Episode 1: Public Speaking Anxiety & Fear of Being Noticeably Nervous: Mind Surgery for High Performers

I'm going to start with what I think is a dramatic story. Patient number one, not in any specific order other than for the flow of this podcast, was a well-known motivational speaker in the finance industry. He contacted me at age 53 after a three-year breakdown driven by performance anxiety. He literally was off the grid for three years. Flash forward, he's live in front of 16,000 people in a sports auditorium. He asked, "Anybody know what a phobia is?" Some responses, fear of spiders, fear of flying. He countered with, "I may be up in front of you now, but I have suffered from public speaking anxiety and went on to describe in detail some of the symptoms that he experienced during his panic, which resulted in his breakdown." He added, "If I'm up here in front of you now, you can be proactive with the things you need to do. After the speech, he got a standing ovation. One person came up to him and said, "Did you find Jesus?" Now, I don't make up any stories. Obviously, it takes balls to say what he did. It also takes a lot of skill and high performance to get to the point that he was in front of 16,000 people. The clinical point here is that with his dramatic behavior, he took himself out of defense. By being open, he took the pressure off of his nervous system. It had been this accruing pressure on his nervous system that resulted in his performance anxiety and subsequent nervous breakdown. Now, let's be clear here. I'm not suggesting that you get in front of a group and tell people you have performance anxiety. My intention is to drive home the point that you can only resolve an anxiety disorder by playing offense. There's no way it can be resolved by playing defense, which most people who come to me for treatment are experts with. The metaphor that I use in treatment is with football. Typically healing, whether facilitated by treatment or self-help, requires an immersion in cross-training and paradoxical approaches. With my patients, I say, "You're the quarterback and I'm the coach. You're Tom Brady and I'm Bill Belicec. Of course, that's before his trade to Tampa Bay." The quarterback may drop the ball or throw an interception, but he takes responsibility for creating motion. Even an act of learning are what is needed to resolve performance anxiety. If the football metaphor doesn't resonate, you need to be the pilot of your ship or plane. You need to drive the healing process with intention. Intention is the key word. It means the effort of focus. One more very important point to this story. Patient number one was going to do a clinical interview with me to add to the free clinical library at socialanxaddy.com. I strongly suggest you listen to the one of a kind interviews, which features successful executives, salespeople, professionals, and entrepreneurs. If you listen carefully, you will get insight into the healing process beyond the testimonial. One day, number one didn't show up for an appointment, which was very unlike him. Long story short, he was in a boating accident and later communicated to me, "My personal and professional life is on hold. I never heard from him again." The moral of the story is people make plans and God laughs. This is a segue into a super important question. Do you know what your most valuable asset is? Think for a moment. It's not your bank account, your mortgage, or even your career. Your most valuable asset is time. Time is not elastic, it doesn't stretch. You can borrow money, you can't borrow time. To resolve performance anxiety and public speaking anxiety, a proactive approach needs to be integrated into your time economy. When is the last time you left your home to go somewhere, to the store, to a friend, to work, on a date, for a lecture, for a presentation? Wherever you went, you had a map in your brain. You knew what streets to make turns on, what numbers to look for. Think of this podcast as your map for resolving your public speaking anxiety and fear of being noticeably nervous. Think of the content here as a surgical strategy and cross-training. The reality is that no one contacts me for public speaking anxiety without a significant problem. The biggest mistake that individuals tend to bring into treatment is regarding how ingrained the problem has become. Make no mistake please. This content is for those who understand they have an anxiety disorder. It's based on a clinical protocol. It's not about organizing your notes, developing content, picturing people in their underwear or practice, practice, practice. Patient number two, early fifties, is the number two person in a Fortune 500 company. Patient number three, also in his early fifties, is head of sales for a television network. Patient number four, also early fifties, there's a pattern here, developed a brilliant software program and a business worth 500 million. Patient number five, age 45, is a genius in complex systems in Silicon Valley. Patient number six, age 42, is an expert in international accounting, working for a top accounting firm. All suffered from significant public speaking anxiety and the fear of being noticeably nervous. These individuals were at pivotal and crisis points in their careers due to performance anxiety. All obviously were blessed with a variety of skills that resulted in their career success. All were in significant pain due to their anxiety. Pain is an important word. All feared that being noticeably nervous would ruin their careers. All resolved their anxiety disorder in treatment with me. Across the board, they communicated, "This is the hardest thing they've ever done in their life," meaning treatment. What they were specifically referencing is the process of introspection or looking into oneself. The typical public speaking anxiety sufferer will do anything to avoid this process, wanting to rely solely on technique. This thinking results in a low ceiling for potential success. High performance resolution to the problem requires an integration of technique and core work. Technique includes a variety of tools. Core work is discovering the root of the problem and resolving the relevant emotional energy. At number 7, the owner and CEO of a 25 million-year business in the Midwest, and a former catcher for a Division I University said, "There has been no one to hold me accountable, meaning for his anxiety and mental health issues." Indeed, many anxiety sufferers at the top of business systems can delegate challenging situations to their subordinates and avoidance. When avoidance of the challenge occurs, anxiety has evolved into euphobia. The fear of being noticeably nervous is driven by uncontrolled adrenaline. It can manifest in a variety of ways. For example, fear of blushing, fear of sweating, fear of stammering, fear of verbal freeze, dissociation and full-blown panic attacks. This fear can bring the most successful business people to their knees, humbled and overwhelmed with thinking that goes something like, "If they can see I'm nervous, they can see who I really am. If they can see I'm nervous, I'm not good enough." As one exec said, "If I go on CNBC and have a panic attack, the stock of the company will go down." At age 42, patient number eight was making two million a year as an investment banker. He wanted to be a team leader. That said, it took him two years to work up the courage to go to toast masters. Once, at a holiday party, everyone put their business cards in the fishbow. For the card that was picked, the winner would win one million American express points. He was praying that he wouldn't win. Why you might ask? Because if he did, he would have to be in front of the group and say thank you. This would risk exposing his nervousness. It's important to consider the diagnostics of public speaking anxiety. Remember, this is a clinical program. There are layers to this. I'm going to keep it as simple as possible. Basically, to measure the degree of the problem, there are three primary variables to consider. Number one, the degree of avoidance of the anxiety situation. Number two, the degree of internal mind body or psychophysiological discomfort during the performance challenge. For example, are you having a panic attack? Are you dissociating? Number three, the degree of obsessive rumination pre and post-performance. As we move forward in this discussion, consider these variables as interchangeable with the term pain. Consider the following. Carol was an ovarian cancer survivor who said, and I quote, "I would rather be back in chemotherapy than speak in front of a group." She explained, "With cancer, there's no judgment." Her interview titled, "I'd rather be back in chemotherapy than speak in front of the group," is at socialanxade.com. Take in a deep breath now, listen to me, inhaling the oxygen, exhaling the tension. What number, on a scale of 1 to 10 with 10 being the highest, is your level of pain. Let's get back to diagnostics. This can get a bit complicated. For example, patient number nine, age 46, is an entrepreneur in commercial real estate. He made a lot of money and was very philanthropic. He had a children. His wife would complain that he did not give enough attention to the family as he was always busy. They had participated in marriage therapy with no success. Given that number nine was always busy and distractable, it was easy for his wife to come to the conclusion that he suffered from ADD, attention deficit disorder. In fact, he did have ADD characteristics. That said, the priority clinical issue for him was his compulsion to detach or disconnect from emotions, compulsions the key here. Any behavior that did not feed his compulsion, he had no interest in. He needed to be always busy, always on, always solving problems, always helping, always making money. The way he did this, which is common to many of my patients, is efficiency at creating external stimuli. Not only did he build a successful business, but his charitable investments were also a huge component of his time economy. There was no time to go inside. And when he attempted this, it created anxiety. Understanding OCPD, that's not OCD, although it's very intertwined, is essential for healing. The primary component of obsessive compulsive personality disorder is perfectionism, which is a symptom of insecurity. For more of an in-depth discussion, you may want to read toward a clinical understanding of obsessive compulsive disorder as etiology of social and performance anxiety. You can access this article at socialanxadi.com, Tip of the Month Club, March 21, 2016. A relatively common diagnostic, impacting public speaking anxiety sufferers, is dysthymia. That's D-Y-S-T-H-Y-M-I-A. The specific DSM criteria is, and I'm quoting here, a depressed mood for most of the day, for more days than not, as indicated by subjective account or observation of others for at least two years. To dumb this down, think of it as an ongoing state of not being happy enough, which can be significantly influenced by performance anxiety. For example, if you had an important presentation on Monday, would you be able to enjoy your weekend? Patient number nine was the go-to guy for public speaking for his hedge fund. Six months before his yearly presentation to the Board of Directors, his obsessive worry was a significant source of agitation. Only his wife and I knew of his condition. Many of the salespeople with whom I have worked have experienced an obsessive worry-driven burnout on a quarterly cycling basis. For example, patient number 10, the head of a sales team, projected 28 million for the quarter. When the reality of 22 million kicked in, he suffered from panic, which mimicked a heart attack and a suicidal ideation, thinking briefly, he should jump out of his 14th story window of a hotel during a professional conference. The degree of obsessive worry is an important diagnostic. Patient number 11 in his early 50s was offered 120 million for his business. That said, he experienced selective mutism in business meetings, rendering him dependent on his partner to do the talking. The more his anxiety accrued, the more he became depressed. The many years of a build-up of performance anxiety concurrent with his adaptation to the covert world, put him over the top, resulting in paralyzing depression. He said, and I quote, "No matter how much anxiety I ever had, I was always excited to make money, watch my stocks grow, play tennis, take my kids on vacation, have sex, go to my summer home, enjoy my pool, buy new clothes, dry my porch, have a few drinks, now I don't." If this sounds over the top, remember the title of this podcast, "Empowerment for High Performers." Staying with Diagnostics for another moment, selective mutism is important to consider here. In essence, selective mutism is a speaking phobia. More specifically, it's a complex variation of obsessive compulsive disorder. Most of the information online and clinically is regarding children, but believe me, the children grow into adolescents and into adults. I've worked with a ton. There's a lot of content on this subject at socialanxiety.com, area of concern, selective mutism. The fact that texting has replaced talking as the most common form of communication may not resonate with you, but for me, having been born in 1950, it's a mind-blowing fact. Society's adaptation to technology has created a challenge for many regarding the accessing of neural pathways required for verbal communication. Here's a common scenario. An individual experiences panic during a business or group meeting. This can be traumatic. The experience of loss of control becomes embedded in the individual psyche. From this point on, hypervigilance and obsessive worry that the panic can occur again can become overwhelming, which leads to the strain of hypervigilance. Hypervigilance is a state of increased alertness. It's the state of being highly or abnormally alert to potential danger. Hypervigilance is when your internal radar is working over time. Hypervigilance can be a bitch. Hypervigilance is the result of trauma, whether acute, chronic, or complex. I experience hypervigilance. A few years ago on Memorial Day, I lost my internet connection in my East Hampton home. Without any observable trigger, it went off, and it went on, and it went off. On and off, on and off. Neither optimum's text nor my personal text could figure it out. No one could figure it out. I was at the mercy of the universe. I was anxious, angry, frustrated, on edge. I'd be at a beautiful beach during the day, and my mind would go to internet anxiety, with the computer beyond when I return home. After all, I have a lot going on, online. My wife was getting crazed, I was getting crazed. After three months of living with this on and off anxiety, the problem was apparently fixed, something to do with IP addresses, that no one was able to previously figure out. I'm knocking on wood right now. This was trauma for me. My sense of control and security were threatened. This episode left me with something I call click anxiety. Any time I click on a technical device, and there is a glitch or delay, my mind reflexively goes to a negative place. Okay, so I put an internet satellite on my roof for a backup strategy. I've learned to compensate effectively, but the worry never completely goes away. On a more ingrained level, after experiencing a kidney stone, which required surgery a couple of years ago, I've become extremely sensitized to any internal sensations that remind me of that trauma because it absolutely rocked my world. These are examples of conscious trauma. When a patient has detached from traumatic content, it's crucial to develop empowering strategies to go inside to bring relevant content vertical to a conscious level. Watchmen is a defense mechanism. It's disconnecting from troubling emotions, thoughts, and memories. The belief goes something like, "If I don't think about unpleasant and troubling content, I'll be okay." The problem is, this unresolved, repressed, emotional energy is recycling right beneath the surface, ready to be triggered at any moment. Without the process of bringing relevant content to a conscious level, anyone suffering from performance and social anxiety will be limited in their attempt to create the high performance mind. In other words, without identifying relevant emotional energy in one's reservoir, this energy can be triggered when you don't want it to. It can render one helpless. The longer hyper-visual and driven obsessive worry is present, the more ingrained it becomes. It accrues and worsens with time. For example, let's go back to patient number four. Number four developed brilliant software as the core of his $500 million business. When he first contacted me for treatment, he experienced a 24-hour episode where he lost his memory. Fearing a stroke, his wife brought him to the hospital at which point the physician said and I quote, "This is a once-in-a-lifetime situation where you lost your memory because of a build-up of stress." Dealing with the many challenges inherent in his business and personal life, with the added component of public speaking anxiety, he imploded. In his early fifties, he was in commercial real estate. He was six foot six and had played semi-pro baseball. He said to me at the beginning of treatment, "Your book was great but don't insult me by saying something about my past is related to my current problem. We were totally incompatible." Please listen now to breathing instructions and then we'll actually do it. You're going to take in a deep breath, inhaling the oxygen slowly through your nose and pacing your exhale through your mouth to my countering from four down to one. Let's do it now. Inhale and slowly exhale, four, three, two, one. One more time. Moving the oxygen and slowly exhaling the tension, four, three, two, one. When was the last time you experienced performance anxiety? I'm sure you remember where you were and what you were doing. Do you know what was going on internally? Many people answer this question with its fight or flight. That's correct. Let's be more specific. Your internal radar sensed danger and the threat of judgment. Once the adrenaline was activated, your internal critical script, when something like, "Oh no, holy shit, excuse my language, this is bad." This script activated the adrenaline and made it worse. Does this make sense? This is not the end of the story, however. The triggers in the environment that activated fight or flight also activated unresolved emotional content from your reservoir, which is your conscious and unconscious past and present. This energy has been repressed and recycling. It's been overflowing in the form of your anxiety. As one Harvard professor said in the seminar I attended, "When the trauma is resolved, there are no more triggers." Well said. Until relevant emotional issues are processed at a conscious level, the emotional energy will remain repressed. It will recycle and drive the disorder until it's processed. If you are building a house, it's important to have a solid foundation. If you want to resolve an anxiety disorder, it's crucial to understand the domains that will make the therapeutic foundation solid and secure. Therefore, think of the anachronymphate F-A-T-E, F stands for function and physiology. A is action or behavior, T is thinking or cognition, E is for emotion. Now you may have heard of the therapy called CBT or cognitive behavioral therapy. It's quite common and well-publicized. If the goal of therapeutic intervention is anxiety control, obviously, the domains of cognition and behavior are needed. That said, leaving emotion and physiology out of the therapeutic architecture is going to be extremely limiting. The claims made by the CBT community and its research regarding social anxiety as I quote, "the golden standard of treatment have been as egregious as Trump lying about the virus." It sets the consumer up for unrealistic therapeutic expectations. I've gotten so fed up with CBT's claims that I decided to research its research which is extremely flawed. Following the research on CBT and social anxiety can be found at the tip of the month club at the website, socialanxiety.com dated January 31, 2020. I'm going to cover the basics of the fate algorithm. First, let's discuss physiology. Interroception is defined as the sense of the internal state of the body. Internal awareness is a prerequisite for learning self-regulation skills. The challenge is that most anxiety sufferers find it difficult to go inside. I've never started a speech or presentation without my hands being cold. I'm not nervous, it's good stress. The Greek word is E-U-S-T-R-E-S-S, you stress. It's an awakening of energy. This is my physiology of performance. Cold hands means vasoconstriction. Warm hands are a manifestation of vasodilation. This is peripheral blood flow. A few years ago, as I was an hour before a two-hour presentation to a group of 600 people, my hands were very cold and damp. My adrenaline was flowing big time. I wasn't nervous. I wanted to be on stage, but the build-up of energy was uncomfortable while waiting for a release. Focusing on my cold hand temperature, I said to myself, "This is exactly the energy which when my patients don't accept in channel, they have a panic attack." The skill of identifying hand skin temperature, that's not body temperature, and it's relation to cognition and emotion, can be an important technique for self-regulation and interoceptive awareness. A tool to help accomplish this is the bio-card, which shows different colors as related to changes in skin temperature. You can get this card at the website for a dollar plus postage. If you get it, the instructions are, number one, use it regularly, make it a way of life. Number two, become an expert at knowing what the color of the card would be without having to put your thumb on it. Number three, when the card shows black or red differentiate between good and bad energy and stress. This is huge. Number four, when the card reads blue, relaxed, become proficient at describing your internal sensations. There's no such thing as good or bad with this card. One woman asked, "Does it really work?" "Yes, it really works as an awareness tool. It doesn't do anything to you." However, you may want to consider that the biofeedback technique of hand-warming as little as a few degrees Fahrenheit can abort a panic attack or stop a migraine. I once published an article titled "Hemorrhagic Diabetic Retinopathy and Temperature Training" based on a discovery that a patient was able to control his hemorrhaging with this biofeedback technique. This requires extensive training beyond basic awareness. Let's go deeper now on to part two. [end]