The Stress Cycle
To understand the impact that stress has on public speaking, we need to go back thousands of years to the time when humans lived in a cave and had to worry about the saber tooth tiger that might enter the cave and hurt them and their families. Primitive humans developed a fight-or-flight response, which prepared them to fight the tiger or to flee and run from the cave to protect their families. When this primitive response is elicited these days in a person who perceives a threat or danger — such as getting up to make a speech to a group he or she has never met before — several events take place. With the perception of imminent danger, the nerve cells release chemicals such as adrenaline, noradrenalin, and cortisol into the bloodstream.
The release of these chemicals triggers blood flow away from the digestive tract and pelvis into the muscles that control the limbs, making it possible to run away from the danger. Heart and respiratory rates also increase, providing the additional oxygen necessary to make those legs run faster than the tiger. Other changes include dilated pupils, improved eyesight, increased awareness, and the ability to be clearly focused on getting out of harm's way. The immune system is activated, and even the ability to perceive pain is diminished, making it possible to get out of danger even if you have been injured by a bite from the tiger.
This hardwired stress response is your body's way of protecting you from danger. If the stress response is working properly, it helps you stay focused, energetic, and alert, and ready to channel that negative stress into good stress (i.e., eustress) and give an outstanding presentation. In an emergency, this same stress response can save your life, giving you increased physical strength to protect yourself and loved ones.
When the fight-or-flight reaction is triggered, the human body is flooded with cortisol and adrenaline, making you strong and ready to take on the danger of that saber-toothed tiger at the opening of the cave. It is this very reaction that allows a soccer mom to pick up a car off a trapped child — something she would not normally be able to accomplish under nonstressed conditions. So the fight-or-flight response helps to preserve our species and protect us from outside dangers and stressors. When we face very real dangers to our physical survival, the fight-or-flight response is invaluable. It is this same fight-or-flight response that is elicited when we are introduced to make a presentation, and we move from the audience or from behind the curtain to the podium.
Stress Relief
The first step in successful stress relief is the recognition that stress is part and parcel of the public speaking process. Public speaking is known to be the greatest fear, even greater than the fear of death,[1] experienced by nearly everyone before giving a speech in public, especially if the speaker does not know the people in the audience. The symptoms of excessive stress include a fast heartbeat, fast breathing, sweaty palms and sweating in general, back pain, a stiff neck or tight shoulders, and urinary symptoms such as frequency and urgency.
Controlling the Butterflies
To tame the butterflies associated with public speaking you must perform an "anxiety bypass." In essence, you are training your body not to overcome the anxiety, but to channel the powerful physical responses into a more energized speech or performance. Just as an athlete cannot expect to run a proper race without stretching and training, you cannot expect to speak clearly and effectively in public without a vocal–physical warm-up. A warm-up consists of rehearsal using cognitive behavioral training techniques, the first steps of which involve relaxing and limbering up your body.
Warming up your whole body involves limbering up your spine, shoulders, arms, and legs; warming up your voice involves relaxing and stretching the smaller facial and jaw muscles as well as your vocal chords, or the vocal folds, located in your trachea. We recommend warming up large muscles first (your full body), then moving to warm up the smaller vocal-oriented muscles. The following sections describe a few techniques that professional actors and storytellers use when preparing to speak in public.
Full-body Stretches
Begin the stretching exercises by standing up and placing your feet about shoulder width apart, microbending your knees so that they do not lock while you stand (this helps you avoid passing out as you stretch!). Roll your shoulders back a few times. Take your hands and clasp them behind your back, roll your shoulders back again, and stretch down to the floor with your clasped hands — you will feel a good stretch again in your shoulders and upper chest. Roll your head from one shoulder, down to your chest, then to the opposite shoulder, then reverse. Avoid rolling your head all the way back, though, because this can damage your voice.
Stretch your hands up toward the ceiling, keeping the microbend in your knees — stretch all the way to the tips of your fingers. Reach with your right hand toward the left wall, placing your left hand on your hip to stabilize your balance. Repeat with your left arm, stretching the left hand toward the right wall with your right hand on your hip. You should feel this stretch all along the sides of your torso.
Bring both hands back up, stretching with the tips of your fingers toward the ceiling. Drop your head, let your shoulders droop, and follow the weight of your head and dangling arms to let your upper body dangle toward the ground, keeping your knees bent. In her book Freeing the Natural Voice, professional vocal coach Kristin Linklater suggests fully relaxing your neck in this position by nodding your head while letting it droop.[2]
The tendency when you come back upright is to lead with your head — but this re-strains all the lovely neck muscles you have just relaxed! Instead, beginning with the base of your spine, roll yourself back up one vertebra at a time, saving your neck and head for last. Repeat this stretch a few times, fingers to the ceiling, then release your hands, arms, head, neck, and shoulders, and allow yourself to droop to the ground, then roll yourself back up. This is called "taking yourself to zero," a way not only to relax your muscles but also to get them ready to spring to action — you are now poised in a state of balance.
Vocal–Physical Stretches
Yawns can work wonders to stretch and relax your jaw muscles — and you can make yourself yawn at any time. The key in using yawns to relax your jaw is to not chomp or bite down on the yawn at its conclusion — this tenses your muscles back up and defeats the purpose of this relaxing stretch. Try yawning as wide as you can, adding that good yawning sound as you open your mouth, and then, as you begin to close your mouth, leave your lips about an inch apart (Linklater recommends placing two fingers into your mouth to stop yourself from fully closing your mouth).
Linklater also recommends a tongue stretch. Linklater suggests placing the tip of your tongue behind your bottom front teeth and pushing outward with the middle of your tongue. Your middle tongue will extend out of your mouth, while the tip of your tongue remains behind your bottom teeth. You should feel the stretch all the way to the base of the tongue, deep in your throat where the trachea resides. This is a lovely stretch, but be warned: you can sprain your tongue doing this stretch too much, so three or four stretches will do it!
Massaging your jaw muscles is also useful. Take both hands and place your fingers on either side of your jaw, and while relaxing your mouth (let your lips part and your jaw hang loose) gently massage your jaw with circular motions, moving from the jaw hinges down to your chin, around to your upper lip and cheeks, and back to your jaw hinges.
Humming is a safe and effective way to warm up your vocal folds, especially in the morning. Apart from humming your favorite tune, making the sound mmm-wow, mmm-wow helps to stretch both your facial and vocal muscles. Try to open your mouth to its fullest extent when articulating "wow" — you'll feel the stretch.
Another useful warm-up is to pair consonant sounds with vowel sounds: buh buh buh ba, cuh cuh cuh ca, duh duh duh da . . .
Getting Oxygen in All Parts of the Lungs
To get oxygen deep into your lungs, roll your shoulders back, opening the chest cavity. Many of us breathe from our chests throughout the day, giving our lungs only short, shallow breaths and not the deep breath needed to support your speech. Take a deep breath, allowing your belly to expand as you inhale — you will feel your diaphragm muscles (resting at the bottom of your lungs) stretch as you take air into your full lungs. Remembering to breathe from your diaphragm: take deep breaths but don't hold your breath. Try to make the exhalation as long as the inhalation.
Increasing Endorphins
The easiest way to increase endorphins is to jog in place. Endorphins are some of the most potent painkillers but they also help oxygenate your muscles and increase the oxygen in all areas of your lungs.
Be Prepared: Not Just a Boy Scout Motto!
Even experienced surgeons get nervous before they touch a scalpel to a patient, and the most practiced actor or storyteller still feels his or her heart race before stepping out on the stage. However, with years of preparation, the surgeon becomes very comfortable providing care for his or her patient. The same applies to public speaking. If you are comfortable with your material, you have rehearsed, and you are warmed up, you will be in a much more relaxed state of mind and ready to give an outstanding program.
Visualization and Self-Talk
One way to help break away from your scripted speech and become more familiar with your talk is to "visualize" your speech or story. Visualization involves breaking your talk down into key movements or themes, and then concretely visualizing those themes so that you "see" each of the mini-stories you are telling in the overall "story" of your presentation.
Use the room itself to help you isolate and focus these themes. Begin your introduction addressing the full audience. For the first theme or topic, primarily address the left side of the room; for the second, address the middle of the room; for the third, address the right. At your conclusion, address the whole room once more. Rehearsing with this "blocking" (an acting term) will help you remember where you are in your speech as you move from point to point.
Jack Nicklaus, one of the most famous professional golfers of all time, used to prepare for big tournaments by closing his eyes and playing the 18-hole course in his mind, actually visualizing the club selection, the drive, the approach shot, and putting on each hole. You can do the same thing by closing your eyes and see the audience and see in your mind's eye their reaction to your presentation.
Visit the Venue
Test takers are often advised to study where they will be taking the examination. This is based on the positive relationship between knowledge learned in a place and knowledge remembered or recalled. We suggest that you do the same thing and become familiar with the venue where you will be speaking. You want to be familiar with the location of the podium, the kind of microphone you will be using, where the teleprompter will be if you are provided with one, and where you will enter after your introduction. If you just show up minutes before the presentation, you can expect to be more anxious and nervous because of the unfamiliarity of the venue. A few minutes to become familiar with the lighting, the stage, the microphone, and the audiovisual equipment will certainly help calm those butterflies.
Bottom Line: Public speaking is an art just like medicine. With preparation and proper warm-up, the butterflies can be coaxed to fly in formation. You can expect anxiety before a speaking engagement but with preparation and a few exercises, you will calm the jitters and just may get that standing ovation.
References
1. Zimbardo P. Shyness: What It Is, What To Do About It. Berkeley, CA: Perseus Books, 1977.
2. Linklater K. Freeing the Natural Voice: Imagery and Art in the Practice of Voice and Language. Berkeley, CA: Drama Publishers, 2006.
Excerpted from Communication Skills, Executive Leadership, and Career Growth for Physicians (American Association for Physician Leadership, 2025).
