A Promotion, a Podium, and Performance Anxiety
• 35-year-old corporate professional, recently promoted, with marked anxiety about delivering a presentation to nearly 100 people in 2 weeks.
• Since learning about the presentation, he has developed persistent anticipatory worry, difficulty initiating sleep, poor concentration and repeated mental rehearsal of possible mistakes.
• He has had a long-standing fear of public speaking since adolescence. He was shy, slow to warm up and highly sensitive to criticism.
• During a school presentation, he forgot part of his speech and was laughed at by classmates. Since then, he has avoided speaking before large groups.
• He remains comfortable in one-to-one interactions and small familiar groups.
• His main fear is that he may forget the content, tremble, become blank or embarrass himself, leading others to view him as incompetent.
• He recognises that the fear is excessive but is unable to control it.
• On imagining public speaking, he develops palpitations, tremulousness, sweating, dry mouth and throat tightness.
• His attention shifts from the presentation to his bodily symptoms and the fear that others will notice his anxiety.
• He becomes excessively self-conscious and interprets neutral audience expressions as criticism or boredom.
• He uses safety behaviours such as memorising every sentence, reading from slides, avoiding eye contact, holding the podium and speaking rapidly.
• After presentations, he repeatedly reviews his performance, focuses on minor mistakes and discounts positive feedback.
• There is no history suggestive of unexpected panic attacks, generalised anxiety, psychosis, mania, substance dependence or significant depression.