I had a question from a reader recently about what to do when all my usual prescriptions (see here, here, and here) for dealing with stage fright – physical work on breathing and muscle group relaxation, coupled with mental work on imaging and replacing the feared outcome with a positive one – don’t work.  Perhaps the level of the specific fear is too high, due to some trauma associated with speaking, or the general level of anxiety is too high to make much headway – or even begin – with the physical and mental work.

There are a few options left after the physical and mental work have failed for you.  I’m going to discuss three here; if you think of others and would share them in the comments, then we can help the anxious and super-anxious people everywhere.

First, consider not doing the presentation.  In the business world, the received opinion is that public speaking is high on the list of abilities you have to master for career success.  There are tons of lore, evidence, and stories to support this widely held contention.

But what if you could get by without presenting – how would you do it?  Could you partner with someone who is comfortable on stage and create a dynamic duo that together got the job done?  Could you minimize the actual speaking you have to do by preparing videos, group talks, panels, interviews, or other formats that you might be comfortable with?  Soon we’ll be able to send our holograms instead of our bodies – perhaps that could be a way around the issue?

Second, consider virtual reality desensitization. Dr. Kristopher Blom has been working in virtual reality since 1998. At the time, movies and books had made a lot of promises about what VR would be like, but the technology was still far from ready for the mainstream.

Blom now works on a product called the Virtual Orator, which aims to help people conquer their fear of public speaking by allowing them to practice on a virtual audience. “It’s kind of the tool I wish I’d had, so that I didn’t have to learn public speaking the hard way,” Blom says.

You can start with a projection of an empty space, and practice giving your speech to no one.  Then, you could add one virtual person – still not very scary for most people.  As you get comfortable with the setting and sensations, you could add more and more people.  The idea is to get to the point where you’re comfortable in front of hundreds of virtual people – so that you’re ready for the real thing.

Finally, consider taking anxiety-reducing medication.  The options from the pharmacy used to be unappealing, unless the alternative was very bad indeed, but today there are many new options with beta blockers (widely taken by musicians to reduce performance anxiety) and other similar, even newer options.  I’m not a doctor, but if you are considering this option, then talk to someone who is and get the latest and greatest option.  Make sure you try out the drug before the big day, so you have some sense of how it alters your perception.  That way you won’t find the experience of being sedated alarming in itself.

I recommend – and have had great success with clients using – the physical and mental work mentioned at the beginning of this post.  But if you’ve tried and failed all other options, then consider one of the three possibilities here.  And good luck.