Professional Help

Day 9 Topic 10

Big idea
Performance anxiety is real—and sometimes it’s amplified by treatable health factors (body or brain). Getting evaluated can open doors: targeted therapy, medical fixes, and a steadier voice and mind.

When to add a pro
• You’re working the tools (breath, Observe, visualization), but symptoms still slam you.
• You have red flags: fainting, chest pain, severe shortness of breath, or thoughts of self-harm. (Urgent/ER or campus crisis line now.)
• You suspect medical contributors (palpitations, heat intolerance, fatigue) or trauma history. National Institute of Mental Health

Hidden amplifiers to check (all treatable)

1. Thyroid overactivity (hyperthyroidism) — can mimic anxiety: tremor, palpitations, heat intolerance, restlessness. Treating thyroid can reduce these symptoms. MedlinePlus+1
2. Iron-deficiency anemia — linked with anxiety, palpitations, fatigue; treatment improves symptoms. PMC+1
3. Autonomic issues (e.g., POTS) — fast heart rate on standing often misread as “anxiety.” Proper diagnosis changes management (hydration, salt, compression, targeted exercise/meds). PMC+1
4. Sleep problems — chronic insomnia worsens anxiety and focus. CBT-I is first-line and effective. PubMedAmerican College of Physicians Journals
5. Voice-specific strain — muscle tension dysphonia or reflux can make phonation feel scary, spiking anxiety. A laryngologist + SLP can assess and treat. Duke HealthASHA
6. Social anxiety disorder (performance-only) — a recognized pattern; CBT/ACT/exposure and, when needed, medication help. National Institute of Mental HealthNICE
7. Trauma history — trauma can sensitize the alarm system. Evidence-based care (EMDR, trauma-focused CBT) reduces symptoms and improves functioning. PTSD VACochrane Library

Your step-by-step pathway
• Step 1: Primary care visit — “I have performance anxiety. Please also rule out contributors.” Ask about: TSH (thyroid), CBC/ferritin (iron), vitals/orthostatics (POTS screen), medication/caffeine review, sleep screen. MedlinePlusPMC
• Step 2: Voice team — If you have chronic tension/hoarseness, ask for laryngologist + SLP evaluation (may include videostroboscopy). ASHA
• Step 3: Mental health clinician — For performance-only or broader social anxiety, request skills-based therapy with exposure (CBT or ACT). NICE guidelines support these approaches; meds (often SSRIs/SNRIs) are options when indicated. NICE+1
• Step 4: Sleep specialist or CBT-I — If insomnia is present, treat sleep first; it lowers baseline anxiety. PubMed

Words to use (copy this)
“I’m a singer. My anxiety spikes in judged performances. I’m building skills and want a full check for medical contributors (thyroid, iron, hydration, meds), a voice team referral if needed, and skills-based therapy with exposure. I’m open to meds if recommended.”

Coach wrap
More info = more options. Testing and trauma-informed care aren’t “extra”—they’re part of your instrument care. Your voice rides on your body and your brain. Getting both tuned is strength, not weakness.