In this guest blog, Dr Kay Capaldi examines the links between performance anxiety, social anxiety, and the self-relationship, and explains how these insights have shaped a new Self-Relationship Training® programme. Read about the aims of the programme, and how to join a forthcoming pilot weekend.
ABOUT THE AUTHOR
Dr Kay Capaldi (www.drkaycapaldi.com) is a BACP-registered integrative psychotherapist, researcher, and university lecturer with extensive experience supporting performers. She is listed in the BAPAM Directory and specialises in the self-relationship, negative self-treatment (NTS), and social anxiety—areas she continues to explore through both research and clinical practice.
Drawing on these insights, Dr Capaldi developed the Self-Relationship Training® programme, which helps people develop awareness of unhelpful patterns, cultivate self-compassion, and build a healthier, more supportive relationship with themselves.
In this guest blog for BAPAM, Dr Capaldi examines the links between performance anxiety, social anxiety, and the self-relationship, and explains how these insights have shaped the Self-Relationship Training® programme.
BAPAM readers are invited to join a pilot weekend of the programme in central/South West London—an opportunity to experience the approach first-hand, provide feedback, and help shape its future. The pilot will be offered at a reduced rate of £95, with a Pay-What-You-Can option available for those in the performing arts community who may need additional support.
Participants will be invited to share their feedback, which will directly inform the next stage of the programme’s development. The exact date is yet to be confirmed, with the pilot planned for early 2026.
This programme is suitable for anyone experiencing challenges in their self-relationship, such as self-criticism, low self-worth, or harsh self-judgement. Places are limited, and participants will be selected based on suitability criteria. If you are unsure whether this pilot is right for you, please contact Dr Capaldi for a confidential discussion.
To register your interest or find out more:
Email: kay@drkaycapaldi.com
Please note that the Self-Relationship Training® programme and pilot are organised independently of BAPAM.
Introduction: Typical Nerves or a Clinical Concern?
Performance anxiety – often referred to as stage fright – sits on a spectrum. Whether it is a clinical concern or simply part of the typical experience of performing depends on its intensity, frequency, and impact on everyday life.
For many performers, some level of anxiety is expected. It often shows up as nerves, butterflies, or physical changes such as increased heart rate, sweating, or trembling before or during performance. Usually situational and mild to moderate, this form of anxiety rarely prevents performance. In fact, it can be adaptive, sharpening focus and enhancing preparation.
However, performance anxiety can escalate into a clinical condition when nervousness becomes intense, persistent, and disruptive. In such cases, it may meet the criteria for a formal anxiety difficulty, most often classified as the performance-only subtype of Social Anxiety Disorder (SAD). Severe physical symptoms such as trembling, nausea, or panic attacks are common, and avoidance of auditions, performances, or evaluative situations may follow. While performance anxiety and SAD overlap, they are not identical. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (known as the DSM-5) recognises a performance-only specifier for SAD, where anxiety is confined to public speaking or performance contexts, reflecting both the shared mechanisms and the distinct features of performance anxiety (American Psychiatric Association, 2013).
Differentiating Typical and Clinical Anxiety
Performance anxiety can be understood by looking at its context, intensity, persistence, and impact (Hofmann et al., 2004):
- Context and triggers: Typical anxiety is situational and proportionate; clinical anxiety may arise even in minor or imagined performance scenarios.
- Intensity and symptoms: Typical nerves are mild to moderate; clinical anxiety can provoke severe, panic-like symptoms.
- Behavioural impact: Typical anxiety allows performance with coping strategies; clinical anxiety can lead to avoidance and lost opportunities.
- Duration and persistence: Clinical anxiety persists across many performances, often lasting six months or more.
- Cognitive patterns: Typical worry is realistic; clinical anxiety involves excessive, intrusive thoughts disproportionate to actual risks.
- Functional impairment: Typical nerves have minimal impact on life or career; clinical anxiety can significantly disrupt functioning.
Shared Mechanisms in Social and Performance Anxiety
Both SAD and performance anxiety share underlying mechanisms: fear of negative evaluation, self-focused attention, and heightened physiological arousal such as a rapid heartbeat and trembling (Hofmann et al., 2004).
These similarities explain why treatments developed for SAD – including cognitive-behavioural therapy (CBT), exposure-based interventions, and emotion-focused therapy (EFT; Elliott & Shahar, 2017) – are also effective for performance anxiety (Hofmann & Smits, 2008).
Key Differences
| Feature | Social Anxiety Disorder (SAD) | Performance Anxiety |
| Diagnostic status | Clinical disorder (DSM-5) | DSM-5 specifier (performance-only) or independent |
| Context of anxiety | Broad social situations | Evaluative or performance contexts |
| Comorbidity/impairment | Often higher, with greater functional impact | Typically lower, but can be debilitating in performance settings |
| Mechanisms | Fear of negative evaluation, self-focus, physiological arousal | Same mechanisms, but situationally triggered |
| Examples | Conversations, meeting strangers, eating in public | Public speaking, stage performance, auditions |
SAD tends to appear across a wide range of social situations, while performance anxiety is more specific to contexts where identity and ability feel on the line (Niering et al., 2023). Both are rooted in heightened self-consciousness and fear of judgement, underpinned by self-critical beliefs and a tendency to interpret situations as threatening.
Importantly, even socially confident individuals can experience performance anxiety. This is often seen in situations such as public speaking, which may be viewed as a specific form of social anxiety characterised by fear of negative evaluation (Bodie, 2010). Clarifying these distinctions enables clinicians to determine whether performance anxiety occurs as part of a broader diagnosis of social anxiety disorder (SAD) or represents a separate concern requiring targeted intervention.
Beyond Symptoms: The Self-Relationship
Research shows that both SAD and performance anxiety are maintained not only by external fears of judgement but also by how individuals relate to themselves in stressful situations. Many worry about revealing perceived flaws or inadequacies, reinforcing avoidance and distress (Moscovitch, 2009).
Traits such as self-criticism, perfectionism, and internalised shame intensify physiological arousal and avoidance, creating a self-perpetuating cycle (Capaldi & Elliott, 2023). Internal self-criticism, rather than fear of external evaluation alone, often plays the central role in maintaining anxiety.
Approaches that focus on the self-relationship (Capaldi, 2024) complement standard treatments by fostering self-compassion, non-judgemental awareness, and supportive self-talk. This shift helps to reduce anxiety in the moment and build resilience over the long term.
The Self-Relationship: An Internal Mirror
The self-relationship reflects how we think, feel, and behave towards ourselves, encompassing our beliefs about our abilities, emotions, and responses under pressure. This relationship can take several forms, including:
- Inner critic – attacking, rejecting, shaming, or comparing ourselves to others.
- Neglectful self – overlooking our physical, emotional or psychological needs.
- Controlling self – striving for perfection, pressuring ourselves, or overly monitoring our thoughts and actions.
- Isolating self – withdrawing to avoid vulnerability.
- Compassionate self – nurturing, validating, respecting, and accepting ourselves.
In social and performance anxiety, the inner critic often dominates, predicting failure and fuelling fears of inadequacy. Capaldi and Elliott (2023) describe this as Negative Treatment of Self (NTS), a pattern of harsh self-derogation, rigid perfectionism, self-neglect and withdrawal. These patterns often originate in earlier relational experiences where emotional safety was lacking.
A Model for Healing: Self-Relationship Training®
Self-Relationship Training® (SRT), developed by Dr Kay Capaldi, offers a structured framework for rebuilding this sense of internal safety and addressing unhelpful self-relationship dynamics:
- Recognise: Identify patterns of negative self-treatment such as self-criticism or neglect.
- Externalise and process: Use reflective and experiential methods to bring patterns and emotions such as shame, fear, or sadness into awareness.
- Develop a compassionate inner voice: Practise self-soothing, boundary-setting, and nurturing responses to balance the inner critic.
- Integrate: Apply journalling, mindfulness, and other practices to embed awareness and encourage emotional growth.
By shifting from adversarial self-monitoring and criticism to supportive self-regulation, SRT aims to address the root of anxiety rather than just its symptoms.
Why This Matters
SRT and related approaches offer more than mere symptom relief; they promote lasting change by transforming the performer’s relationship with themselves. Through this process, individuals are able to:
- Rely less on external validation for their sense of self-worth and confidence, cultivating an internal sense of assurance.
- Strengthen resilience to rejection, whether it is real or perceived, allowing setbacks to be met with greater composure.
- Develop a secure, supportive inner foundation, creating a stable base from which to thrive both personally and professionally.
By shifting the focus inward, these approaches equip performers with tools that extend far beyond performance contexts, enhancing overall well-being and self-reliance.
Conclusion: You Deserve to Be on Your Own Side
Recovery from clinical anxiety is not simply about acquiring coping techniques – it is about cultivating a deeper sense of allegiance to yourself. When the inner critic is met with compassion, acceptance, and clarity, its intensity begins to soften. This inward journey is less about eliminating nerves entirely and more about reshaping your relationship with them. In doing so, performers discover a path to resilience, allowing them to move forward with greater confidence, authenticity, and ease.
Acknowledgement: AI-based tools (OpenAI, 2023) were used to support background research and language editing. All interpretations, analysis, and conclusions in this blog remain the author’s own.
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
- Bodie, G. D. (2010). A racing heart, rattling knees, and ruminative thoughts: Defining, explaining, and treating public speaking anxiety. Communication Education, 59(1), 70–105.
- Capaldi, K. (2024). The power of Self-Relationship Training [Blog series]. www.drkaycapaldi.com
- Capaldi, K., & Elliott, R. (2023). Negative treatment of self in socially anxious clients. Person-Centered and Experiential Psychotherapies, 23(1), 101–121.
- Elliott, R., & Shahar, B. (2017). Emotion-focused therapy for social anxiety (EFT-SA). Person-Centered & Experiential Psychotherapies, 16(2), 140–158.
- Hofmann, S. G., Heinrichs, N., & Moscovitch, D. A. (2004). The nature and expression of social phobia: Toward a new classification. Clinical Psychology Review, 24(7), 769–797.
- Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioural therapy for adult anxiety disorders: A meta-analysis of randomised placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621–632.
- Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualised case conceptualisation and treatment. Cognitive and Behavioral Practice, 16(2), 123–134.
- Niering, M., Monsberger, T., Seifert, J., & Muehlbauer, T. (2023). Effects of psychological interventions on performance anxiety in performing artists and athletes: A systematic review with meta-analysis. Behavioural Sciences, 13, 910.
- OpenAI. (2023). ChatGPT (GPT-5) [Large language model]. Used for background research and language editing. https://www.openai.com/chatgpt