The symptoms associated with performance anxiety, or the so-called stage fright syndrome, are similar to those of α and β adrenergic stimulation. Suppression of symptoms and improvement in instrumentalist's performance after β blockade suggest that this modality would be of benefit for singers as well. To evaluate the dose-effect relationship of β blockade upon singing performance and the possible effect of these agents upon performance maturation, we studied 34 singing students during end of semester juries, using a double-blind crossover paradigm. Students performed once with either placebo, 20, 40, or 80 mg of nadolol, and again 48 hours later, with placebo. There was a significant dose-related, limiting effect upon intraperformance cardiac rate. A small, but statistically significant, dichotomous effect upon performance rating was noted: low-dose nadolol tended to enhance performance, whereas larger doses impaired performance. We conclude that the effects of low dose β blockade upon singing are minimally helpful and high doses may detract from performance ability.
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