Public Speaking Anxiety & Fear of Being Noticeably Nervous: Mind Surgery for High Performers

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No Surgery No Drugs: Performance Anxiety and Blushing Resolved

Diane describes overcoming erythrophobia after once considering surgery to sever nerves responsible for blushing. Her fear had restricted career advancement and contributed to depression. Through therapy, she recognized deeply ingrained beliefs about blushing and judgment that originated in childhood and learned to overcome her avoidance.

Episode Overview

What This Episode Is About

“Diane,” a woman in her forties, describes reaching such a low point with erythrophobia that she considered undergoing surgery to sever nerves in an effort to control blushing and sweating. She was experiencing anxiety and repeated blushing throughout her workday—on the telephone, while meeting people, and in many other ordinary interactions. Her symptoms had begun interfering with her ability to advance professionally because she feared getting “in front” of the people necessary for career growth. Diane believed that when she blushed, others would conclude that she was not intelligent or capable enough. Over many years she had also become extremely skilled at hiding her anxiety and adapting her behavior around it. Through therapy conducted by telephone, she began exploring the deeply ingrained origins of the problem, including experiences dating back to grammar school. Diane discusses how understanding those roots, reducing avoidance, and changing her response to anxiety allowed her to improve without surgery or medication.

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:

min,

sec

October 27, 2025

Full Transcript

This episode's transcript:

[00:00:00]

I’m here with Diane from Tennessee. Thank you for joining us. Thank you. Would you be kind enough to tell the listeners what was going on in your life when we first met? I was at a really low point in my life. I was having a lot of anxiety continually blushing several times every day periodically throughout my work day on the phone meeting people in all aspects of my life. And that was about the time that I was considering a surgery that I had done some research on the Internet. And that for me had to be the very lowest point because I’m very health oriented.

[00:00:51]

And for me to even consider a surgery that wasn’t necessary would just show for me that that was just such a low point in my life. And that was about the time that through my research that I found you. Well, I would really like to hear more about how your mind was working where you were actually considering the option of surgery, which I believe is to sever nerves to help with the hyperhydrosis and theoretically control the sweating. Yes, that’s true. I was getting to the point in my career that I felt I wasn’t functioning. That the anxiety was so strong that it was really interfering with my work day. And I was getting depressed. I was at a point that it was very difficult to even go into work.

[00:01:45]

It was embarrassing. I guess that was the big word. It was embarrassing. And I guess to back up a little bit, I had just moved here. So I was in a, I think that maybe played in some part of the anxiety. Another job change and starting again went to a place I didn’t feel at that time that they were real supportive. So that kind of anxiousness fed into it a little bit too. Wasn’t the kind of group of people that I had left previously. Okay, but you were saying that you weren’t functioning. But you had a good career. You were making decent money. You were married. You have a family. What do you mean you weren’t functioning? I wasn’t functioning in the sense to where I wanted to go with that career. I let it, the anxiety hold me back. I was doing okay.

[00:02:35]

I think we’re pretty good at hiding. At least I thought I was pretty good at hiding a lot of things. But I was at the point where really I wanted to take the next step. And I was having a hard time doing that. What were you hiding? What were you avoiding? I was avoiding putting myself in front of people. In the position that I wanted to transfer to, it would be working with people in a sales capacity. And I was avoiding that because I felt that if I was continually nervous and blushing that I wouldn’t come across professional. And that bothered me a lot. That was holding me back from going to the next step. So what was happening in your mind when you would blush? What were you feeling? What interpretation were you putting on it?

[00:03:33]

In the work environment, it’s real embarrassing. It’s like I’m not smart enough that I don’t know what I’m talking about. In different situations, I guess I just read different things into it. But I guess for me a lot of it was that I didn’t feel as smart and maybe didn’t know what I was talking about or trying to pull something over on someone. So the blushing had been going on for how long a time when you really take a look back at your life. I mean, blushing in a negative sense the way it was impacting you negatively. Going back, I would say I think in a negative way that I felt it was impacting me in the sense that we’re looking at it now was junior high.

[00:04:24]

I can remember back further. Actually, I can remember back further than that in grammar school too. Just like we did once in the therapy session, link back to the first thing that comes to mind as far back as you can historically. I mean, if you don’t mind now, I’m going to say you are a woman in your 40s. But when you link back to the first thing that comes to mind, a situation where you knew something was not right, what was it? When I was auditioning for the choir, and she said, I’m trying to remember back. She said no when I auditioned and then she said she’d give me another try. I did get in and then I was performing and we were in a rehearsal and at that time she pulled me out in front of everybody and said, I wasn’t doing well enough and asked me to leave in the middle of this rehearsal.

[00:05:22]

I had to walk back into class. I think that stands out as a real embarrassing moment. As we’ve done our work together, you understand that that was an example of trauma, a situation associated with acute levels of embarrassment. You’re doing research on this problem a while ago. The part of you that was considering this operation, let’s go back to that. You’re thinking what? I’ve got a blush. Okay, so I’m blushing and it means what? What did it mean to you? A year or so ago? At that time it meant that I guess part of it did. I didn’t feel as sophisticated as smart as my co-workers.

[00:06:15]

I felt it was very hard to come to the right words for that. It was just such a low period. It was even meeting, I was mentoring and working with recent college graduates. I didn’t even feel as mature as they were from that. That’s how my mind related that. You would be in a situation, either a social or work situation, and you would blush. You would think about the blush in terms of what other people were thinking. I would think they thought, what’s wrong with her? Why is that reaction? I could read that on someone’s face. Even if I was introduced to someone, I would just blush. Sometimes you could read it in their face. What is she getting so nervous about or blushing about?

[00:07:08]

That’s how I would interpret it. Then that would make me feel worse. What’s wrong with me? Why can’t I even meet somebody and I would have this problem? Why on the telephone when I don’t even have face to face with someone, why would this happen to me? Then I would start saying, what’s wrong with me? There’s got to be a reason. This has got to be a biological reason that I’m having this. That’s where I think I started that research and was looking for something that someone could cut to surgery fix it. Now what you’re saying right now is so incredibly important. You just said, I thought that this was a biological one. Something, a biological problem that they could just cut out, fix, and I’d be fine. I was sharing with this. How come you didn’t follow through on that surgery?

[00:07:59]

Thank goodness I kept doing research and I came across your name and I called and we spoke. Surgery, that for me, would have been the ultimate last draw. Again, I just look at surgery is that it should be something that’s life threatening and I always try alternative. I’m a very alternative person, alternative medicine. I barely take an aspirin. That just shows how a low point and my husband was quite concerned because of how I am that I would consider that. I continued to look for another source and there was something on that website that triggered me enough to call. That maybe this would be something I could work through.

[00:08:50]

Okay, in all honesty, where would you say that you are currently at with the social anxiety and blushing and sweating? From when we started to now, it’s like a 360 turnaround. It’s not that I never blush. It does still happen occasionally, but I look at it differently too. And I think as situations come up, it happens less and less. I am in a different place.

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Since 1978 The Berent Treatment Method has adapted therapy to the specific needs of social anxiety sufferers rather than try to fit the disorder into the narrow confines of an existing treatment modality. Having provided direct treatment, and supervised treatment, to approximately 10,000 individuals of all ages in individual, family and group therapy the following […]

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.

Licensed Clinical Social Worker (LCSW)
40+ years in private practice
Author of "Beyond Shyness" and "Work Makes Me Nervous"
Featured on national television and radio
Specialist in performance and social anxiety

Guest Speaker

Frequently Asked Questions

Common Questions About Social Anxiety Treatment

Why do I blush when speaking in front of people?

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

What is erythrophobia?

Erythrophobia is an intense fear of blushing. A person may become preoccupied with when they might blush, whether other people can see it, and what others might think about them. This fear can lead to avoiding triggering situations like presentations, social situations, meetings, dating, professional opportunities, and other circumstances where the person fears becoming visibly red.

How can public speaking anxiety affect your career?

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.

Can public speaking anxiety be overcome after having it for many years?

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.

Can fear of blushing actually make blushing worse?

Yes. Fear and self-monitoring can intensify the emotional and physiological response associated with blushing. A person may think, “I’m starting to blush,” become alarmed by that thought, and generate even more anxiety and adrenaline. Treatment therefore needs to address the deeper emotional response concurrent to adrenaline control technique.

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.