No-Pills Anxiety Buster

By Dr. David H. Rosmarin

Those dreaded oral reports in school. Clammy hands, shaky voice, pounding heart, fear of making a fool of yourself and being judged unfavorably… If this doesn’t describe you, it likely describes someone you know. Nearly 7% of the U.S. population in any given year has social anxiety disorder and many more feel anxious when they need to speak in public.

The most common strategy that people use to deal with fear of public speaking is avoidance. Routinely, patients who come to the Center for Anxiety with a fear of public speaking report having dropped one or more classes because of the requirement to give a presentation, or passing up opportunities to speak in public. Sure, this approach is a relief in the short run, but the consequences of avoidance are often quite significant, such as not having your voice heard at meetings, nervousness and loss of sleep before important engagements, and missed opportunities for career advancement and promotion.

If you have a fear of public speaking, what can you do about it?

First of all, we recommend writing down in great detail what it is that you’re nervous about. Are you concerned that you’ll freeze or stumble on your words? How about blurting out something that makes no sense? Or running away after you’ve started? After you’ve written out your “worst case scenario,” ask yourself honestly: If you had to make a wager of $1,000, would you bet that it will or won’t happen if you were to give a public speech? Almost always, this exercise leads to a recognition that one’s feared consequences are far less likely to occur than one feels.

The second step is to test things out with a “behavioral experiment” by actually speaking in public and trying to make your worse scenario come about. Go ahead: Try to freeze or stumble over your words. Our experience has consistently shown that people who are afraid of public speaking are often very gifted and can do a fine job if they’re willing to treat their speaking as an experiment (i.e., to simply observe what happens).

Of course, this latter step is easier said than done and can require treatment, but don’t fret: We are happy to lend a hand. v

David H. Rosmarin, Ph.D., is an instructor in the Department of Psychiatry at Harvard Medical School and Director of the Center for Anxiety in Manhattan, a clinical-research facility with a focus on the Jewish community. He can be reached at


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