The below information is based on my clinical training and experience working with many clients. It is for your information only and does not constitute clinical advice or establish a patient-therapist or client-coach relationship.

For some people with public speaking anxiety, there is actually a fear not of public speaking, but of the fear of fear itself in the context of a social-evaluative situation. The fear is about the anxiety symptoms themselves.

When Anxiety Becomes the Threat

A person might initially be able to tolerate some nervousness. The problem begins when anxiety is interpreted as the problem iteslf.

I'm getting anxious →What if this keeps escalating? → What if I can't bring myself back down? → Why is my heart beating so fast → Try to stop it → What if I lose control of it when I'm speaking? → Now my throat feels weird → More anxiety

Anxiety therefore becomes a warning signal for more anxiety. This is particularly important in public speaking because the person may not actually fear anxiety in other environments. A racing heart at the gym may be irrelevant. Feeling anxious at home may be uncomfortable but manageable.

The feared experience is often anxiety becoming uncontrollable while the person is visible to other people.

Anticipatory Anxiety and Fear of Fear

This process often begins well before the speaking event. For many people the worst time is before the presentation, not during. For example, a presentation on Friday produces anxiety on Monday. The person notices this and thinks:

If I'm already this anxious now, how am I going to feel on Friday?

Now Monday's anxiety becomes evidence about Friday.

The person starts monitoring whether the anxiety is increasing or decreasing and trying to make sure it doesn't escalate. Many peoples thoughts also become obsessional about the situation, trying to figure out how to ‘solve’ it.

This can create a self-reinforcing cycle:

Anxiety → fear of anxiety → attempts to control anxiety → increased monitoring → more perceived threat → more anxiety.

Thus, the person's attempts to prevent escalation can themselves become part of the escalation.

Resistance to Anxiety

Once anxiety is treated as dangerous, it makes sense that the person will try to control it. They may reassure themselves, regulate their breathing, repeatedly practise, analyse why they feel anxious, distract themselves, check their physical sensations, mentally rehearse the event, or try to convince themselves that everything will be fine. Many of these behaviours can provide temporary relief. The problem is that they can also reinforce an important underlying rule:

I am safe as long as I can keep my anxiety under control.

This makes the next experience of anxiety more threatening, because anxiety itself begins to represent a loss of safety. The person can then become increasingly vigilant for signs that they are losing control.

The Problem With Trying to Feel Ready

Fear of fear also helps explain why some people become preoccupied with needing to feel ready or have no anxiety at all before speaking.

They practise and then check:

Do I feel confident now?

If they still feel anxious, they practise again.

They reassure themselves and then check:

Do I believe I'll be okay now?

If not, more reassurance is required.

Preparation is no longer determined by what the presentation reasonably requires. It is determined by whether the person has successfully changed their internal state.

Feeling calm becomes evidence of safety. Feeling anxious becomes evidence of danger. This can make anxiety increasingly important.

Appropriate Help for Fear of Fear

Treatment therefore does not necessarily involve finding better ways to control anxiety.

In fact, this can inadvertently strengthen the problem if the person learns that they are safe because they successfully regulated their anxiety. Instead, the work may involve changing the person's relationship with anxiety itself: reducing repeated monitoring and attempts to control it, allowing uncertainty about how anxious they might feel, and learning that anxiety can rise and fall without needing to be immediately suppressed.

The aim is not to force anxiety to remain present, nor is it to suppress thoughts about the upcoming presentation. Both can become another struggle with the internal experience. Rather, the person learns to allow anxiety to be expressed and move through without treating its presence as evidence that something is going wrong.

The goal becomes closer to: I can feel anxious about Friday and know that the anxiety itself means nothing. I don't need to work out how I'll feel on Friday today. I can get on with my day.

By the time Friday rolls around, anxiety is often minimal to none.

Conclusion

For some people, public speaking anxiety becomes self-perpetuating because anxiety as an experience itself has become threatening.

The person fears that anxiety will escalate, become uncontrollable, and eventually lead to the outcome they are most afraid of. They therefore monitor, resist, regulate and attempt to control anxiety whenever it appears. These responses are understandable, but they can inadvertently teach the person that anxiety really is something that must be kept under control.

In these cases, an important question is therefore not only:

What are you afraid will happen when you speak?

But:

What are you afraid will happen if you allow yourself to feel anxious when you do?.