For some, a raucous audience, a lonely stage, and a spotlight zeroing in on a microphone is a pretty terrifying image. Public speaking is often cited as the world’s most common phobia, beating out trips to the dentist, spiders, and even death on the list of biggest fearsVirtual reality system for treatment of the fear of public speaking using image-based rendering and moving pictures. Lee JM, Ku JH, Jang DP, et al. Department of Biomedical Engineering, Hanyang University, Seoul, Korea. Cyberpsychology & behavior, 2002 Jun 5 (3):191-5..

Ladies and gentlemen (gulp): Why it matters

Research suggests the fear of public speaking can stem from poor self-imageThe causal role of negative imagery in social anxiety: a test in confident public speakers. Hirsch CR, Mathews A, Clark DM, et al. Institute of Psychiatry, De Crespigny Park, London, UK. J Behav Ther Exp Psychiatry. 2006 Jun;37(2):159-70. . Studies show people who think negatively of themselves tend to experience more anxiety when reciting a speech, believing that they will appear more anxious— and perhaps vulnerable— to othersSocial anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing. Makkar SR, Grisham JR. School of Psychology, University of New South Wales, Sydney, Australia. Behaviour research and therapy, 2011 Jul 13.. It seems combining anxiety with the fear that everyone’s watching makes the eye twitch, sweaty brow, and jittering hands-reaction that much worse!

Typically, people with normally low levels of anxiety get nervous before speaking but begin to relax once they get started. People with normally high levels of anxiety, however, are also anxious when they start speaking, but their apprehension only gets worse as the speech goes on. As the anxiety intensifies, the body experiences a surge in stress hormones, which encourages a fight or flight reaction. Watch out— we’ve reached the point of no return!

Take a few deep breaths: The answer/debate

Although public speaking usually poses no physical danger (well, except for the occasional freak accident), this social phobia can have some very real consequences. For some people, it causes the palms begin to sweat, knees to buckle, and stomachs to run amok with butterflies. Those with an extreme fear might suffer from actual panic attacks, although it is unclear if the attack is the cause or the consequence of phobiaConditioning theory: a model for the etiology of public speaking anxiety? Hofmann SG, Ehlers A, Roth WT. Veterans Affairs Medical Center, Palo Alto, CA. Behav Res Ther. 1995 Jun;33(5):567-71..

But though the fear or speaking might be crippling, there are ways to overcome the phobia. A stiff drink might take the edge off for some, although research suggests it could actually exacerbate anxiety for more people than it helpsEthanol administration dampens the prolactin response to psychosocial stress exposure in sons of alcohol-dependent fathers. Zimmermann US, Buchmann AF, Spring C, et al. Max Planck Institute of Psychiatry, Munich, Germany. Psychoneuroendocrinology, 2009 Aug;34(7):996-1003..

Not up for drowning anxiety with booze? There are lots of safer, sober ways to overcome that fear, tooTreating individuals with debilitating performance anxiety: An introduction. Powell DH. Harvard Medical School, MA. Journal of Clinical Psychology 2004, Aug;60(8);801-8.Cognitive therapy techniques before a speech— like deep breathing exercises, concentrating on the material, and plenty of practice to build confidence— have also been found to effectively calm nerves. And while a few cocktails before a big speech might seem like a good way to relax, it’s probably best to save the alcohol consumption for the celebration afterwards!