Fear of public speaking is a common phobia. It can range from slight nervousness to paralyzing fear and panic. Many people with a fear of public speaking avoid public speaking situations altogether, or they suffer through them with shaking hands and a quavering voice. But with preparation and persistence, you can overcome your fear.
These steps may help:

* Know your topic well
The better you understand what you're talking about and the more you care about the topic, the less likely you'll make a mistake or get off track. And if you do get lost, you'll be able to recover quickly. Take some time to consider what questions the audience may ask and have your responses ready.

* Get organized
Ahead of time, carefully plan out the information you want to present, including any props, audio or visual aids you'll use. The more organized you are, the less nervous you'll be. Use an outline on a small card to keep yourself on track. If possible, take time to visit the place where you'll be speaking and review available equipment before your presentation.

* Practice, and then practice some more
Practice your complete presentation several times. Do it for a few people you're comfortable with. Ask them to give you feedback. Or, record it with a video camera and watch it so that you can see opportunities for improvement.

* Visualize your success
Imagine that your presentation will go well. Positive thoughts can help decrease some of your negativity about your social performance and relieve some anxiety.

* Do some deep breathing
This can be very calming. Take two or more deep, slow breaths before you get up to the podium and during your speech.

* Focus on your material, not on your audience. People mainly pay attention to new information not how it's presented. They may not notice your nervousness. If audience members do notice that you're nervous, they may root for you and want your presentation to be a success.

* Don't be afraid of a moment of silence
If you lose track of what you're saying or you begin to feel nervous and your mind goes blank, it can seem like you've stopped talking for an eternity. But in reality, it's probably only a few seconds. Even if it's longer, it's likely your audience won't mind a pause to consider what you've been saying. This might be a good time to take a few slow, deep breaths.

* Recognize your success
After your speech or presentation, give yourself a pat on the back. It may not have been perfect, but chances are you're far more critical of yourself than your audience is. Everyone makes mistakes during speeches or presentations. Look at any mistakes you made as an opportunity to improve your skills.

* Get support
Join a group that offers support for people who have difficulty with public speaking. One effective resource is Toastmasters, a nonprofit organization with local chapters that focuses on training people in speaking and leadership skills.

If you can't overcome your fear with practice alone, consider seeking professional help. Cognitive behavioral therapy can be a successful treatment for reducing fear of public speaking.
As another option, your doctor may prescribe a calming medication that you take before public speaking. For example, beta blockers (usually used to treat high blood pressure and certain heart conditions) have been shown to help. Some beta blockers are more effective than others. If your doctor prescribes a medication, try it before your speaking engagement to see how it affects you.
Nervousness or anxiety in certain situations is normal, and public speaking is no exception. Known as performance anxiety, other examples include stage fright, test anxiety and writer's block. However, people with severe, debilitating performance anxiety that includes anxiety in other social situations may have social anxiety disorder (also called social phobia). Social anxiety disorder may require treatment with medications, talk therapy (psychotherapy) or a combination of the two.

Daniel K. Hall-Flavin, M.D.

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