It would be funny if it weren't so horrifying: Public speaking is the Number One fear—an even greater fear than death. That's right. A vast number of people would rather die than speak in public! From a clinical perspective, I can tell you there is a lot of truth to this. For example, Harold was an engineer in a manufacturing plant. He received a promotion that required him to address a group of colleagues about plant operations—the very next day. He called me, sounding very wired, saying, "I think I might get in an accident on my way to work tomorrow." That's how much he wanted to avoid the group.

One of my clients recognized anxiety in a high-powered billionaire who was giving a keynote speech. All eyes were on the presenter, an entrepreneur who had developed many companies. Suddenly, the man had to stop talking and sit down; it appeared there was something medically wrong. As EMTs escorted him from the room, his colleague took over. An hour or so later, the presenter returned and apologized, saying he had been thinking about a dear friend who had just died." But my client recognized the other man's episode for what it was: a panic attack—the same thing that my client himself, the go-to guy for his hedge fund's presentations, also experienced when he found himself in monologue situations. The moral of the story is that you are not alone.

As we define it, "public speaking" is akin to "speaking up"—not just giving a speech, but also chiming in at a meeting or asking a question in a class or during a conference call. Any time you are speaking to two or more people and all eyes are on you, you are engaging in public speaking.

Public speaking matters, and not just because your livelihood may depend on it. Public speaking allows you to communicate, to express yourself, to educate, to learn, to persuade, to impress, to enhance your profile among your colleagues and professional peers, and to invest in your self-esteem. Speaking in public allows you to learn. If you want to ask a question or are confused about a concept but keep silent out of fear, you are choosing to pay a high price: You are choosing to remain less effective and less knowledgeable. And if you can step outside yourself for a second, consider this: You are also limiting the contribution you can make to the effectiveness and knowledge of others who themselves may wish to ask that same question. After all, how many times have all of us sat in an audience and listened to someone else raise a point that we were wondering about. "I'm so glad she asked that question!" we think. Take a chance. Be that person—and make a difference in your own life and the lives of others.

There's a popular saying that describes the line between suffering from anxiety and using stress management techniques to transform it: If you always do what you've always done, you'll always get what you've always gotten.

Here's another way of putting it: The definition of insanity is doing the same thing over and over and expecting a different result. As you well know, even if you feel like you're going to die when a panic attack hits, your anxiety is unlikely to strike you down like lightning. You could go on as you have been all along. But your productivity, your effectiveness, and your reputation at work will not improve. "You'll always get what you've always gotten."

As you prepare to imagine a life in which you are no longer nervous at work, take in a long slow deep breath then slowly exhale 4 ... 3 ... 2 ... 1 ..., pacing the inhale–exhale to 8 to 12 seconds. For the next 60 seconds, focus on your rhythmic breathing—that's about six inhale–exhales. Then, see if you can extend the inhale–exhale to 12 to 14 seconds.

Now, envision your life as it will be when you use your new stress-management skills to conquer your public speaking anxiety. Wrap your mind around the scenarios that have immobilized you in the past. Now picture yourself in those situations—minus your fear but with the addition of your stress management skills. Really picture it: The room, the furnishings, the faces of the people who are listening to you. How will you feel? What will you do? What will that make possible?

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Now, return your thinking to the way things have been in the past. Tell yourself, if things continue that way, if I do not use the skills I have learned to control my public speaking anxiety, this will be the result:

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Before responding to the next question, pause for a moment. Take in another deep breath 1 ... 2 ... 3 ... 4 ... and exhale slowly 4 ... 3 ... 2 ... 1 .... Pace your inhale-exhale to 14 seconds if you can.

You first took a look at your motivation for mastering your workplace anxiety in Chapter 2. Now, let's get specific: What is your motivation for learning to face your public speaking anxiety?

What emotions do you feel when you are speaking up and your anxiety kicks in? Panic? Frustration? Fear? Embarrassment? Shame? Anger? It may not have occurred to you, but anger is a major part of the problem. When adrenaline shows up, you are furious. "Why, why, why do I have to feel this way? What is wrong with me? How did I get myself into this?" Often, people turn that anger outward so they can detach from the feelings of self-loathing. They hate their bosses for assigning them to make presentations, and despise them even more for ambushing themselves with spontaneous speaking requests. They hate their colleagues for causing the anxiety simply by being there. If someone tries to help and fails, the anger is turned on the helper. I received a phone call from a middle manager who mentioned he had played semi-pro basketball. He wanted help with his phobia of conference calls. "I will pay you four times the amount of your fee if you help me," he said, "but nothing per session."

"I hope you don't mind if I pass the ball on this one," I said. This guy was obviously angry. I felt sure he had no inkling of the connection between anger and public speaking anxiety, so I just asked him what prompted his attempt to make a deal. It turned out he had participated in a number of public speaking programs and "none had worked." Rather than blaming himself—rather than attaching to his response to adrenaline during conference calls and learning to accept it—this man held others responsible for his suffering. That's a shame. My theory about those other programs' failures was that they probably did not teach adrenaline acceptance. If adrenaline acceptance is not learned, anger will appear at the first sign of adrenaline—which, as you know by now, will worsen the problem. Unrealistic expectations, excessive CP, create anger. This is why it's essential to counter the excessive critical script with Adult logic and Nurturing Parent encouragement.

Even so, nonacceptance of adrenaline is a surface issue. Here is an example of a deeper one. Nora, age 48, worked as a manager in a national call center. She was often required to present at regional meetings. While she had substantial anxiety in these scenarios, Nora was good at what she did. She received feedback from her supervisor that her performance was good, and she kept getting raises. Nevertheless, Nora's critical script beat her up with the fact that she did not have a college education.

Even worse, going deeper, she had been living with her partner for over 15 years. She wanted to get married. He always avoided talking about it. He had gone so far as promising to put her in his will but never would show it to her. The few times that Nora pursued a discussion with him about this, he was selectively mute. He simply wouldn't discuss it. Nora was furious, but never resolved the underlying issue. In fact, she was an expert at detaching from such issues.

But detachment does not mean those issues didn't exist. Instead, they lurked under the surface as unresolved conflicts. These issues attacked her self-esteem. They made her feel both powerless and furious at herself for taking no action. She repressed that anger, but it surfaced in the form of physical anxiety symptoms during her presentations (recall Sarnow's mind-body pain connection theory).

On February 9, 2010, I Googled the term "public speaking" and saw there were 57,100,000 listings. Obviously Warren Buffett was right. Unfortunately, although there are millions of resources for how to speak publicly, there are very, very few that offer help for those who are afraid to do so. I have sympathy for all the people who have tried to find self-help and never had the chance to get beneath the basic "here's how to give a speech" sort of advice. In working through this program, you have learned the stress management techniques that will allow you to move on and learn the how-to's of public speaking. I discovered just one short paragraph in one of those resources that refers to "channeling your nervousness." In The Exceptional Presenter, author Timothy Koegel uses an acronym—OPEN UP—that is easy to remember and implement. According to Koegel, the exceptional presenter is someone who is

And who must:

The most common reference to monologue is probably to the first few minutes of Jay Leno or David Letterman's talk shows, when they crack jokes and talk about that night's guests. For our purposes, a monologue is any situation in which you are talking and no one else is. True, it may be a speech or presentation. But it could also be a large meeting, a conference call, or a webcam conversation. When all eyes (or ears) are on you, you're in a monologue situation. You have the floor. Everyone is looking at you, listening to what you have to say. You may believe they are expecting you to be perfect. "I am worried that I am going to be noticeably nervous." "Are they looking at me?" "Can they tell?" "Is my voice quivering?" "Am I speaking too softly?" "Am I making sense?" "I am going to be exposed." "They're going to see who I really am." or "They're not going to see who I am."

One client asked me if I memorize my presentations. This was a good question. At this point in my career, there is an extensive script in my mind that I can pull out at any given time for any audience. Give me an anxiety-related concept and I've got a story, believe me. My ease with presentations is the result of extensive experience and practice. If I were giving a speech on an unfamiliar subject, I would prepare and make notes, but I would not memorize because I would want to preserve the Natural Child mind state's passion and overall confidence.

Use mind state balance to get into High Performance Mind mode before you enter the room or approach the podium. Your audience wants to hear what you have to say. If someone asks a question or is confused by something you've said, interpret it as interest in your topic. For some nervous speakers, a request to "speak louder" feels like criticism. It's not; it's because your audience wants to hear you clearly. Take a deep breath, then let your NP and A work together to improve your performance there and then. Your audience will respect that.

If you have ever closely observed a good public speaker, you will see that even the best make mistakes—saying the wrong word, pronouncing something incorrectly, or maybe even stuttering. The effective speaker does not focus on the mistake. He or she just moves on to the next word or concept. I see this all the time. Once I was doing a radio show with a substantial audience in New York City. One of the interviewers had a substantial stuttering challenge. During this 40-minute interview, she stuttered at least five times but proceeded confidently into her next words. Don't let your minor human mistakes faze you!

Remember Alice, the human resources professional who for one solid year never said a word in her weekly meetings with 20 of her colleagues? Her silence at meetings was selective. She said she "had nothing to say" and "did not want to sound stupid." She was censoring herself. This was extreme CP. Her A and NC were absent in interactive scenarios where her role required spontaneity. Her mute moments were characterized by obsessive overanalyzing, which turned into paralyzed speech. Yes, she had public speaking anxiety, but the dynamics of selective mutism were the specific cause of the problem.

Zach, age 28, was a parks department policeman, whose selective mutism was triggered by interaction with his supervisor. For example, Zach was in the coffee room at the office when the road supervisor came in to ask him for an update. "What's been happening the last couple of days?" he asked. "Not much" was all Zach said. Then the supervisor asked the same question of Zach's associate, who holds the same position as Zach. He gave a long, informative answer, detailing situations that he and Zach had taken care of together. How ridiculous Zach felt that he hadn't communicated! He spent the rest of the day obsessing about his gaffe. He was sure his supervisor would think there was something wrong with him—that he was uptight, unobservant, or even incompetent. And he may well have been right.

Just as you have established your hierarchy of adrenaline challenges, it is necessary for you to do the same with verbal expression challenges if this issue applies to you. One step at a time—utilizing the same principles as the Five-Step Technique as you experiment (NC) with your verbal skills. In establishing this challenge hierarchy, you will discover which situations are relatively easy for you to handle and which are a major challenge.

Ed was a 40-year-old chiropractor who had developed a successful practice. One day, seemingly out of nowhere, he had a panic attack during his weekly community educational seminar. His wife researched options for help, acting as his administrative assistant, and made the initial call to me. This was approximately two months after the initial attack, a point at which Ed was certain the problem was worsening. Here was Ed's Challenge Hierarchy, which he compiled three weeks into treatment:

10 = Giving his Ph.D. dissertation in front of a group of 50 colleagues and professors. (This was scheduled approximately six months after his first panic attack.) It was that underlying anticipation that was draining him.

In Ed's case number 5 was the starting point and was built into his calendar on a weekly basis. He could not escape it. Ed was a quick learner and applied the Five-Step Technique quickly and productively. During treatment it was discovered that the anticipatory worry about the upcoming dissertation presentation was pervasive and worrying him on both a conscious and unconscious level.

Take some time now to establish your own Challenge Hierarchy. If you like, you can begin by listing all the situations you can think of that make you nervous at work. Don't censor yourself. Just note whatever comes to mind. Once you have made the list, rate each item on a scale of 1 to 10.

One client, an enterprising 20-year-old who had just sold a recreation-related Web site for enough money to support himself for a few years, expressed to me that he was mute in many situations: social gatherings, business meetings, and some family events. Dating was a real challenge because he would only go out with women who approached him first. He was quite creative, and his Natural Child mind state was evident in his having developed and sold his Web site at such a young age. He used that same mind state to come up with his own public speaking "laboratory," an improvisational theater workshop. This did take courage (NP) and was a big risk, if not adventure (NC again). The experience had a wonderfully positive influence on the development of his spontaneous verbal skills (NC).

Amy surprised herself several years ago by taking the courageous step of confronting her phobia of singing in front of other people—engaging both her NP and her NC. Without telling any of her friends, she signed up for a class called "Singing for Shy Voices," which was targeted specifically to people like her who "couldn't even sing Happy Birthday in a crowd." She says now, "I did not know anyone in the class—which made me far less self-conscious than if I had." At the third class, the 10 students stood in a circle, each taking a turn singing one line or the other of a two-line folk song. But when Amy's turn came, she had a full-blown panic attack. She burst into tears and headed outside to pace in the cold winter air. "I was outside for half an hour, crying and trying to catch my breath. Eventually, I was able to calm myself with a nurturing thought that this was my laboratory. I went back in, still crying. But I shared my feelings. A few of them observed something I had been completely unaware of: Before I panicked, I sang my line with perfect pitch and pacing!"

This 12-minute exercise is designed to serve as your personal relaxation retreat. Set aside uninterrupted time to complete it. Sit in a comfortable chair. Make sure there are no obvious distractions such as the television or phone. Get out of range of hearing computer noises. The goal is to have a focused, solitary experience.

What is the temperature of your hands now? 78 degrees? 85 degrees? 94 degrees? What do you think? Identify your specific emotions at this moment. Identify your specific thoughts at this moment. Allow yourself to feel comfortable with this attachment.

Survey your body, and identify any muscle groups that feel tense. Focus on each area for a few moments, and replace the tension with the sensations of looseness. Take your time.

The goal now is to take at least 12 minutes to focus on your Quieting Response. Start by slowing yourself down with your breathing, consciously maintaining the 8-to-14-second pace and then evolve into an unforced even rhythm at your own pace. Can you feel the oxygen upon inhale? Can you feel the tension release upon exhale?

When you are comfortable, close your eyes and use your hand-warming suggestions and technique; continue to do so for 12 minutes. Then open your eyes and do a deep inhale and exhale.

Exactly what is the temperature of your hands now? Exactly what are you experiencing emotionally? Exactly what are your thoughts?

A brilliant engineer who had gone to one of the world's top universities, Raj worked for a well-known corporation. Despite his potential, he was stuck in a low-level management position. A native of India, Raj hardly interacted with his peers because he believed his accent made him difficult to understand. He censored himself verbally to the point of developing social phobia, becoming one of millions of children and adults who suffer from selective mutism. In reality, his accent was not hard to understand; during my telephone sessions with him, there was only about 5 percent that I had to ask him to repeat. Raj was highly analytical. His intellectual intelligence was impressive. At the same time, his social avoidance and emotional repression were characteristic of delayed social and emotional intelligence.

Raj was passed over for promotions for eight years despite his highly respected expertise. He worked hard to overcome his selective mutism. At first, he came across as combative, but then he got under control through these Quieting Response exercises. Raj recently managed to answer a question in a seminar with 100 people. He had been the focus of attention and had handled it well.

Toastmasters is an international self-help program for public speaking. I have referred hundreds of people to this program as an adjunct to therapy. When a client is working Toastmasters, I teach the concept that giving a good speech is a secondary goal to befriending adrenaline. That's why I considered Christine's decision to take beta blockers before her Toastmasters meetings unproductive—like wearing a life jacket at swim team practice. Toastmasters is a place to experiment with adrenaline management and the Five-Step technique. In Toastmasters people give formal speeches as well as "the topic of the day," which allows for spontaneous two-minute presentations—think-on-your-feet exercises such as "Talk about restaurants in your city."

At this point you, too, want to be actively implementing your Five-Step Technique, working your way up from lowest to highest on your hierarchy of challenges. Again, the idea is to use your life as a laboratory: Take on an easy challenge for practice, and then work your way up. For most people with public speaking anxiety, Toastmasters is a solid six, seven, or higher. For some people, though, it's much lower precisely because the group is designed to serve as a laboratory and therefore has a more sympathetic and receptive audience. If and when you're ready, consider joining Toastmasters. It has been a great asset to many of my clients.

Remember Victor, the economist who very much wanted to give presentations, yet felt too nervous to pursue the opportunities presented to him? He was working Toastmasters for about a year before he started working with me. At a certain point in therapy, when I was convinced he was ready for a higher level of risk-taking, I suggested he do the 40-Second Embarrassment Control Exercise. Instead of launching directly into his speech, he was to stand in front of the group for 40 seconds with his eyes closed in a kind of meditative posture, feeling his adrenaline and doing the Five-Step Adrenaline Control Technique. Of course this paradoxical approach would itself require embarrassment control. What in the world would the audience think he was doing—standing there for a minute or two breathing in and out in silence? He used his Natural Child mind state to experiment with being different! It was a reach for him—but it was also a triumph. He was quite successful. Only a low percentage of my clients have the courage to pull this off. But work up the courage some time when, realistically (Adult) you know your job is not on the line. You will have the adrenaline—take advantage of the learning opportunity in a relatively benign scenario that offers a tremendous growth opportunity in real time.

Amy has given group presentations, taught nonfiction writing to adults and children, and served as discussion panelist or moderator numerous times—and she has learned to see the public speaking-related stress as a normal, natural, and very valuable part of the experience.

I definitely feel the adrenaline wave that occurs as I am about to begin. The truth is, it feels kind of good! Ahead of time, I plan what I will say, and I may even make notes to have with me if I think I need them. But what truly makes a difference in how I feel—and how well I speak—are the techniques in this program. I breathe, but my audience doesn't see the breathing exercises. They see someone who moderates her voice and paces her speech, someone who is prepared, yet natural, someone who is actually having fun up there at the front of the room.

Do the following exercise as often as you want. It is especially useful when preparing for public speaking. Before you begin, take a moment to realize how well-trained you are at self-regulation: If you have been diligent and precise in practicing the 35 or so exercises in this book, your mind will have begun to develop an autonomic internal Quieting Response to the word "warm," even if your hand is not actually warm.

If, however, you've merely skimmed the exercises, or picked and chosen the ones you felt like doing and ignored the others, then I can't confidently say this next exercise will work for you. If you believe you should be able to be productive with this exercise right now without having been diligent, then you have done a wonderful job of detaching and investing in excessive AC.

This exercise is effective as a regular practice and also before a public speaking event. You can do it anytime you have at least four or five minutes for yourself. Note: As with the other exercises in this book, you must perform this exercise precisely as it is written here—be mindful of both the instructions and the timing.

You are ready to go!