You’ve prepared. You know the material. But the moment you step up to present, interview, or perform, something takes over. Your heart races, your thoughts scatter, and suddenly you can’t access what you know. The version of you that shows up under pressure isn’t the real you—it’s a diminished, anxious version that doesn’t reflect your actual abilities.

Performance anxiety refers to the intense fear and nervousness that arises in situations where you feel evaluated or judged. It’s more than normal nerves. It’s a pattern that undermines your confidence, limits your opportunities, and makes you dread situations you should be able to handle.

In Washington DC, where careers are built on presentations, hearings, media appearances, and high-stakes conversations, performance anxiety can feel career-threatening. But it’s also treatable. You don’t have to keep white-knuckling through—or avoiding—the situations that trigger anxiety.

At Therapy Group of DC, our therapists help people overcome performance anxiety using evidence-based approaches. We help you understand what’s driving your anxiety, develop skills to manage it, and build the self-confidence to perform like yourself when it counts.

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Is Performance Anxiety Therapy Right for You?

You might benefit from performance anxiety therapy if you:

• Experience intense fear before presentations, meetings, or public speaking situations
• Notice your mind goes blank when you’re being evaluated, even when you know the material
• Avoid opportunities—promotions, speaking roles, leadership positions—because of anxiety
• Experience physical symptoms like racing heart, sweating, trembling, or rapid breathing before performing
• Have negative thoughts about being judged, failing, or embarrassing yourself
• Perform well in practice but “choke” when it counts
• Experience stage fright that’s gotten worse over time rather than better
• Notice performance anxiety affecting job interviews, professional presentations, or important conversations
• Experience sexual performance anxiety that’s affecting your intimate relationships
• Feel self-doubt that doesn’t match your actual competence or preparation

What to Know

• Performance anxiety is extremely common—it affects everyone from students to executives to professional performers
• Performance anxiety is not a character flaw or sign of weakness; it’s a treatable pattern
• The physical symptoms of performance anxiety come from your body’s stress response—the same fight-or-flight system that helped our ancestors survive
• With professional support, most people can significantly reduce performance anxiety and perform with greater confidence

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Understanding Performance Anxiety

Performance anxiety refers to the fear, nervousness, and physical symptoms that arise when you anticipate or engage in situations where you might be evaluated. It’s often called stage fright, though it extends far beyond the stage to any performance situations where you feel observed or judged.

What Triggers Performance Anxiety?

Performance anxiety can show up in many contexts:

Professional situations. Public speaking, presentations, job interviews, important meetings, media appearances, congressional testimony, court appearances—anywhere your professional competence is being evaluated.

Creative and athletic performance. Music performance anxiety affects musicians, actors, and other performers. Athletes experience it before competitions. The common thread is that your abilities are on display.

Academic settings. Test anxiety, oral exams, thesis defenses, and classroom presentations can all trigger performance anxiety.

Social situations. For some people, performance anxiety overlaps with social anxiety—networking events, first dates, or any situation where you fear negative evaluation from others.

Intimate situations. Sexual performance anxiety affects both men and women, creating a cycle where worry about performance interferes with the ability to be present and connected.

In DC’s high-pressure professional culture, performance anxiety often goes unaddressed because admitting to it feels like admitting weakness. But the attorneys, policy experts, executives, and advocates we work with aren’t weak—they’re dealing with a common and treatable condition.

What Causes Performance Anxiety?

Several contributing factors can lead to performance anxiety:

Past negative experiences. A presentation that went badly, public embarrassment, or criticism can create lasting anxiety about similar situations. Your brain learns to anticipate danger even when the current situation is different.

Fear of judgment and negative evaluation. Worrying about what others will think—that they’ll see you as incompetent, unprepared, or foolish—fuels performance anxiety.

Perfectionism. Setting impossibly high standards means any performance feels like a potential failure. Perfectionism and performance anxiety often reinforce each other.

Self-doubt and low self-confidence. When you don’t trust your own abilities, every performance situation feels like a test you might fail.

The spotlight effect. We tend to overestimate how much others notice our mistakes. This cognitive distortion amplifies anxiety.

Lack of experience. Sometimes performance anxiety reflects genuine unfamiliarity with a situation. Practice and exposure can help.

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Symptoms of Performance Anxiety

Performance anxiety manifests physically, emotionally, and cognitively. Understanding your symptoms helps you and your therapist develop an effective treatment plan.

Physical symptoms come from your body’s stress response—the activation of your fight-or-flight system. These include racing heart or rapid heartbeat, sweating, trembling or shaking, rapid breathing, muscle tension, dry mouth, nausea, dizziness, and blushing. These bodily sensations can feel overwhelming and create a feedback loop—you notice your heart racing, which makes you more anxious, which makes your heart race more.

Emotional symptoms include intense fear or dread before performance situations, panic or feeling overwhelmed, irritability in anticipation, shame or embarrassment, and frustration with yourself.

Cognitive symptoms include negative thoughts about your abilities (“I’m going to fail”), mind going blank, difficulty concentrating, catastrophic thinking about negative outcomes, self-doubt that doesn’t match your preparation, and negative self-talk before, during, and after performing.

Behavioral symptoms include avoiding performance situations entirely, over-preparing to compensate for anxiety, seeking excessive reassurance, “choking” (performing significantly below your ability level), and rushing through performances.

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Performance Anxiety and Related Conditions

Performance anxiety exists on a spectrum and can overlap with other anxiety disorders:

Social anxiety disorder involves fear of social situations more broadly, not just performance contexts. If your anxiety extends to casual conversations, parties, or being observed in daily life, social anxiety may be part of the picture.

Generalized anxiety disorder involves chronic worry across many life domains, not specifically performance situations.

Panic disorder involves unexpected panic attacks. If your performance anxiety includes full panic attacks, this may be relevant.

Performance anxiety isn’t listed as a standalone diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, but it’s a well-recognized pattern that responds well to treatment. Your therapist can help clarify whether your experience fits primarily under performance anxiety or involves other mental health challenges.

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How We Treat Performance Anxiety

At Therapy Group of DC, we use evidence-based approaches to help you overcome performance anxiety and perform with self-confidence.

Psychodynamic Therapy

For many people, performance anxiety connects to deeper patterns—perhaps early experiences of criticism, perfectionism learned in childhood, fear of failure tied to self-worth, or core beliefs about not being good enough. Psychodynamic therapy explores these roots, helping you understand where your anxiety comes from and why certain situations trigger such intense responses.

This approach examines how past negative experiences shape current fears, how relationships with parents, teachers, or early authority figures may have created templates for how you expect to be evaluated, and how your sense of self is tied to performance. Understanding these patterns often creates space for change that purely symptom-focused approaches can’t reach.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy CBT is one of the most effective treatments for managing performance anxiety. CBT helps you identify and challenge the negative thought patterns that fuel your anxiety—thoughts like “I’m going to fail,” “Everyone will judge me,” or “I can’t handle this.”

In CBT, you’ll learn to recognize cognitive distortions (like catastrophizing or mind-reading), challenge them with evidence, and replace them with more realistic thinking. You’ll also develop behavioral strategies to approach rather than avoid anxiety-triggering situations, gradually building tolerance and confidence through practice.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy helps you change your relationship with anxiety rather than trying to eliminate it entirely. ACT teaches you to notice anxious feelings without being controlled by them, and to take action aligned with your values even when anxiety is present.

This approach recognizes that some anxiety before important performances is normal—even helpful. The goal isn’t to feel nothing, but to prevent anxiety from hijacking your performance.

Mindfulness-Based Approaches

Mindfulness techniques help you stay present rather than getting lost in worried thoughts about future negative outcomes or rumination about past negative experiences. Learning to anchor your attention in the present moment—your breath, your body, the room around you—can interrupt the spiral of performance anxiety.

Skills Training

Beyond insight-oriented therapy, we teach concrete coping skills for managing performance anxiety in the moment:

Deep breathing techniques. Slow, diaphragmatic breathing activates your parasympathetic nervous system, calming the stress response. The physiological effects are real and immediate.

Grounding techniques. Methods like the 3-3-3 rule for anxiety (name three things you see, three sounds you hear, and move three parts of your body) help interrupt anxious spiraling and bring you back to the present.

Positive self-talk. Replacing catastrophic predictions with realistic, encouraging self-talk can reduce anxiety levels and boost confidence before performances.

Visualization. Mentally rehearsing successful performance can reduce anticipatory anxiety and enhance performance by priming your brain for a positive outcome.

Medication Referrals

For some people, medication can help manage anxiety symptoms, particularly the physical symptoms of performance anxiety. Beta blockers are sometimes used to reduce physical symptoms like racing heart and trembling—they don’t eliminate anxiety but can prevent the physical symptoms from spiraling. If medication might help, we can refer you to psychiatric providers for evaluation.

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What to Expect in Therapy

Your therapist will conduct a thorough assessment to understand your specific experience of performance anxiety—what triggers it, how it manifests, how severe it is, and what you’ve already tried. They’ll also assess whether other anxiety disorders or mental health conditions are part of the picture.

Based on your assessment, you’ll develop a personalized treatment plan that might include weekly therapy sessions using psychodynamic, CBT, ACT, or mindfulness-based approaches; between-session practice; skills training for in-the-moment management; gradual work toward challenging performance situations; and referral to psychiatric providers if medication could help.

Many people see meaningful improvement in 8-16 sessions, though this varies. The goal isn’t to eliminate all anxiety—some activation before important performances is normal and can even enhance performance. Success means anxiety no longer controls your choices or undermines your abilities. You can feel nervous and still perform like yourself.

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Strategies for Managing Performance Anxiety

While therapy provides the foundation for overcoming anxiety, there are strategies you can use between sessions and in daily life:

Prepare and practice. Familiarity reduces anxiety. Practice in conditions as close to the real thing as possible.

Arrive early. Rushing increases anxiety. Give yourself time to settle.

Use deep breathing. Before and during performance situations, slow breathing calms your nervous system.

Challenge negative thoughts. When you notice catastrophic thinking, ask yourself: “Is this thought realistic? What’s the evidence?”

Focus on connection, not perfection. Shift your attention from being evaluated to connecting with your audience or partner.

Accept some anxiety as normal. Trying to eliminate all anxiety often backfires. Notice it, accept it, and perform anyway.

Get enough sleep. Sleep deprivation amplifies anxiety. Prioritize rest before important performances.

Limit caffeine. Caffeine can intensify anxiety symptoms. Consider reducing intake before high-stakes situations.

Exercise regularly. Regular physical activity helps manage stress and reduce anxiety levels overall.

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Our Performance Anxiety Therapists

Our therapists bring expertise in anxiety disorders and performance-related stress. They understand the high-stakes professional culture of Washington DC and work with clients across industries who need to perform under pressure.

Dr. Tyler Miles, Psy.D.

Dr. Miles specializes in anxiety using ACT, client-centered therapy, and cognitive behavioral therapy. She helps clients develop psychological flexibility to perform with greater confidence even when anxious feelings are present. View Dr. Miles’s full profile →

Dr. Kevin Isserman, Psy.D.

Dr. Isserman uses client-centered and psychodynamic approaches to help clients build self-confidence and work through self-doubt. His supportive style creates space for exploring what’s behind performance fears. View Dr. Isserman’s full profile →

Dr. Dana Treistman, Ph.D.

Dr. Treistman uses CBT and mindfulness to help adults manage anxiety in professional and personal contexts. Her warm, collaborative approach helps clients build coping strategies and self-confidence for high-pressure situations. View Dr. Treistman’s full profile →

Dr. Michael Burrows, Ph.D.

Dr. Burrows draws on psychodynamic and relational approaches to help clients understand the roots of their anxiety. His focus on self-esteem and identity helps clients address the deeper patterns fueling performance anxiety. View Dr. Burrows’s full profile →

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Begin Performance Anxiety Therapy in Washington DC

You’ve spent enough time dreading presentations, avoiding opportunities, or performing below your ability. Enough time letting anxiety speak louder than your competence.

Performance anxiety is fixable. With the right professional support, you can learn to manage anxiety, build self-confidence, and show up as yourself when it matters most.

Schedule an Appointment →

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Frequently Asked Questions

Is performance anxiety fixable?

Yes. Performance anxiety responds well to treatment. Cognitive behavioral therapy, exposure therapy, and acceptance and commitment therapy all have strong evidence for helping people overcome performance anxiety. Most people see significant improvement with professional support.

How do you treat performance anxiety?

Effective treatments include psychodynamic therapy (to understand the roots of your anxiety), cognitive behavioral therapy CBT (to address negative thought patterns), ACT (to change your relationship with anxiety), and skills training (breathing, grounding, visualization). Some people also benefit from medication to manage physical symptoms. A mental health professional can help determine the best treatment plan for your situation.

What is the 3-3-3 rule for anxiety?

The 3-3-3 rule is a grounding technique to help interrupt anxiety in the moment. You name three things you can see, three things you can hear, and move three parts of your body. This simple practice brings your attention back to the present and can reduce anxiety levels quickly.

How do you break the cycle of sudden performance anxiety?

Breaking the cycle involves several strategies: preparing thoroughly so you feel confident in your material; using breathing and grounding techniques to manage physical symptoms; challenging negative thoughts with evidence; gradually building comfort with performance situations through practice; and working with a therapist to address underlying patterns. The goal is to interrupt the feedback loop where anxiety triggers more anxiety.

What’s the difference between performance anxiety and social anxiety disorder?

Performance anxiety specifically relates to situations where you’re performing or being evaluated—presentations, interviews, athletic events. Social anxiety disorder involves fear across a broader range of social situations, including casual conversations and everyday interactions. They can overlap, and some people have both. Your therapist can help clarify which pattern fits your experience.

How can I help someone with performance anxiety?

Be supportive without dismissing their experience (“just relax” isn’t helpful). Encourage them to seek professional support if anxiety is significantly affecting their life. Help them practice if they want to, and avoid adding pressure. Recognize that performance anxiety is a real condition, not a choice or character flaw.

Can performance anxiety affect sexual performance?

Yes. Sexual performance anxiety is common and creates a cycle where worry about performance interferes with arousal and presence. Therapy can help address the negative thoughts and anxiety patterns that fuel sexual performance anxiety, and improve both confidence and connection.