John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Performance Anxiety & Stage Fright

RRP Treatment of Performance Anxiety & Stage Fright by Dr. Tkach

Information for Musicians, Music Students, and Public Speakers

Performance Anxiety, commonly called Stage Fright, is a common uncomfortable feeling. Just about every performer and public speaker experiences it to some degree at some times. Many people who appear happy and calm on-stage are experiencing it, but mask it well.

Why is it important? If performance anxiety is consuming 30% of your performance energy to keep a lid on the anxiety, it robs you of putting your whole energy into the performance. It distracts you. It prevents you from being all you can be. Plus, it just does not feel good. For people making public speaking presentations such as department seminars, class presentations, oral examinations, and lectures, it distracts from your ability to think clearly, organize your speech, and answer questions.

With 100% of your mental energy freed up, you will be surprised how well you can perform. The performance anxiety sort of locks you in a prison. RRP can set you free.

Settings for Stage Fright

Musicians experience stage fright (performance anxiety) when performing in public as soloists, as part of an orchestra or group, at student jury, and in private lessons with only the teacher present. Some musicians have more trouble with group performances that solo.

The most severe stage fright occurs with voice performers. When a pianist hits a key, he/she is pretty sure about what note is going to come out. Vocalists never know if they are going to hit the first note right. I have observed at student recitals that you can get a pretty good idea of how a vocal performance will go based on the first note sung.

Actors seem less inclined to stage fright because of the different nature of their performance medium. Being transformed into the characters they are playing, they seem less bothered by the presence of the audience. Nevertheless, actors are aware of the responses they are getting from the audience. Acting is a two way street and the presence of the audience influences the actors.

Professionals, who speak to groups, present seminars, or are taking oral exams, may find themselves freezing up and unable to speak. This is accompanied by dry mouth, nervousness, shaking, confused thinking, inability to speak, and dizziness.

Standard Treatments

  1. Propranolol (Inderal) is a beta-blocker. It does calm people. The problem is, performers tell me, that it dulls the mind. This can interfere with giving 100% of what you have to offer. Some people find propranolol very helpful.
  2. Desensitization Training involves doing performances over and over until it does not bother you anymore. Sometimes it just takes a few successful performances to gain one's self-confidence.
  3. Cognitive Therapy involves a team effort between you and the therapist to talk you out of your anxiety. Patients have told me this works well for them until they walk out of the therapist's office. Then the problem is back.

Rapid Reintegration Procedure

Rapid Reintegration Procedure (RRP) is a non-threatening new form of psychotherapy invented by Canadian medical doctor Edgar Barnett in August 2003. It is new, but evolved from his 40+ years of experience treating patients with phobias using hypnosis.

Dr. Barnett was born and raised in England and went to medical school in England. He has been doing psychotherapy for over 40 years. He has written two books on psychotherapy: 1. Analytical Hypnotherapy 2. Unlock Your Mind. His RRP evolved after 40 years of his experiences and ideas in treating patients with psychological problems especially phobias (fears).

I started training in RRP with Dr. Barnett in May 2004. Dr. Barnett and I have written a book about RRP: RAPID REINTEGRATION PROCEDURE.

What is RRP?

At first we thought it was a type of hypnosis or "waking hypnosis," and it may very well be. The problem with that is that hypnosis traditionally requires a procedure called induction, induction of a hypnotic trance. In RRP, there is no hypnotic induction done. You retain full consciousness and complete control at all times. So, what do you call that? We are thinking of calling it "RRP State." By that, I mean a form of altered conscious state unique to RRP. Dr. Barnett thinks that, since the doctor is talking directly to the unconscious mind, RRP involves some sort of enhanced consciousness.

The reason traditional psychotherapy often fails is that it requires people to reveal their innermost, private, secret, embarrassing or personal secrets. With RRP, you are not required to reveal anything you want kept secret. Some people chose to talk about some things, but that is up to you. I guide you, and I am there with you so you do not need to go through it alone. You won't go through it alone. But, you are not required to tell me anything you don't want to. That's why it is non-threatening.

I have an interest in RRP, but I am not a trained psychotherapist or psychiatrist. I do not prescribe psychotropic drugs. You may have heard that propranolol (Inderal) taken an hour before a performance will overcome stage fright. It is helpful. The problem is that Inderal is a beta-blocker and may impede, to some extent, the full skills you can bring to the performance. Beta-blockers prevent the racing heart beat and pounding in the ears. Some people experience low blood pressure with beta-blockers, and I have one patient who fainted from Inderal. For some people, Inderal impairs memory.

Dr. Barnett and I wonder if there is a non-drug way to achieve the same goal, a better way, a more natural way, a way that puts you in control instead of the anxiety in control. This is a trial of RRP to achieve those goals. It is an experimental study. We are trying to find out the efficacy of RRP for performance anxiety. You will hear me refer to the performance anxiety as "that uncomfortable feeling."

In the RRP session, you sit in a chair with your eyes closed in a relaxed state, and I guide you through recalling feelings and old memories. It is very simple, it occurs very easily, and it is not threatening. In fact, you will find it fun. You will feel alert, awake, and in control.

What you will experience is akin to daydreaming. Daydreaming occurs naturally. We just experience it and do not usually find it upsetting.

During RRP you will still be in control at all times. If something about RRP puzzles you, just ask me. If you want to stop and backout, of take a break, you will be able easily to do so with no harm.

The case of Joseph

Joseph, a French Canadian psychotherapist, is an amateur classical guitarist. He has been playing classical guitar for 10 years. He found that he can play alone, but when he plays in public, he forgets the notes or just stops playing and cannot get back into it. In RRP, the feeling of performance anxiety carried him back to a memory a few years earlier when he was going on sabbatical. He was able to let go of the uncomfortable feeling at its origin and to imagine himself playing comfortably.

I have had similar experiences with cello players, piano players, vocalists, trumpet players, and guitarists. Stage fright may hit vocalists hardest of all. Students making seminar presentations before faculty are benefited.

Joseph's RRP was done by Dr. Barnett and videotaped by Fig Newton, Ph.D. a famous clinical hypnotherapist. This was the first RRP case videotaped. It was my introduction to RRP and started my RRP career.

The Case of K.

This 17 year-old suffered from 8 years of stage fright that inhibited her cello performances. Everyone in the orchestra agreed that she should be 1st cello, but sitting directly exposed to the audience caused her to be nervous and distracted, and made her bowing hand shake.

A one-hour session allowed her to resolve the repressed conflict behind her stage fright. She left seeming more mature and confident. Over the next five years, K did well with many public concerts, recitals, and performances with two symphony orchestras and a cello ensemble. She performed here and in other states and nations. I have watched many of her performances.

The Case of I.

I. was a 16-year-old gifted voice student who suffered from stage fright causing her voice to fail during public performances. In front of her voice teacher and small groups of friends, she performed very well. He teacher brought her to me.

Her 1 hour and 30 minutes session allowed her to identify a source of trauma at age 9. She was able to identify traumatic events at age 9 which she was able to resolve. She was able to resolve the conflict. She got her smile back.

Her teacher told me that after that session her stage fright was gone and she consistently performed well. Three months after her RRP session, she had a particularly stressful performance out of state and did quite well.

Risks of RRP

Dr. Barnett and I think RRP is safe. However, there is something you should think about before deciding to try RRP. What will your life be like once you have achieved freedom from stage fright? If you have been a victim of stage fright for years, you have built up a life style, and those around you have adjusted to it. RRP is really like being set free from a prison.

Dr. Barnett has treated hundreds of patients with RRP and has found no negative consequences. RRP is new, and there is no history of adverse outcomes. The main risk of RRP is failure to get results. But, Dr. Tkach and Dr. Barnett feel that RRP is highly likely to get results. When results are slow to achieve, it may require multiple sessions.

Uncovering forgotten old traumas can be distressing, but finding and working through such critical events is the whole point of therapy. You will not go through it alone. Dr. Tkach will be with you every step of the way. If you become too uncomfortable, just open your eyes and stop the session. Then talk about it with Dr. Tkach before resuming RRP. You will not be required to do anything you do not want to do.

The main concern therapists generally have is suicidal ideas. If you are feeling suicidal, tell Dr. Tkach, and he will help you to work on that.

How will your significant others and family and friends react when you suddenly stop acting that way? There are social implications.

RRP Results

RRP results are immediate and dramatic. When you have achieved results in RRP therapy, there will be no question in your mind about it. Your whole attitude about performing will change and surprise you and others. You will be delighted. You will be looking for opportunities to perform. As I have said before, it is like being released from jail and given all the respect, rights, and privileges of a normal citizen, a first class citizen.

If at some later time, you experience a recurrence of the old uncomfortable feeling, I recommend another RRP session to find out what stirred it up and to correct it. During the trial period, RRP is free even if we need to do several sessions. Hopefully, your work with me will help you to learn how to do some of the RRP yourself.

RRP does not replace your need to study, practice and master the material, whether music, public speaking, or for oral examinations.

We are seeking volunteers to participate in the trial study. Because it is experimental, and because I am still learning it, there will be no charge for the trial sessions. To enroll in this limited trial, you must do the following things:

  1. Determine if you want me to help you.
  2. Make a commitment to work with me. That will be very easy. I won't ask you to do anything difficult. You will find it easy to work with me.
  3. Obtain a letter of referral from your teacher, doctor, or therapist if possible.
  4. Agree to have the sessions with me videotaped for Dr. Barnett to review and for me to study them.
  5. Call my secretary to schedule yourself for RRP. 587-5442.
  6. Come to my home on a Saturday morning or several Saturdays. If you are not going to come, you must call my office two days in advance and cancel. I am doing this in my spare time, and I don't have much spare time. If you fail to show up for your session, you will be dropped from the study. I'd like you to bring your teacher or a friend for a chaperone. If you cannot, please let me know. Musicians, who feel comfortable, bring your instrument.
  7. Send me a letter at 6 months, one year, two years, and three years letting me know how you are doing.

You will have to read and sign a copy of this with the release form before being seen by Dr. Tkach for RRP.

Learn more about the Rapid Reintegration Procedure or buy a copy of Dr. Barnett and Dr Tkach's book.