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The Noisey Guide To Music and Mental Health

The Dark and Lonely World of Performance Anxiety

It affects 75% of musicians, contributes to drug addiction and alcoholism, and can end careers. Why aren't more people talking about performance anxiety?

by Hannah Ewens
17 May 2016, 8:39am

This feature is part of The Noisey Guide to Music and Mental Health (in association with Help Musicians UK). You can read more from this series right here, and follow 'Mental Health Awareness Week' on Twitter here.

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“I did actually think about paying someone to kick the shit out of me; to put me in hospital about a week before a show. I thought if they broke my leg or both my legs, then I wouldn’t have to do it.”

Dave Jakes, the lead singer of Lonely The Brave, is sat in Regent’s Park, describing what happened when he found out he was playing the main stage of his favourite festival, Reading, last year. In his own words, he’s an extremely anxious person – he’s sat turned away from me, just as he does with an audience onstage, and ripping up chunks of grass with every other sentence.

“It completely ruined the whole of my summer. I was thinking about it, worrying about it the whole time, every day, going through all the worst case scenarios. My brain just goes AWOL.”

Performance anxiety can affect any musician, regardless of how confident they may appear to the outside world. Mariah Carey is said to have suffered from it, so has Ozzy Osbourne, Van Halen, Lorde, Brian Wilson, and Niall Horan. According to a recent survey conducted by Help Musicians UK, 75% of musicians said they suffered from it to some extent.

Back in 2011, Adele opened up about her own experiences, saying, “I’m scared of audiences. One show in Amsterdam I was so nervous, I escaped out the fire exit. I’ve thrown up a couple of times. Once in Brussels, I projectile vomited on someone. I have anxiety attacks a lot.” By 2013, it was reported she was having hypnotherapy. Last year – despite her towering career as Britain’s biggest pop star, with a mammoth arena world tour to come – she said it was only getting worse. “Or it’s just not getting better, so I feel like it’s getting worse, because it should’ve gotten better by now.” Symptoms can range from a racing heart, dry mouth, throwing up, or a loss of appetite for hours or days before a show. It can mean getting up on stage and being completely paralysed, or losing the ability to sing altogether.

While there has been a growing conversation about performance anxiety in the world of classical music, where technical precision is of paramount importance, it’s not taken quite as seriously in the pop and rock worlds. In terms of studies, there are basically none. According to experts, this is because the anxiety is being self-medicated by musicians and enabled by the industry. “I’ve done the population research which shows pop musicians are a very, very vulnerable population,” Dianna Kenny, a leading professor of psychology and music, says. “I would say more vulnerable than classical musicians. That’s something that has to change.”

It doesn’t take a genius to work out what the “self-medication” is. “Drink and drugs,” as Shaun Ryder told the BBC in 2011 when asked how he overcame his crippling fear of performing. It’s no secret that drink and drugs are often considered socially acceptable, and sometimes actively encouraged in the music industry, therefore they can easily become a crutch. “In the earlier days I was drunk all the time,” Jakes says. “Heavy drinking was a comfort blanket. But I get fucking on edge and really snappy with a hangover.” These days, he doesn’t drink on tour to try and keep a handle on his anxiety, because while alcohol might feel helpful in the immediate short term, the after effects often work to fuel mental health problems.

Jess Weiss from Brighton band Fear Of Men, who also gets anxious about performing, has a similar view. “There’s a level of drinking you do before going onstage to feel more comfortable, but then you’re kind of losing touch with what’s actually happening,” she says. “And if you’re doing that every night, these things add up, and people can have problems before they even realise it.”

Jakes’ performance anxiety is often so debilitating, it’s made him unsure whether he can carry on. Last spring, he tried to leave the band when Lonely The Brave (whose third album comes out this Friday, May 20) were reaching their peak. “It was after a bad gig, and my manager came round the next afternoon to have a massive chat. I was really upset obviously. It was an emotional couple of days but I got talked around. Part of me thinks that when it’s all over I’ll have a huge sigh and think, ‘Thank fuck for that, thank fuck it’s all over. It’s been amazing but I don’t have to worry about that again’. It’d be comforting. But I can’t stop. There are too many people I’ll let down, including myself and my daughter. I’d only be working back in a little white van, like we did before I was in a band.” Jakes says if he could just be a recording musician he’d be very happy – but unfortunately, the performance element is difficult to avoid when you’re in a successful rock band.

It’s a situation that has him caught in a paradox. Lonely The Brave are only two albums in, and their last was particularly successful, meaning that the spotlight may shine even brighter upon them with time. “There’s one aim when you’re in a band and that’s to get as big as you possibly can. So using that as a template that means my gigs are only going to get bigger. If people stopped liking our band then that’d at least be a proper reason to quit…”

Like many of the artists I spoke with, his pre-show anxiety manifests in a certain way. Jakes’ stems from the possibility that his voice will break while singing. He also gets postnasal drip – the official health term for when an excess amount of mucus drips down your throat – which frequently irritates him. “I had an absolute nightmare a couple of years back with it at Rock AM Ring, a German festival,” he says. “Basically, I decided to drink a bottle of wine before I went onstage. It was about 40 degrees before we went on, the red wine glued my throat up. I was basically making these horrendous squawking noises. I nearly started crying onstage; it was the worst day of my life. And now I’ve got to do the same festival again next month. We had a practice a couple of days back and my voice was croaky, and I’m worrying about going on tour soon when it feels like the old demon’s coming back.”

Laura-Mary Carter of Blood Red Shoes has had anxieties around performing since the beginning of her career, but it was after reading about herself on the internet that it peaked. “People would say that I was really quiet compared to my bandmate. I was thinking about it on stage, and thinking I wasn’t being a certain way. I think there were moments where I got really depressive about it, but I remember on tour every show I came off and would be really annoyed at myself, and just think that I was rubbish. More than often before a show, I’m still pretty much shaking. I’ll have to talk myself around.”

In a high-pressure situation like a gig, the body’s “fight or flight” response will often kick in. The nervous system pumps two hormones – adrenaline and noradrenaline – into the bloodstream. When these levels get high, it leads to a quicker heart rate, muscle tremors and a feeling of nausea. When you harness the power of this imbalance, it can lead to a heightened state of awareness and a confident, power-packed performance. But for some people, it can lead to anxiety, memory loss or a panic attack, which often perpetuates long term anxiety.

While performance anxiety might be unwelcome, it’s not exactly unreasonable. “It’s not a natural thing to do; going out and dealing with such high levels of stress in public,” Aaron Williamon, professor of performance science at the Royal College of Music told the Guardian. “And it’s nothing to do with age or inexperience. No matter how highly skilled a person is, the body’s pre-programmed stress responses mean they can enter a different physical state, and sometimes even a different psychological state.”

The inclination of the public and fans, understandably, is to believe that lead singers are attention grabbing beacons of charisma who are always desperate to be onstage. If an artist does have a negative reaction to the idea of performing, it’s simply put down to “stage fright” – a term now so colloquial that it often underestimates the experience. In reality, it’s something much more than that. “When I began researching in this field 15 years ago, it was in disarray,” Kenny explained. “Performance anxiety wasn’t well established as a psychological condition – it still only gets five or six lines in the DSM 5 (the diagnostic manual of mental health disorders published by the American Psychological Association), and it’s not very well understood.”

Far from being something minor or undiagnosable, Kenny has created a sliding scale for the severity of performance anxiety. The first category is a “normal” level of nerves which arise as you’re embarking on a performance. As she says, by virtue of being a musician, you are going to experience that in some form. That’s the evolutionary response. “The way you manage that type of anxiety is to be very well prepared with your repertoire having reached mastery in the technical aspects of what you are going to play and all the other sensible things that performers do prior to a performance such as being fully rested and hydrated.”

The second severity is “clinical” music performance anxiety, which she says occurs in a person who has a form of social anxiety already. Martyn Watts is a senior partner at North London Stress Management Centre where he treats this with a combination of hypnosis, cognitive behavioural therapy (CBT) and psychotherapy. “In effect, all performance anxiety, or stress-related issues are thoughts, and thoughts can be controlled through specific techniques,” he says. “With hypnosis I can also take people to a different level, where the negativity that is embedded in the subconscious can be released.”

In some cases, artists may have had performance anxiety all their life in some form. For others, there’s a trigger. “Most of the time they tend to at least suspect what the trigger is, and it can be anything,” explains Watts. “It can be a new relationship, it can be some kind of criticism from an unexpected source. For example, a bad review or a series of bad reviews tends to sap people’s confidence when it’s there in print.”

As is the nature of CBT and hypnotherapy – alongside mediation, exercise and relaxation, which music psychologists wholeheartedly recommend – there is no quick fix for performance anxiety, and it’s often more about maintenance and keeping stress to a minimum. For this reason, Watts does a lot of hypnosis sessions over Skype so he can reach musicians while they’re on tour in hotel rooms. Occasionally, artists will come to him using beta blockers – the prescription drug of choice for classical musicians. Otherwise known as propanolol, they are cardiac medication, now on occasion given to people who suffer with panic attacks because they slow a racing heart. Watts says that he’ll work with artists with the aim to be weaning off beta blockers over the course of his sessions.

But Kenny’s third and most severe form of performance anxiety, that also includes depression and panic, is lifelong and often severe enough to end careers. A total depression or sheer sickening panic when you’re called upon to perform. "That kind of anxiety is not treated by the common sense approaches or cognitive behavioural therapy,” Kenny says. “The source of this type of anxiety is related to the quality of the attachment relationship they had with their parents. Because theirs was an anxious, insecure attachment, they are subject to feeling more overwhelmed, humiliated and ashamed by a performance or the prospect of one. The anxieties arising around that trigger their earlier shaming experiences.”

Far from rare, Kenny believes that about a quarter to a third of musicians with performance anxiety suffer from this type. “To treat this severe anxiety, Kenny has adapted a form of psychotherapy – attachment-based psychodynamic psychotherapy – that “doesn’t focus on the symptoms but looks to resolve those attachment issues.”

For many musicians, the battle with performance anxiety is recognising it as a common problem you can work on and get help for, and not just some inherent fault within you. And fighting the tendency to rely on drugs and alcohol to fix it is the first step towards tackling the problem. “It can get to a point where an artist can’t get on without being zonked,” says Watts. “You blame the record company or management for allowing that to get to such an extent. The rest of the band, tour managers, publicists, and so on have to look out for those signs. But ultimately, it is when a performance is not up to scratch that people notice it.”

When you step out on stage, the audience shouldn’t be the enemy and the stage a fighting pit. In many cases, it’s about shoving evolution back in its little box, and thankfully, with work and professional help that’s doable – even with the most severe form. For Laura-Mary Carter from Blood Red Shoes, there were even positives to take from her battle. “I think I’d probably have that anxiety in other areas of life were I not to be in a band. Working through this has helped me overcome certain things and that confidence has spread throughout my life and now I say yes to more. I welcome what scares me.”

You can follow Hannah Ewens on Twitter

This feature is part of 'The Noisey Guide to Music and Mental Health'. You can read more from this series right here. If you are concerned about the mental health of you or someone you know, talk to Mind on 0300 123 3393 or at their website, here. And if you would like to know more about the work of Help Musicians UK, you can visit them here.