Presentation Panic Attacks
November 14, 2010 3:45 PM   Subscribe

I have panic attacks when I start presentations. This isn't general nervousness - I feel fine leading up to the presentation, and usually chat with the group (between 2 - 20) people beforehand. But the second I turn to start the presentation, the adrenaline kicks in and I struggle like crazy to get through the first section. This is becoming concerning - aside from the trauma of the actual attack - because recently giving presentations has become part of my job. Any help?

Additional info:
yes, I understand what panic attacks are;
yes, I know that I could take Xanax but I would prefer to beat it, rather than medicate it;
yes, I know to consider my breathing and take a break/ make an excuse if necessary, but I've been asked to give a lot of presentations recently and there are only so many excuses I can come up with for leaving the room;
yes, I have a therapist and we talk about this;
yes, I've done research online and as a result have given up caffiene;
yes, I know that thinking about it re-enforces it....

I just kinda want/ need it to stop!

(Oh, and I have two presentations this week: I excused myself with "wait, I've forgetten something!" last week when the attack came on - I don't think this is going to fly again.)
posted by anonymous to Health & Fitness (23 answers total) 14 users marked this as a favorite
My advisor always says that we should have our speech during the first few slides completely memorized, word by word. It's very easy to get up there and freeze up right at the beginning, but once you've got things going you can ease up and just speak as the ideas come to you (which will be much more natural-sounding over the course of a talk). It sounds like a trick that would really help in your case.
posted by you're a kitty! at 3:49 PM on November 14, 2010 [3 favorites]

I'd actually say avoid memorizing...when I try to memorize I can get it in my head without having to look at anything, but that also means if I forget one little part I get completely stopped up. I see memorization as being like a train with many cars, but if you get stuck on one you can't move past it (alright, that doesn't make that much sense, but whatever).

I don't actually get panic attacks (so my experience might be a little different), but I do get VERY VERY NERVOUS when I have to give a presentation/speech. I start speaking too quickly, the adrenaline is coursing, and I suddenly feel like the breath is being choked out of me. With my last speech I was completely terrified, and it turned out to be fine and even enjoyable. I think the two things that definitely helped the most were:

1) PRACTICE-- There's no replacement for this; when you practice you just develop a comfort/rhythm with what you have to say. By the time you get to your presentation it's like just another go at saying the same thing. I used to skip this (ah, procrastination) but I didn't this last time and I'm sure it made a difference.
2) Don't have the whole thing (or even a large chunk) memorized, JUST your most important points. I think it's easier just to make sure to hit those important points--with all that other extra stuff you have some room for improvisation, you don't have to stick to it word by word.

Lastly, I hesitate to suggest this because I don't know how appropriate it is for your audience/industry...but I find it can be helpful to ease the tension by saying something joke-y or clever in the beginning. Not anything wild, or anything that would make things ten times worse if no one laughs. Just an offhand comment. I usually feel more relaxed if I can provoke a chuckle in the audience.
posted by sprezzy at 4:04 PM on November 14, 2010

I used to do this when I started playing music in front of people. I finally realized about a year into it that I wasn't actually staying calm beforehand, I was just DELAYING the adrenaline rush until the middle of the first song or so. Since I realized that, I decided it would be easier to stop trying to stay calm and let myself get nervous about 10 or 15 minutes before the show, going as far as to consciously trying to worry about possible issues, who is in the audience, etc. By the time I'm up there the initial jitteriness of the adrenaline has worn off and I'm focused.

If there's one thing to be said about that adrenaline rush/mild panic, it's that it seems to follow a predictable pattern. Once you learn to recognize it, you can shift it to your advantage.
posted by Benjy at 4:11 PM on November 14, 2010 [2 favorites]

I don't know if this would work in context for you, but in similar situations I've always found it helpful to say something like, "Forgive me for being nervous; presentations always do this to me." That way it's out in the open, and people will be on your side almost automatically. It's easy to root for the underdog. Clearly this wouldn't work in sharky Glengarry Glen Ross situations, but if it's just something informational where you're useful, it could work really well.
posted by lauranesson at 4:14 PM on November 14, 2010

Practice really helps me get past anxiety. Practice the first two minutes until you can do it on autopilot. When you get nervous you won't be able to think on your feet very well and might stumble -- unless your mouth just remembers the words and points you want to make because it is used to them.

I find it also helps to consciously breathe slowly; to think about the words as I say them so that they're not rushed; to ignore the temptations to add little asides further explaining a point (because tangents lead to stumbling); and in the preceeding minutes, to think affirming thoughts like "Relax", "I understand this material", "I will give a really good presentation", "the audience will be interested in the points I am going to make", and so on.
posted by PercussivePaul at 4:21 PM on November 14, 2010

While I understand your second point under "additional info" and I'm not going to tell you to try medication if you don't want it, I would encourage you to not dismiss using medication as somehow inferior to beating it on your own. For some people (and I'm not saying you're one of them), their brain chemistry is such that medication can really help get them over the hump so that the other coping mechanisms (breathing, pausing, etc) actually have a chance. The medication certainly doesn't do the work for you, it's just another tool.

Have you tried doing something a little athletic about an hour or so before the presentation? Even if it's just a brisk short walk, it might help you stay on an even keel.
posted by SugarAndSass at 4:36 PM on November 14, 2010

I have the same issue and have to present quite a bit. At first I thought the solution is to find a new job - that I just couldn't over come this. Drugs don't help, actually, they made me feel foggy and feel like I was out of my body. What really helped was experience - I did about ten presentations last year and the first five probably SUCKED. I was visibly nervous. But improved each time. My suggestion - make the presentation YOUR OWN. Tell it in your own words, your own style, use your own humor, personality. Own it. The folks in the audience just don't want to be bored. So try to level with them, tell them off the bat "hey, I don't want to powerpoint you to death today, so lets make this interesting/lets make this a discussion". Be as personable as possible and you'll get a better response. If folks start looking confused, stop and ask if there are any questions. Be your true authentic self - cut the caffeine, exercise or take a long walk, breathe a little deeply and have faith in yourself and be OK with the fact that the first couple of times you present may actually suck a little bit but that it will get better - and you will be OK.
posted by dmbfan93 at 4:49 PM on November 14, 2010 [4 favorites]

It used to happen to me quite a lot. I even understood the idea that people can't really tell that I am having a panic attack. To them, I am just this guy who is making a few more umm/ahh sounds than the average. But knowing this from reading about it was of no help.

What really helped me was seeing myself on video. I went through a communications workshop (mandatory training sort of thing) with about 20 people. One of the sessions involved making a 10 minute presentation to the group. The presentation was taped and then analyzed. The biggest takeaway for me was that I don't appear nervous at all. That was a turning point for me. I still get a bit nervous, but it is nowhere close to being the problem that it was.

Videotaping yourself isn't very expensive these days, and can even be done at home - but try to replicate the atmosphere of your official presentations (dress formally, have some printouts handy, a glass of water perhaps, a laptop etc.).

Also, even if you can't start the presentation with a quip about your nervousness or a jokey comment, you should try just smiling (assuming the content of your presentation isn't about something morbid). It really takes away whatever little nervousness the audience might perceive.
posted by vidur at 4:52 PM on November 14, 2010

You say you have no problem conversing with your audience before the presentation. So just start the presentation as an extension of the conversation. E.G. You have been talking to John about a point in your presentation, well make damn sure that conversation is relavent to your FIRST slide. Then begin the presentation by saying..."OK, John, recalling our conversation of a minute ago, I think I have some slides here that will clarify and expand...slide one relates to our conversation...etc.

In other words ease into the presentation by continuing the conversations. This will also act to involve your audience on a personal level.
posted by Gungho at 4:55 PM on November 14, 2010

Has anyone ever recommended Toastmasters to you? It's a club for getting better at public speaking, and there are chapters of it all over the place. It gives you a safe space to practice prepared speaking and get advice/encouragement from other club members.

The practicing really is the best part, to me. You just get so used to being up there and talking in front of people that it becomes familiar and much less freaky.
posted by cadge at 4:57 PM on November 14, 2010 [1 favorite]

I've never experienced the level of panic you descirbe, so I'm not sure if this will assist you, but a long time ago I learned a speaking tip that helped me a lot: "You'll never get rid of the butterflies in your stomach, but you can learn to make them fly in formation."

The awesome trainer who told me this added: don't memorize, because self-consciousness obliterates recall. Rather, form a visual map of your main talking points, the simpler the better, then write it down on an index card for reference, if needed.

She had a couple of other tips that helped me:

- For the time you are presenting, you enjoy the gift of their attention until such time as you squander it; generally speaking, audiences are predisposed to listen appreciatively.

- Remember that your audience cannot see inside of you. You may be freaking out, but if you don't let it show, they will never know.

- Take control of your space. Even if you don't feel confident, striding into the audience, looking at people as you speak, forms a connection that you yourself may not feel. But they will.

- Discipline yourself to eliminate the telltale body language of nervousness, such as white-knuckling the lecturn.

- Never apologize. It undermines your authority, and, therefore, your message.

Best wishes to you!
posted by Short Attention Sp at 4:58 PM on November 14, 2010 [5 favorites]

What you describe sounds very normal & common, so don't sweat it thinking you've got some particular kind of mental screwup. It's very normal.

Next up, some things that help me a lot:

- Memorising is OK, but I prefer just to run through key snippets of rhetoric in my head beforehand, in a semi ad-lib sort of style. But the key snippets kind of cement the talk in place, and then you can talk around those bits ("You're putting the cart before the horse if you approach widget-making in the wrong manner...")

- It's great for confidence to have small cards with dot-point notes to fall back on, if you feel you're getting lost. People often use Powerpoint in the same manner, but it's crappy to run a presentation by following Powerpoint - better if you try to do it off your own head, but with the cards as backup.

- Enrol in a Toastmasters club if you can. These are fantastic for improving your confidence & skills in a friendly & safe environment.

- Most importantly (for me): smile & look around the audience, making eye contact, especially in the beginning. This helps so much to relax you. People will often perk up a bit & smile back, which boosts your mood & confidence. I find it helps, too, to open with something casual & chatty - not a rehearsed joke but just something lighthearted to break the ice. In most situations, I find it's actually OK to say something slightly self-effacing like "Gee, I was hoping there'd be fewer people here today, because I'm not the biggest fan of public speaking..." - people will sympathise & somehow admitting your anxiety can help to instantly overcome it.
posted by UbuRoivas at 5:05 PM on November 14, 2010

One thing that can be helpful is to just notice when the anxiety starts and then think to yourself, "Yep, there's my anxiety. I know this always happens when I speak, but in the past I've been fine so I'm just going to allow the anxiety to be there and keep going with my talk." The key is not to fight against the anxiety. You just notice that it is there and proceed. Some cognitive techniques, such as reminding yourself that you have been anxious before and your talks have still gone fine, can also be helpful.

It is great that you have many opportunities to give talks in the future -- the worst thing you can do for anxiety is to avoid the situation. By virtue of your job responsibilities, you are essentially being required to engage in exposure, a very effective technique for the treatment of anxiety. If you're interested in a more formal introduction to treating panic attacks, you could pick up one of the many cognitive-behavioral treatment (CBT) manuals available online (you mention that you are "talking about this with your therapist," but I'm not sure if that means specifically CBT. FYI, CBT is extremely effective for the treatment of panic attacks)
posted by Bebo at 5:20 PM on November 14, 2010

one thing that i do (that i didn't realize i do) is that i talk the audience *through* my presentation as if i'm *one of them*.

that has the effect (for me) of turning the "evaluative" pressure off of me and onto the slides themselves.
posted by DavidandConquer at 5:24 PM on November 14, 2010 [1 favorite]

Have you tried beta blockers? Excellent side effect profile, none of the fuzzy alprazolam fuzziness. Got a fairly high-powered (as in has lunch with Bill Gates to sell him on donating to his cause) that swears by them. I've heard they are very popular with classical music performers.
posted by digitalprimate at 5:30 PM on November 14, 2010 [1 favorite]

I've posted a version of this once before, but I hope it might help. I didn't ever have actual panic attacks over presentations, but I was nervous enough that it made me a horrible presenter. No matter how well prepared I was, my notes would be rattling in my hands and I'd be talking a mile a minute without knowing quite what I was saying. Now, I love presenting -- it's one of my favorite parts of my job. 80% of that transformation happened in one session I had with a therapist who I was seeing many years ago for other reasons. Here's what she had me do:

Relax somewhere comfortable with your eyes closed. Picture yourself where you most would love to relax. Hang out there in your mind and enjoy for a few minutes. Choose a physical signal you can give yourself during the presentation -- I picked touching my thumb to my middle fingertip. Do this signal and keep imagining yourself relaxing in your selected place for a few more minutes, noticing the physical signal while you picture yourself there.

Now, imagine yourself in front of an audience speaking well, while everyone looks at you with interest and positive regard, and whatever other reaction you're wishing they'd have. Keep using your physical signal and noticing it. Visualize everything you can about the room, your audience, and yourself. Maintain your relaxation, or, if you feel it slipping, restore it by imagining relaxing in your selected place again, then switching back to your presentation.

Do all this a few times in the days leading up to a presentation, including as immediately before it as possible. When you get up to give the presentation, give yourself the physical signal. That's it. Unbelievably to me, especially since I'm not at all a new-agey type and this all seemed a little flaky to me, the first presentation after I did this went great instead of horrible, and they've pretty much all been going great ever since. Though I don't go through the whole routine anymore, I occasionally still give myself the physical signal right before I present.

I also sometimes pick someone who's not there to be my imagined audience -- someone who I know likes me, and who I like, and who would want things explained in clear, basic terms. (I often chose my grandma.) Good luck!
posted by daisyace at 5:53 PM on November 14, 2010 [4 favorites]

There is a crucial difference between anxiety and panic attacks that is not being reflected in every response here. Anxiety is butterflies in your stomach. Panic attacks feel like you're going to have a heart attack, quite literally. Tricks that nix anxiety aren't going to necessarily work for panic attacks, and might actually make things work.

The problem as I see it is that you've made presentations a trigger for your panic attacks. This is a difficult problem to solve. I wouldn't rule out drugs, as others have suggested - have you tried benzos? But if you don't want to go the drug route, you're going to have to find a way to remove the trigger. Maybe get some co-workers and simulate a presentation situation, or try to sneak into the room where you're going to present and go through it there on your own. Whatever you do, take it can beat it, but it will take a little time. Good luck!
posted by hiteleven at 6:07 PM on November 14, 2010

I just want to suggest to you that "medicating it" does not necessarily have to take the form of constant use of medication. I thought that if I "gave up" and used Xanax to deal with my panic attacks, I would be taking Xanax constantly. I thought this because at the time, my panic attacks were very frequent. What actually happened is that I used it three or four times, and then basically never again. It got me out of the pattern that I was in (of reacting to specific situations with panic) and once that pattern was broken, I didn't need to use the Xanax any more.

I'm sorry to be giving you an answer you didn't want, but I just wanted to make sure you knew that medication can work without being a constant presence in your life or body. I didn't really understand this before, and if I had, I would have been far less reluctant to try it.
posted by prefpara at 6:27 PM on November 14, 2010

Chiming in to agree with hiteleven and prefpara. I had this problem years ago when I used to give presentations for work. I tried everything, memorization, deep breathing, typing out my talks verbatim so all I had to do was read. The situation got worse and worse until one time I was curled up in fetal position on a hotel bed before one meeting, sobbing because I was so afraid of reading a damn report. hiteleven is right, it's a matter of having made the public speaking a trigger. Once you've had the experience of the flushing face, shaking voice, heart pounding, it's hard to train your body out of it. I think we become more afraid of the symptoms than of the actual performance.

For me, the only thing that worked was xanax. And like prefpara, I took it only when I had to speak (about three times a year) and only in very small dosages. That was all it took to get over the hump; now, I don't have nearly the trouble with speaking in public.

I have a friend who did CBT in combination with drugs for panic attacks, and had good success and ramped off the drugs pretty quickly. I'm in CBT now for other reasons, and do find it useful.

Best of luck.
posted by torticat at 7:12 PM on November 14, 2010

Whenever I argue something in front of a jury or judge, I write out the first couple sentences and have them in front of me. I find that I'm not nervous about speaking until right when I'm about to do so, but then I just read the sentences and start speaking and things seem to take care of themselves. Good luck!

(I don't recommend this, but back in law school I knew some people who would take a quick shot of whiskey before they had to argue in competitions.)
posted by lockestockbarrel at 9:08 PM on November 14, 2010

The more you do it, the better it will get. So voluntarily subject yourself to extra, outside-of-work opportunities to give presentations, like joining Toastmasters.

I used to be deathly afraid of public speaking to the point where I would stammer and freeze. So when I was in college I joined the speech and debate team. A year of that cured me completely, and now I can give presentations (including relatively off-the-cuff ones) without any extra nervousness over just regular conversation.
posted by Jacqueline at 9:49 PM on November 14, 2010

I used to get this way in graduate school. I see that you aren't willing to try medication, which personally, got me through many a horrific experience. However, it seems that you are doing okay. Yes, you have the panic attacks, but you are seeing a therapist and talking through your issues. The goal is probably not to stop the panic attacks, but rather, to deal with them. And from what I'm reading, that's what's happening. Carry on.
posted by Sal and Richard at 12:55 AM on November 15, 2010

I tend to freak out before presentations as well... one thing I do lately that seems to help (even if as a placebo) is to vacuum out my lungs. It calms me down and refocuses me.
posted by mammary16 at 2:56 AM on November 15, 2010

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