A Cure for Stage Fright? Can Blood Pressure Medication Help or Hurt?

In honor of #ResearchTuesday, I have chosen to blog about a study I was given to peruse this past week about a double-blind controlled trial about how stage fright affects the voice. Stage fright is an issue for many performers and public speakers, and has varying degrees of intensity. The study wanted to explore quantifying these effects of stage fright stress on the human voice.

In previous studies, fundamental frequency (your voice’s pitch) is the constant here, as it is documented to increase with stress. Conflicting evidence on vocal intensity (loudness) and speaking rate exists, so I guess for some individuals experiencing stage fright, you might get louder with a faster rate of speech or quieter and slower….or a combination….My mind begins to wander back to middle school presentations I had to give. I stood there at the front of the class, shaking and flushed in the face. I can’t remember what my voice did, so I’m was interested in the outcome of this study.

Some folks don’t like the shaky, sweaty palms, nausea or diarrhea that stage fright brings upon a person…I wonder why? So, they take beta-adrenergic blockers. This is your basic medication to lower the blood pressure by blocking adrenaline and slowing the heart beat, but side effects are a danger.

So this study took individuals and induced stress upon them by putting them in a room with 200 IEP goals to formulate in 1 hour’s time. No, I’m kidding. They used cold pressor testing, then gave one group a placebo and one group medication and tested Fo (fundamental frequency), voice onset time, speaking rate, jitter (cycle-to-cycle differences in frequency or pitch), shimmer (cycle-to-cycle differences in amplitude or loudness), and a few other measures. Cold pressor testing is your hand in ice water for one whole minute (aka how one tries to prepare for the pain of child labor…ha. Just keep breathing and imaging yourself on a sunny beach…)

Findings were an increase in blood pressure more in female participants than in male, but both the placebo group and the medication group showed an increase. Jitter increased following medication for stage fright, and speaking rate increased with no medication following the cold water test. I am pretty sure I would have the same reaction if you made me hold my hand in an ice cold glass of water. “Please let me take my hand out now thank you very much yadayadayada…..” It would be like truth serum.

It was interesting to me that the researchers hypothesized that the voice parameters measured would all increase in a person with stage fright. They thought the changes in the lungs from the body’s reaction to the cold water test would increase the airflow in the throat and therefore increase the vocal fold vibratory speed (making the person’s pitch increase). They found that without medication to combat the stress, a person’s pitch increased.

Unfortunately, the only statistically significant finding from this study was that jitter increased after receiving medication for the stress. This means that there is no reason to pop some blood pressure meds before your huge opera debut or that presentation you have to give this week to keep your voice from going all wonky. In fact, this study actually suggests that professional voice users should avoid any medication of this type before singing or speaking because it might be counterproductive, as it increases the noise in your voice.

I guess we will all have to just rely on practice, practice and more practice to keep the “jitters” away during any performance or speaking engagement. Fake it ’till you make it, and by then you will have performed so many times, the stage fright should only come from a ghost light



Beta-Adrenergic Blockade and Voice: A Double-Blind, Placebo-Controlled Trial. Giddens, Cheryl L.; Baron, Kirk W.; Clark, Keith F.; Warde, William D. Journal of Voice , Volume 24 , Issue 4 , 477 – 489.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.


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