Clinicians often see clients who have debilitating performance anxiety. They suffer from public speaking anxiety, stage fright, test-taking anxiety, and writing block. Their condition is so severe as to threaten to end their academic or professional career. Musicians and athletes also seek help because their anxiety before and during an event causes them to perform at a level well below their demonstrated capabilities. An estimated 2% of the U.S. population is afflicted by debilitating performance anxiety. Effective treatments are now available. This article reviews those behavioral, cognitive, and technological therapies that have shown great promise for treating individuals who have debilitating performance anxiety and introduces this issue of the Journal of Clinical Psychology: In Session devoted to this topic.

This article presents and illustrates the behavioral treatment of medical students and physicians whose debilitating test anxiety was associated with their failure to pass the United States Medical Licensing Examination (USMLE) or a specialty board test. Seventy-two medical trainees were treated consecutively because of at least one failure to pass these professional examinations. Behavioral treatment focused on their anxiety, which resulted in the "dual deficits" of poor test preparation, poor test performance, or both. Treatment featured progressive muscle relaxation, systematic desensitization, the self-control triad, behavioral rehearsal, and a psychoeducational component. Ninety-three percent of the clients eventually passed the examination while in treatment. Pass rates for this group were substantially higher than the national average for repeat USMLE test takers. Limitations of this treatment method are that it seemed too elaborate for some medical trainees and was less effective with those who had difficulty evoking anxiety.

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Increasingly, clinicians obtain data from tests across modalities. Little actual information, however, exists as to normal patterns. An example is auditory and visual recall of digit span. The effects of modality on recall of digit span, sequence, and order were examined with 80 subjects (M age 24.3 yr.). Subjects were given the Wechsler Adult Intelligence Scale-Revised, and a research version of MicroCog: Assessment of Cognitive Functioning. Both contain forward and backward digit spans. Recall for visual presentation was significantly stronger than for auditory presentation of backward digit span. Recall for visual backward digit span was also superior to auditory backward digit span when the sequence of presentation was controlled. The mean number of digits recalled was higher when visual digit span was preceded by auditory digit span.