Beta blocker band

I was in front of the entire company, and my mind was completely blank. Everyone was staring at me, including the company founders and the chief operating officer, who were conveniently sitting in the first row of chairs, right in front of me. That March morning in 2014, I was supposed to be detailing the incredible findings my MailChimp colleagues and I had learned from our first large-scale audience survey, but words—words I had written and practiced and chewed on—failed me.

I was able to read the words on each slide, but I neglected to set up why the information I was sharing was important, or how we collected it, or how it impacted anyone in the room.

I tried to make a joke, but—again—I blanked; I lost the thread halfway through my sentence. My face was flush, my forehead burned, and my breathing was labored. I muttered something about how what I had just showed everyone was the tip of the iceberg, and that they’d be blown away by the forthcoming report that summarized everything we learned about our millions of customers. But they were supposed to be blown away by the presentation.

What had happened was both a familiar feeling and a shock all at once. The same thing had happened to me numerous times before: I prepare a presentation or talk, I practice my delivery, I visualize the space, and I feel ready to conquer the world. Then, as soon as it’s showtime, the blankness starts and I’m surprised anew. And every time it happened, I’d tell myself, “Next time I’ll be even more prepared.” I kept pursuing speaking opportunities, even while joking about my greatest fear:

The only course of action that made sense to me was to keep practicing. I experimented with index cards (old school, I know) and different types of speaker notes (verbatim vs. bullets). Nothing changed. I knew I had a lot to say, but I wondered if maybe I wasn’t meant to say it to more than a couple of people at a time. Or maybe I should just stick to writing.

When I got home after that last MailChimp speaking fiasco, my wife asked me how my day went. I told her it did not go well at all. I described to her exactly what had happened, and how frustrating it was that I knew I had something valuable to say, but I was completely incapable of expressing it when I got in front of a large group. I hadn’t told her about my public speaking issues before.

My wife is a psychologist, and she had seen some clients with similar struggles. She recommended I see my general practitioner, as there is medication that helps this specific scenario. My doctor prescribed a beta blocker, propranolol. Beta blockers are a class of medication designed to lower blood pressure by blocking certain nervous system receptors. A fortunate coincidence is that the blocked receptors also happen to activate when we feel anxiety.

Some people require the adrenaline rush of being in front of a large group to do their best; for others the large group is kryptonite. My doctor explained that even professional concert pianists at the top of their game experience stifling stage fright, no matter their expertise, and that they rely on a beta blocker to prevent anxiety from interfering with a performance.

Now, about an hour before I give a talk or a presentation—whether it’s to my colleagues or a large conference—I take one pill. Once the pill kicks in, here’s what happens: nothing. I remain the same person I was before I got on stage. I am able to tell a linear story at a relaxed cadence, improvise a bit, and answer questions at the end. I feel like myself, which only reinforces my calm.

In an article on the topic in The Atlantic, Carl Elliott explained that “beta blockers do not alleviate anxiety so much as block the outward signs of anxiety.” Elliott goes on:

This is why beta blockers are so useful; people who have taken a drug that blocks the outward effects of their anxiety become less anxious—not because the drug is affecting their brain, but because their worst fears are not being realized.

I’ve spoken at many conferences since I started taking propranolol, and I’ve given plenty of presentations to my colleagues. I still get nervous every single time, but my nerves are no longer debilitating. And I end every talk with a sense of accomplishment: I was able to clearly articulate what was in my head to a large group of people.

Public speaking takes planning and practice—no pill will change that. But if you’ve done the work and put in your 10,000 hours, only to draw a blank when it matters most, the issue might not be your preparation. Sometimes the obstacle that prevents us from achieving what we know we’re capable of is our own physiology. Fortunately, that might be fixable.