Managing Performance Anxiety In Teens

Posted on December 23rd, 2014

When it comes to performance anxiety – whether for public speaking, tests, sports events, or dance / musical recitals – few are truly immune from its stomach-churning, sweaty-palm-making effects. As a parent, it can be especially difficult to watch your teen experience these unpleasant feelings, particularly if her symptoms are intense and involve headaches, stomach aches, or full-blown panic attacks.

It is important to understand that these fears can translate into genuine physiological symptoms, including rapid heart rate; fast, shallow breathing; increased blood pressure; stomachache; dry mouth; and tightened muscles. Your teen’s body may respond in any of these ways, so when he complains of any anxiety-related symptoms, you can know they are, in fact, real and not “just in his head.”

The good news is that help is available and it doesn’t have to involve medication. Cognitive behavioral therapy (CBT) and clinical hypnosis are both highly effective yet simple skills that empower teens to gain control over and conquer life’s many challenges. The best results occur when CBT and hypnosis are used together.

Cognitive-behavioral therapy complements clinical hypnosis by teaching teens to recognize the thought distortions that contribute to feelings of increased anxiety, most notably:

“This is too scary” (overestimating the risk or challenge)
“I can’t do this” (underestimating her internal strengths and weaknesses).

As your teen learns how to understand her cognitive distortions (or irrational thought processes), how they contribute to her problems, and how to talk back to the negative thoughts, she will gain a sense of mastery over them, producing real and lasting change.

This is an example of how you can use CBT with your child or adolescent:

Your teen feels anxious due to a negative thought, such as, “I will probably get a bad grade on this test.” There are 10 common cognitive distortions, or thinking errors, that can lead to this negative thought. One common thinking error is catastrophizing, or expecting a poor outcome, even though there is no evidence for one. It’s not the event that creates the anxiety but rather how we think about it. When we can change how we think about it, we can change how we feel, thus decreasing our anxiety.

So once your teen recognizes the distortion in his thought, he can defeat the negative thought by replacing it with a positive thought. David Burns, MD, has described “50 Ways to Untwist Your Thinking,” as part of his ebook for therapists. One of the many powerful ways that he helps individuals defeat their negative thoughts is through examining the evidence. For example, “I’ve done well on the other exams in this class, and I’ve studied for this one and understand the material, so there’s really no way that I will get a bad grade on this test!”

During clinical hypnosis, your teen is led through a series of guided imagery/visualization exercises that leaves her feeling safe, relaxed, and alert. Then, once your teen feels open to change, she is encouraged to create individualized strategies and build skills to prevent or better control her specific challenges. And, like any other skill, it will improve with practice.

An example of this might be for a baseball player who has struck out a few times in a row. When he goes up to the plate, he feels anxious because he is expecting to strike out again. He can visualize himself swinging the bat well and confidently because he has the skills to do this. It turns out that when you visualize yourself hitting the ball well, the same areas of your brain are working as when you’re actually hitting the ball, thus creating stronger muscle memory.

Or if you get nervous when you perform in a play or a musical recital, and you feel calm while at the beach, you can imagine being at the beach while you’re performing. Practicing this visualization a few times a day leading up to the performance is key; don’t wait until you are on stage to try it for the first time.

Teens generally report marked improvement in as few as three sessions, often completely eliminating their distressing symptoms or greatly diminishing them; frequently enabling them to wean off any related medication. (This is true for both CBT and clinical hypnosis.)


What strategies have you used when your teen demonstrates anxious thoughts related to specific situations?

Has your teen tried CBT and/or hypnosis before, and was it effective?

Share your thoughts in the comments section below.
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Would you like additional guidance in this area? Los Gatos Teen Therapy provides individual teen therapy, family therapy, group therapy, parent support counseling, and in-home teen and family coaching 7 days a week, including afternoons, evenings, and weekends. For more information, contact us at 408.389.3538.

11 thoughts on “Managing Performance Anxiety In Teens

  1. Lindsay Smith

    I really like these practical tips for helping our teens to overcome performance anxiety! How we think about something really does impact how we feel about that thing and how we will react to or interact with that thing. Knowing that we have the ability to change our thoughts around it really gives us more power over our own lives. Dr. Lazarus mentioned one of the techniques that Dr. Burns teaches, examining the evidence. In his book “Feeling Good,” Dr. Burns explains many other techniques that also help people to change their thinking. It’s amazing how powerful these techniques are!

    1. jeffrey Lazarus, MD

      Dear Lindsay:

      Thank you, Lindsay, In addition, Dr. Burns’ book, When Panic Attacks, is also a very useful book. And, a relatively new book by Reid Wilson and Lynn Lyons, Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children, has a step-by-step approach for children, adolescents, and their parents.

  2. Robert

    Hi Dr. Lazarus, Thanks for writing about hypnosis and how it can help with performance anxiety. I understand that one tool you use is positive visualization. My question is about exposure therapy. For anxiety disorders, the big thing right now is exposing oneself to your worst fear and actually facing failure without any positive self talk (in order to avoid reassurance and other safety behaviors). When do you suggest one uses positive techniques such as positive visualization and positive thoughts vs when would you suggest exposure to the feared catastrophe. For example, in imaginal exposure, one purposely thinks their negative thoughts in order to habituate to the feared outcome, which is often so exaggerated anyway.

    1. jeffrey Lazarus, MD

      Dear Robert:
      You asked a great question!
      You are correct that for anxiety of any sort, one needs to face one’s fear and do it! And, for patients with obsessive compulsive disorder, exposure is one of the key components in treatment.

      As you know, there is a strong mind-body connection. So, when we become anxious, we experience that flight-or-fight phenomenon, with rapid heart rate, shallow breathing, sweaty palms, etc. And, in exposure therapy, not only do we have to recognize and accept the unpleasant emotional feelings that we experience, but we also have to recognize and accept these physical sensations. And, the physical sensations often create even more anxiety, causing a vicious circle.

      When I work with patients with anxiety and somatic symptoms, I ask them, “Which is getting in the way of your life more, that worrying or those sensations (often headaches and stomaches triggered by the anxiety)?” Then, we work on that component first.

      I find medical hypnosis to be extremely effective in tolerating the physical sensations, and cognitive behavioral therapy effective in understanding and therefore controlling anxiety.
      Medical hypnosis can also be helpful for anxiety. We are all taught about muscle memory. And, it turns out that mental imagery also helps with muscle memory. And, mental imagery can also lead to mental memory. So that when you visualize performing well in a musical recital, or performing well on the sports field, this can be very helpful.

      I would also like to make clear that therapy of any sort should be done by a licensed professional who is trained to use these methods, and that people reading your astute comments should not attempt to try exposure techniques on their own.

      I hope these comments help you and other readers.

      Jeff Lazarus, MD, FAAP

  3. Pat628

    I guess I never realized the importance of repetitive visualization and that the same brain paths are used when performing the actual functions. Makes total sense though. Also I wish I had started more positive self talk with kids facing challenges when the were younger. Never too late!

    Thanks for these very helpful articles !

  4. Carol Satterlee

    Dr. Lazarus, you have provided such an important article here around teens and anxiety. One of the most helpless feelings for a parent is when they just don’t know how to help their kids, particularly around something like anxiety and how it can manifest. Parents who seek out support as soon as possible give their kids an opportunity to learn early on how to manage this with effective skills. However I know how difficult it can be for both student and parent to know how, when and who to turn to. Your book suggestions are a good start as a way to ease into learning more about it and possible “home” solutions. Describing how effective CBT and hypnosis can be invites them to feel great hope to overcome their anxiety. Thank you.

  5. Carolyn

    Which approach would be the best for teens who are “afraid” of dancing in front of others (ex. , at a school dance)?

    1. Lindsay Smith

      Hi Carolyn, I think a combination of both techniques Dr. Lazarus explained would be the most effective. For example, your teen can talk with you about the specific negative thoughts around dancing in front of others and then look at the validity of those thoughts and change them to something more realistic and then also visualize him/herself dancing in front of others, really enjoying it and having a wonderful time.

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