performance anxietyAlthough I have given thousands of presentations to professional audiences over the course of my career, when I was beginning that career I had severe dread of presenting. I would hardly sleep the night before a presentation and was visibly trembling as I went on to the stage (at least that’s how I saw it). Thinking back on that time it is remarkable how much I worried about appearing to be anxious and how much effort I put into trying not to show that anxiety.

I was reminded of this today as I prepared a talk about anxiety for the UCSF residents in psychiatry and found an intriguing study about this tendency to feel anxious about tests and performances that suggested that the tendency itself was associated with either improved performance or worsened performance depending on how one looked at it.

The study showed that if you understood that state of increased energy to be excitement rather than something shameful and had a realistic sense that it could be useful (allowing you to be more alert) then that trait was associated with improved performance on tests and in other situations.

But, on the other hand, if you worried about it and felt the need to hide it or get rid of it, it was associated with worsened performance.

The vivid illustration of the value of that energy or excitement or anxiety before a talk that still comes clearly to mind was the morning, many years ago, when I gave a talk to the California Association of Family Physicians. For whatever reason, it was a beautiful day and I had a nice run first thing in the morning, I remembered having absolutely no anxiety about the talk. I stood up, gave my talk and had no anxiety during the talk either.

I sat down and thought to myself, if only I could have this experience every time I give a presentation.

The surprising result, though, was that I got very poor reviews for that talk. People said that they thought I was a “flat speaker” and I “seemed uninterested in the talk.”

On my own, then, I conceived of the value of anxiety and came up with an image in my mind for that moment right before a talk: I imagined myself at the top of a roller coaster looking down with that wonderful mixture of terror and eager anticipation for the thrills to come. Over the years, I found that idea of grabbing hold of the experience of excitement and anxiety to be a useful one and to help me use this state of mind for good.