The right therapy can. This requires a methodology that integrates FATE.

F=(function) physiology

A = (action) behavior

T = (thinking) cognition.

E = Emotion

Of course. That said it requires hard work and a major investment in technique concurrent with deep emotional work. The length of time someone has experienced public speaking anxiety does not necessarily determine whether meaningful improvement is possible. Long-standing patterns can become deeply ingrained, but people can learn new ways of responding to adrenaline, anxiety, self-criticism, avoidance, and the fear of being evaluated by others. In most cases it requires resolving complex trauma.

Because it takes a lot of misplaced energy. Trying desperately to conceal anxiety requires constant self-monitoring. Instead of focusing on the conversation, audience, or message, attention becomes focused inward: “Am I blushing? Is my voice shaking? Can they see me sweating?” This heightened monitoring can increase anxiety and make normal physiological sensations seem more threatening.

Because you are experiencing negative rumination. It’s one thing to objectively evaluate the variables of performance to enhance the performance. It’s another to recycle thinking and over-analysis to nowhere which is a symptom of underlying self esteem challenges and unresolved and repressed emotion.

Yes. Perfectionism is OCPD. That means obsessive compulsive personality disorder. Unrealistic expectations can create terror and toxic pressure

Yes. Avoidance can strengthen public speaking anxiety because the person never gets the opportunity to develop a different response to the feared situation. Each avoided presentation or meeting can reinforce the belief that anxiety is unmanageable. Gradually developing the ability to tolerate and work through anxiety is an important part of long-term improvement. Common sense will tell you that practice is required for learning anxiety control skills.

Avoidance provides immediate relief from anxiety, which can make it feel like an effective solution. However, that relief reinforces the idea that the situation was dangerous and needed to be escaped. Avoidance accrues and becomes more ingrained over time. It collects negative interest! Avoidant behavior can morph into avoidant personality disorder and a deep sense of self-loathing and shame.

Public speaking anxiety can cause people to avoid presentations, meetings, interviews, leadership opportunities, networking, sales situations, promotions, and other activities important to professional advancement. Someone may possess the knowledge and ability to succeed but find that anxiety prevents them from demonstrating those abilities consistently. The more avoidance takes place the more the individual is susceptible to dysthymia which is a subset of depression.