Government health pages describe several approaches to anxiety, and on beta blockers they differ from systematic reviews. NCCIH says anxiety disorders are generally treated with psychotherapy, medication, or both, and NIMH says cognitive behavioral therapy (CBT) is commonly used to treat social anxiety disorder. NIMH calls beta-blockers commonly the medication of choice for the "performance anxiety" type, while a 2008 systematic review says evidence for their efficacy in treating performance anxiety was lacking. This guide sets the sources side by side and does not decide between them.
Psychotherapy and CBT
NCCIH's page on anxiety and complementary health approaches (last updated September 2024) says anxiety disorders are generally treated with psychotherapy, medication, or both. As quoted here, it does not name performance anxiety or a specific drug.
NIMH's page on social anxiety disorder describes CBT as a research-supported type of psychotherapy that is commonly used to treat that disorder. That page is about social anxiety disorder, not performance anxiety alone.
A 1991 abstract on performance anxiety in musicians tested buspirone and CBT. It reports that CBT resulted in statistically significant reductions in subjective anxiety, improved quality of musical performance and improved performance confidence, while buspirone was not an effective treatment. The summary used here does not give the study's size or design.
Beta blockers: where the sources differ
| Source | What it says |
|---|---|
| NIMH, social anxiety disorder page | Beta-blockers can help control some of the physical symptoms of social anxiety disorder, such as rapid heart rate, sweating, and tremors. |
| NIMH, same page | Beta-blockers are commonly the medication of choice for the "performance anxiety" type of social anxiety disorder. |
| 2008 systematic review and meta-analysis | Evidence for the efficacy of beta-blockers in treating performance anxiety was lacking. |
| 2016 systematic review and meta-analysis | The quality of evidence for the efficacy of propranolol is insufficient to support its routine use in any of the anxiety disorders. |
The NIMH rows are patient information. The 2008 row comes from a review of placebo-controlled randomized trials of drug treatment for social anxiety disorder, and the 2016 row from a review of propranolol for anxiety disorders. The sources used here do not explain why they differ.
Benzodiazepines: tolerance and dependence wording
NIMH says that with benzodiazepines some people build up a tolerance and need increasing doses to get the same effect, and that some people even become dependent on them. An FDA Drug Safety Communication on the benzodiazepine drug class says benzodiazepines can be an important treatment option for treating disorders for which these drugs are indicated, but that even when taken at recommended dosages, their use can lead to misuse, abuse, and addiction. The same communication says physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed. These statements are about benzodiazepines as a class. The sources used here do not compare benzodiazepines with propranolol on these points.
What FDA says about off-label use
An FDA patient page says unapproved (off-label) use can mean a drug is used for a disease or medical condition that it is not approved to treat, such as a chemotherapy approved for one type of cancer that healthcare providers use for a different type. The same page says that if you and your healthcare provider decide to use an approved drug for an unapproved use, FDA has not determined that the drug is safe and effective for the unapproved use.
NIMH says health care providers may prescribe beta-blockers off-label to treat short-term anxiety symptoms, even though the medication is not approved for that specific purpose.
What this does not tell you
As quoted here, the NIMH statements are about beta-blockers as a group and do not name propranolol. These pages are general summaries, and none of these sources compares CBT, benzodiazepines and beta blockers head to head. The 1991 abstract was in musicians, and its summary here gives no size or design. The benzodiazepine wording is not a statement about propranolol, and the FDA page makes general statements about off-label use, not about propranolol. A licensed provider decides which approach, if any, fits a person.