Public Speaking Anxiety & Fear of Being Noticeably Nervous: Mind Surgery for High Performers
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Pharm. Rep Resolves Chronic Public Speaking Phobia and Fear of Being Noticeably Nervous

Bill, a successful pharmaceutical sales representative, struggled when career advancement required group presentations he had previously avoided. Rather than relying on medication, he learned techniques for controlling his psycho-physiological response, sweating, and blushing, developing greater confidence when facing public speaking and performance situations.
Episode Overview

What This Episode Is About

“Bill,” a pharmaceutical representative, describes how fear of blushing, sweating, and appearing visibly nervous caused him to avoid group presentations, meetings, and potential career opportunities. Although he had achieved considerable success in sales through one-to-one interactions with physicians and spontaneous conversations in hospitals, advancement increasingly required him to participate in the very group situations he had learned to avoid. During these experiences, he describes feeling as though an “elephant” were sitting on his chest as his breathing became difficult and embarrassment intensified. He had read extensively about anxiety and explored psychiatric treatment, but did not want medication to become his primary solution. Bill discusses learning to understand the physiology behind his symptoms and implementing a paradoxical approach to controlling adrenaline, sweating, and blushing. As his confidence grew, he became better able to enter challenging professional situations rather than organizing his career around avoidance and fear of being noticeably nervous.
At a Glance

This podcast is best for:

CEOs, executives, clinicians, attorneys, students and performers whose careers depend on speaking — and who have found that competence alone did not resolve the fear.

Episode Details:

13
 min, 
23
 sec
June 25, 2024
Full Transcript

This episode's transcript:

[00:00:00]
On the telephone with Bill, who’s got an interesting story to tell because what he did was achieve his objectives in an especially short period of time. Bill, thank you for sharing. Thank you. Could you describe what the situation was in as much detail as you can when you first came into the program? I was avoiding a lot of behavior in my professional environment. I’m a pharmaceutical representative and I’m in sales. I would avoid group presentations. I would avoid meetings. I would avoid additional job opportunities because I felt that I had a problem with blushing in front of crowds. I had a problem with sweating.
[00:00:54]
I had a problem with just being visibly nervous when I’m in those types of environments. Like an elephant was sitting on my chest when I’m trying to talk and breathe, starting to breathe heavy and felt a sense of embarrassment when I was in those situations. I did everything that I could in order to avoid those. Being a professional man, I couldn’t totally avoid it. Those feelings would creep in. I’ve read a lot of things over the years in order to try to combat this type of situation. You don’t want to a psychiatrist to ask him if there’s anything I could really do about this. His answer was put me on medication, which was not what I wanted to hear.
[00:01:49]
Let me ask you something. How does one in your profession of pharmaceutical sales do your career if you are avoiding and you have so much anxiety? I couldn’t avoid everything. I did very well in the one-on-one settings. I did very well. It may be spontaneous settings, seeing a doctor in an hospital in the hallway or something like that, but I really tried to avoid giving presentations in front of groups. I didn’t always have an opportunity to do that. I was able to achieve a level of success and get away from the group presentation thing. Being in the position that I am right now, it was starting to become very unavoidable.
[00:02:43]
It was really starting to cause me a lot of stress knowing that I would come up with reasons to try to avoid these things. Can you give an example of how you used to manipulate to avoid a presentation? I would have opportunities to do lunch presentations over at some of the hospitals that I would call on, and administrative assistants would call me up and ask me if I would like to do one of those. I always would come up with all, I’ve got a prior engagement, or maybe I can have another representative from my company come over there because I tried everything I possibly could to avoid those types of situations. We had situations at my work where we would have to do group presentations from time to time, and it was even times when I would schedule a vacation period.
[00:03:42]
Oh, she’s I’m sorry I can’t make it. I had a vacation scheduled at this particular time, and I can’t change it. How would you feel when you were aware that you had just consciously manipulated to avoid a situation that you really should not have? How did you feel about yourself? I didn’t feel good about myself. I think it caused a lot of internal anger towards myself. I didn’t feel good. I just felt like I wasn’t doing my job. It just didn’t make me feel good about myself. It’s been happening over the last x amount of years. Finally, I was in the car going to a golf tournament and I heard yourself on the radio on the fan and I said I’ve got to give this a shot.
[00:04:35]
Well, I’m glad you did. I’m glad you did for yourself and certainly made me feel good in terms of the work we’ve done. Now, using one of my famous 1 to 10 skills, considering the layers of your problem, which were the anxiety itself, the physical symptoms that you experienced like the blushing, the sweating, the avoidance, which is known as phobic behavior, how you were obsessively worrying, how it was impacting your mood, the whole ball game, so to speak. If on the scale of 1 to 10, the problem was a 10. It was the most severe after beginning and one is the most minimal. Where would you say you’re at at this point? It’s probably about a 2 and a half, something like that. It isn’t completely gone, but I have confidence now that I know what’s causing it, and I know what I have to do to rectify it, and if I start doing it, first of all, I’m not avoiding anything.
[00:05:41]
That’s the biggest thing. And internally, that makes me feel so much better about what I’m doing and who I am. So that’s the first step. And the second step is occasionally you might be with a tough crowd and I might get a little hot under the collar there. But with the techniques that we’ve learned, I have been able to change my behavior from trying to do anything I can. Oh my God, I’m sweating. I gotta turn to stop sweating. Who cares? Let’s see how much I can sweat. Let’s see if I can sweat even more. And that turned to right off. It’s done in about 30 seconds and I just continue doing what I’m doing. Okay, that’s an incredible technique, by the way. I want you to elaborate a little more because the thing with people who have to bring to the table sweating issues, hyper-hydrosis, blushing, they may find me on the internet. They listen to interviews like yourself and they give me a call.
[00:06:37]
One thing that they all have in common is they’re all angry. They’re all really, really angry. They’re angry that they have the problem. And very often they have absurd expectations like, I have to get better yesterday. And we’re all too conditioned to, you know, you’re not well, take a pill. You don’t have to take responsibility for the problem in a relatively short period of time. And I don’t even want to tell the listeners how long it took for you because they’re all going to tune into that number. But just knowing that you did it, you achieved a lot of high quality objectives in a relatively short period of time. How did you do it? What did you do? Well, the first thing that I think that I have, maybe that some of your patients hopefully will have when calling you, is I had a high degree that I wanted to change this behavior.
[00:07:38]
It wasn’t acceptable anymore. I didn’t feel good about it happening. And I was willing to try anything in order to change this. And for me, the biggest technique, or I wouldn’t even say the biggest technique, the biggest reason why I think I was able to get better is I changed my mindset. Like I told you from trying to avoid the blushing, trying to avoid the sweating. As soon as you feel it before, I used to be like, oh my God, I can’t, you know, let’s stop. I got to stop. This can’t happen. And that just would make it worse. Now I’ve taken control of the situation. I’m the quarterback and it’s happening. I let it surf. I let it happen. I know that adrenaline is a good thing. And, you know, I try to challenge myself. Okay, I’m starting to get a little hot. There’s a collar here. Let’s see if I can really sweat. Let’s see if we can really get it going.
[00:08:30]
And then when I just accept it, roll with it, realize it’s not a big deal and concentrate on what I’m doing. Next thing I know, it’s gone and I’m doing things that I’ve never done before. And that’s really a great feeling. Like sign up to that management program. I’m in the management development program. I’m looking at other jobs within the corporations that I would have never looked at before because they’re higher level positions where I have to do group presentations to, you know, physicians and doctors which would have gotten me. Or which I would have avoided in the past. How did you deal with the embarrassment or humiliation associated with your anxiety? I think what we’ve learned is it caused me a lot of anger. A lot of anger towards myself. A lot of irritability. It just, it didn’t make me feel, the biggest thing is it didn’t make me feel good about myself.
[00:09:24]
I knew I had the skills to do the job but because I just felt so bad about myself if I started sweating in a social situation that I would try to avoid these behaviors. You know, it just made me not feel good about myself and probably caused me to be angry and lash out more at other situations. And could you talk for just a moment on the connection between anger and your problem, what you did with your anger? Well, what I deal with my anger really is when we went over the, some of the states that I should be in, I realized that I was just very, very critical on myself. And when I look back at certain situations and certain things that have occurred, I just realized how my critical script was just totally out of balance.
[00:10:19]
And I’ve learned to quiet the critical script and be more nurturing. And if you sweat, so what? What’s the big deal? Or if you’re a little nervous, well, how do I call it? That’s common. Well, here went to not a big deal. And, you know, the more I have nurtured myself and the more that I’ve quieted that calm down my critical script, just the better I felt about myself. And the anger has really, really dissipated. And what percentage, if you could, I know you said you went from a 10 to a 2 and a half, which is extraordinary. What percentage of your physical symptoms, anxiety-based physical symptoms, have diminished? Well, you know, there not as intense before a thousand-a situation. I would have started sweating profusely.
[00:11:12]
Now, if I’m in that stressful situation, I might get hotter out of the collar for 20, you know, 20, 25 seconds and it goes away. I can’t remember the last time I’ve washed. And I can’t remember the last time that I had that so-called elephant sitting on my chest. And that is something that I’ve had for the last 20, 25 years of my life. So my physical symptoms have really, really not totally gone away. But now instead of sweating profusely, I might, in the most stressful situation, I might have a break of B to my forehead and that’s it. And that’s just amazing. If people knew how I was, you know, even, you know, six months ago, they would be very shocked about my turnaround. Listen, I thank you really. Thank you very much for sharing. Your story was really quite inspirational. Okay. Thank you very much.
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Meet the Speaker

Jonathan Berent, LCSW

Psychotherapist & Author — Social Anxiety and Performance Anxiety

Jonathan Berent, L.C.S.W., A.C.S.W., is a psychotherapist who has been practicing since 1978. He has created the Berent Treatment Method for Social Anxiety, which is the result of his clinical work with thousands of individuals of all ages with social anxiety since 1978. He has extensive clinical experience with avoidance and dependance personality disorder, and is the author of Work Makes Me Nervous: Overcome Anxiety and Build the Confidence to Succeed (Wiley, 2010), Beyond Shyness: How to Conquer Social Anxieties (Simon & Schuster, 1992), and Social Anxiety: The Untold Story, which is a training course for mental health professionals in using the Berent Method to treat social anxiety. (Andrew Kukes Foundation, 2011).
SocialAnxiety.com, has served millions of unique visitors as a multimedia clearinghouse for patients, parents, and fellow mental health professionals in search of articles, educational materials, and books on social anxiety and related subjects. His library of clinical interviews appears to be the most documented clinical success with social anxiety.

Guest Speaker

Frequently Asked Questions

Common Questions About Social Anxiety Treatment

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.

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.

Probably because you are prone to hyper-hidrosis. Anxiety activates the body’s sympathetic nervous system, which can increase perspiration. When excessive sweating becomes a major focus of attention, a person may begin worrying about whether others can see it. This internal script can further increase adrenaline and perspiration, creating a cycle similar to fear of blushing.

Blushing is considered to be an involuntary response to heightened emotion, self-consciousness, embarrassment, or adrenaline. For someone who fears blushing, noticing even a small change in facial warmth can trigger additional anxiety. This can create a feedback loop in which the fear of blushing contributes to additional blushing. That said, the Berent treatment methodology provides clinical evidence that blushing can be controlled

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.

Take the Next Step

You Do Not Have to Manage This Alone

Public speaking anxiety, performance anxiety, and social anxiety respond to treatment. If this episode described your experience, a conversation is the great next step.