as I’m so fond of doing. I’m all about going into “TMI Territory” if it means that even just one person can be lifted out of feelings of shame.

Second, it’s to make clear that while I use beta blockers, they aren’t some mystical solution to all of life’s problems. I’m not interested in persuading people to start using them, and I certainly don’t chastise those of us who already do.

Third, it’s to share that photo of my dog, who is just too darn cute.

In all seriousness though, if you feel I’ve left anything out of the equation, please feel free to leave a comment below. As always.

In the meantime, I wish you full breaths and stoic limbs.

***Addendum***

I regrettably have omitted something very pertinent and quite prolific.

There is a wonderful new documentary that explores performance anxiety and how musicians manage. It’s called Composed, and it is a thoroughly comprehensive investigation into this topic. We are so fortunate to have this resource…check it out!

About Doug Rosenthal

No one told Douglas Rosenthal to give up playing music. Not even his patient siblings, who endured many early-morning practice sessions; even they encouraged their brother to follow his passion. As the years passed, that passion evolved from simply playing music to advocating for music, musicians, and music-lovers. Douglas is based in Washington, DC. He is the Assistant Principal Trombonist of the Kennedy Center Opera House Orchestra/Washington National Opera Orchestra. He currently makes his home on Capitol Hill in DC with a pug named Jake, who serves as a constant reminder to relax, eat well, and sleep plentifully.

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7 thoughts on “You can’t spell “Propranolol” without “LOL”

  1. I love this post. Performance anxiety is something that I think of as a common part of the human experience, and it’s great that you are working to shift the stigma around it. The documentary looks fantastic. Love you!

  2. Re: your worries about drug dependency…there’s no medical evidence that propranolol can be addictive…especially because it’s not psychoactive at all (like Ativan, Xanax, Buspar from the earlier comment!) So even if you were to take propranolol every day for 10 years and suddenly stop it, you still wouldn’t be “addicted” to it. That being said, I do think some musicians become “dependent” on it primarily because of the effect of thinking “I really NEED this in order to perform at all!” But that would be the kind of thing that could be overcome with therapy and having successful experiences with performing without it. Anyway, just wanted to address your comment about dependence…but also yay propranolol! 😀 Yay pugs!

  3. I’m surprised that beta blockers are used to help with performance anxiety. Years ago when I was dealing with some anxiety, my doctor prescribed Buspirone or Buspar. It’s a milder med than Xanax and doesn’t cause drowsiness. It also is not as addictive. I took it for a year or two to get me through the anxiety. Have musicians researched other options I wonder?

    • I’m not sure, beta blockers are the only medication I’ve tried. For me, I’d be hesitant to go onstage with anything that is directly mind-altering. But that’s just for me personally, I know everybody’s different.

  4. There’s a film that people may find helpful as well called COMPOSED that talks about beta blockers and features Dr. Noa Kageyama. Classical musicians from all over the country talk about stage fright, the music culture, education, and how to start addressing these challenges. It’s out now and even has a short clip of Doug!

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