oral presentation of stress

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Don’t Let Anxiety Sabotage Your Next Presentation

  • Riaz Meghji

oral presentation of stress

Stop focusing on yourself and start focusing on your audience.

If you want to beat speaking anxiety, you need to stop focusing on yourself and point your focus outward. This shift isn’t something that can happen instantaneously. It takes time, patience, and practice. Here’s how to get started.

  • Be a giver, not a taker. Takers tend to have more anxiety. They want and need validation from their listeners.
  • Givers, on the other hand, are all about service. They do work beforehand to connect with stakeholders and use the information they receive to address the needs of their audience. As a result, their presentation becomes less about them and more about helping the other people in the room.
  • If you want to turn your presentation into an act of service, you need to talk to the people in the room — well before your presentation begins.
  • Choose about three to five influential leaders, and meet with them before to learn their concerns and goals surrounding the topic you’re presenting on.
  • Then, incorporate your findings into you presentation. This will help you shift your focus outwards, from yourself to the audience, and as a result, ease some of your nerves.

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How many times have you had an important message to share, only to be sabotaged by anxiety right before you speak?

oral presentation of stress

  • RM Riaz Meghji is a human connection keynote speaker, author of Every Conversation Counts: The 5 Habits of Human Connection That Build Extraordinary Relationships and creator of The Magnetic Presenter speaker coaching program. He is also an accomplished broadcaster with 17 years of television hosting experience. Riaz has hosted for Citytv’s Breakfast Television, MTV Canada, TEDxVancouver, CTV News, and the Toronto International Film Festival.  

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Managing presentation stress

Tips and advice for managing stress.


Here are some things you might try before presenting – most of these things can be done well before you actually get up and talk in front of an audience.

  • Read it, practise talking about it with people.
  • The more you get to know it, the more comfortable you’ll feel presenting on it.
  • When you know it more, you’ll care more about it and become passionate and ‘feel’ the content – that’s when great presentations happen!
  • Oral presentation skills revolve around voice (tone, pace, pauses, word stress), language (content, functional), body language (gestures, face, movement). They all affect engagement and message.
  • You can specifically work on these things.
  • If you speak too fast, practise slowing down purposefully.
  • If you are monotone, then purposefully practise over‐toning.
  • Think about who they are and what they expect to hear from you; adjust accordingly.
  • A lot of audience satisfaction comes from the perception that you have met their expectations.
  • Take confidence in knowing that the audience members want to listen to you – they are interested.
  • Also take confidence from their perception of you – they see you as the expert on what you are presenting on, or at least knowledgeable. You are starting from a positive position.

Change your perspective on how you are feeling from nervousness to excitement. Enjoy this!

  • Turn negative thoughts into positive ones. E.g. from ‘This will be terrible!’ to ‘I’m going to do the best I can.’
  • Visualise your audience, see yourself talking to them, see them smiling, see yourself happy as you finish.
  • Be ready – have your slide advancer, slides, water, notes, handouts all ready to go.
  • Familiarise yourself with the venue or platform (e.g. Zoom) early. Make sure it’s ready and you can use the technology.
  • Know what to do if things go wrong (e.g. technical issues – don’t panic; get support from your instructor).

Before you being, do something you know relaxes you and puts you in a happy zone. E.g. put some headphones on and listen to music you like, read a book, play a game you like on your phone.

  • We tend to use things such as coffee or energy drinks when we’re feeling down, tired or stressed, but these are counter‐productive in this situation.
  • Some nerves are actually good (See tip 16 below), but when stressed, we are over‐stimulated. We want to be in control, not even more over‐stimulated, so avoid these ‘energy boosters’.

It may help you to realise that the main thing is actually not all about you, it’s the message that people are coming to hear – focus on that. They’re not there to judge you, they want to hear what you have to say.

Break down the task. Treat the presentation as a series of small chunks or parts, not a single big thing. This helps you to focus on smaller, more manageable sections and helps you with pacing and sequencing.

Physical techniques

These can be tried at any time, including during the presentation.

Try focused slow breathing technique. Breathe in, hold for three beats, breathe out slowly, think only about the breathing. Do this until your heart has calmed.

Sit comfortably or lie down. Place one hand on your chest and one on your stomach. Slowly breathe out through your mouth, then slowly breathe in through your nose, concentrating on keeping your chest still while expanding your stomach.

Exercise different muscles especially around the neck, shoulders and back to relieve tension.

Roll your shoulders to loosen the muscles, gently swivel your head in circles, first one way, then the other.

A couple of drops of natural lavender on your wrists provides a calming feeling and is a recognised stress relief.

  • There is a thing called ‘performance anxiety’. We actually need some nerves to perform well – entertainers and athletes are great examples.
  • Accept that you will have some nerves and that’s not a bad thing. If the anxiety becomes excessive (i.e. it blocks the message), then you need to try some of the things listed here.


These strategies are things you might do as you are presenting.

You need to monitor that the audience is with you but try to use the people smiling and nodding their heads; don’t focus too much on the person you notice who looks bored.

If you make a mistake, stop, take a breath and re‐start. If you miss something, you don’t need to say anything, just pick it up later or leave it out (nine times out of ten, the audience don’t even know).

Learn to read the signs that you are getting too tense (e.g. shaking, fast‐breathing) and try one of the physical techniques, even if just for a few seconds, to come back to a calmer space.


Here are a couple of things you might do after the presentation is complete. They relate to actively thinking about what you have done.

  • You don’t need to listen to everything that is said to you about your performance, certainly, but if you keep getting repeat messages (e.g. you’re speaking too fast, too monotone) then you need to act.
  • As mentioned in tip 2 above, you can purposefully practice things to help you improve. If you are speaking too fast, then purposefully practise speaking more slowly. If you are monotone in your voice, then purposefully practise speaking with more tone – over‐tone in practice. This is called overloading.
  • Sit down somewhere quiet after the presentation and deliberately think about how it went. What went well? What didn’t? Why?
  • Be honest with yourself. Analyse performance and be willing to change.
  • If it is possible, or appropriate, ask someone to give you feedback. If you can analyse parts of the presentation that give you most anxiety (e.g. answering questions, a particular transition) then purposefully practise those.

As part of reflection now focus on the positives of the presentation – be aware or ‘mindful’ of what went well, why it did and how you will do that again next time. Write down these things, affirm your own performance. Extend this to other parts of your life.

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How to Stop Stress from Derailing a Big Presentation

Stress is contagious—which can be bad news for presenters..

Posted September 19, 2022 | Reviewed by Devon Frye

  • What Is Stress?
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Photo by Andrea Piacquadio via Pexels

We suspected it. The research and speculation about mirror neurons predicted it. And studies have proved it: stress—and the emotions of frustration, anxiety , and fear that go with it—are contagious.

Strangers leak their stress to you. Watching TV—with its never-ending stream of bad news—stresses you out. All of that may make you sick.

More precisely, here’s what happens: Under stress, your body kicks into high gear and releases increased amounts of glucose from the liver (and other storage areas) into the blood. Your heart rate increases, and sends more of this enriched blood to your muscles. Anything that doesn’t relate to short-term survival slows down. Your senses are sharpened and your immune system kicks into high gear. You may even be ready to fight.

All of that’s great for short-term survival—such as escaping an unfriendly lion—but not so great for long-term health. The flight-or-flight-or-freeze reaction is meant to get you out of emergencies. But watching others in stress mode, or watching TV with its stressful news and stories, puts you in that mode over a longer period of time—and that’s what can imperil your health.

Unsurprisingly, it turns out that if you know the person or people involved, you get more stressed out watching other people suffer than if they are strangers. But either way, you catch the contagion. You get stressed.

With no lion to escape from—and get over—that stress lingers, and that’s where the concern for your health comes in. Various studies show that low, persistent levels of stress over long periods of time cause problems for systems that weren’t meant for that kind of scenario.

Now, how can you take all of this into account if you have a big presentation to give?

A couple of things. For presenters, thinking about your long-term health means being mindful of the adrenaline cycle and paying as much attention to the release of the stress as you do to the accumulation of it as you go into presentation mode.

In other words, consciously create a way to relax after the tension of the moment. Meditation , time alone, gentle exercise—whatever works for you to bring your body back to normal.

But presenters need to think about what’s happening between them and the audience as well. If you walk onto the stage or step to the front of the room with a lot of adrenaline coursing through your system, you could be leaking that fight-or-flight-or-freeze magic to your audience. You’re going to create low-level stress in the people in front of you.

That’s going to make them less able to take in what you’re saying, because adrenaline causes tunnel vision and narrowed focus, and it’s optimistic to assume that you’ll be the beneficiary of that focus. The exit signs may be more appealing, I’m afraid, than your message.

So you need not only to school yourself in relaxation techniques, and ways to transmute that tension into positive emotions like excitement and passion, but you also need to make sure you help the audience do the same.

Rather than allow a negative doom loop of tension, anxiety, and fear to distract your audience from the message you’ve worked so hard to present, you need to manage your emotions so that what you leak to the audience is passion and enthusiasm rather than the shakes.

If it seems odd to talk about managing emotions, do recall that you’ve probably spent a good deal of time preparing your content. Why shouldn’t you prepare your emotional attitude toward your material as well?

Before you get ready to present, find a quiet space to focus your emotions on the positive ones you want to evoke. For some people, it can help to recall a time when you naturally felt those emotions—a time when you were naturally “up” and passionate about something. For others, simply focusing on the opportunity in front of you, redefining it as an honor, a great responsibility, a chance to shine, or a moment to share your wonderful ideas with a receptive audience—whatever the specifics, find a way to turn your anxiety into excitement.

oral presentation of stress

Everyone’s endocrinal systems will thank you. And the audience will be able to pay attention to you and your message.

Nick Morgan Ph.D.

Nick Morgan, Ph.D. , is president of Public Words Inc., a communications consulting company, and the author of books including Can You Hear Me?: How to Connect with People in a Virtual World.

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oral presentation of stress

  • > The Art of Presenting
  • > How to Deal with Stress

oral presentation of stress

Book contents

  • The Art of Presenting
  • Copyright page
  • Acknowledgements
  • Introduction
  • Part I Preparing Your Presentation
  • Part II Delivering Your Presentation
  • Chapter 5 The Moment of Truth: Stand Up and Deliver
  • Chapter 6 Discussion Time
  • Chapter 7 Verbal and Non-verbal Behaviour
  • Chapter 8 How to Deal with Stress
  • Part III Adapting Your Presentation
  • Part IV Attending Oral Presentations

Chapter 8 - How to Deal with Stress

from Part II - Delivering Your Presentation

Published online by Cambridge University Press:  15 August 2020

Many people feel anxious when delivering a presentation before an audience, and this is perfectly normal. You should probably get worried if you're not a bit nervous. The good news is: a modicum of stress can be good for your presentation. Too much stress, however, can be crippling and hinder your presentation. We will therefore provide some tips and tricks in this chapter to help you manage your stress levels so that they are actually constructive, rather than destructive, for your oral performance. We also provide several exercises to help you get a better grip on your presentation anxiety.

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  • How to Deal with Stress
  • Fieke Harinck , Universiteit Leiden , Esther van Leeuwen , Universiteit Leiden
  • Book: The Art of Presenting
  • Online publication: 15 August 2020
  • Chapter DOI: https://doi.org/10.1017/9781316488348.011

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How to not be nervous for a presentation — 13 tips that work (really!)

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Why do I get nervous before presenting?

How not to be nervous when presenting, 5 techniques to control your nerves, quotes for inspiration, speak with confidence.

If you feel nervous or scared about talking to someone new, giving a speech, or being on stage, rest assured: you’re not alone. 

Experiencing symptoms of performance anxiety like an increased heart rate, trembling hands, or excessive sweating is perfectly normal. In fact, people often fear public speaking . But the more you’re immersed in these types of situations, the more comfortable you’ll become . 

We’ll explore how to not be nervous for a presentation and offer inspirational quotes to help you step out of your comfort zone.

Man Speaking Through A Microphone In Dark Conference Hall-1

Based on data from the National Social Anxiety Center, fear of public speaking is the most common phobia . The official term for this fear is glossophobia, colloquially termed stage fright.

Stage fright typically arises from the perception that when you're in front of a group of people, they'll judge you. The brain’s frontal lobe aids in memory, and when we’re stressed, increased stress hormones temporarily shut that region down . This is what causes us to freeze up and stop talking. 

There’s nothing wrong with being nervous. We all have different social comfort zones, communication styles, and presentation skills. But we can expand and improve our skills if we’re cognitively flexible .

Cognitive flexibility plays a big role in our behavior and attitudes and impacts our performance. You can use your fears as a catalyst for growth and learning — including giving a great presentation.

The following techniques will help you shift your thinking from reactive to proactive to combat nerves throughout the presentation experience:

Before the presentation:

Student girl preparing for presentation writing notes in her computer at home-how-to-not-be-nervous-for-a-presentation

1. Know your topic

Don’t wing it when it comes to presenting any topic. The better you understand your subject matter, the more confident you’ll feel. You can answer questions right away and won’t have to rely on your notes.

If there are a few points or any information you think might arise during the presentation or Q&A, research it and become comfortable speaking to the subject.

Here are a few ways to study: 

  • Break down concepts onto notecards
  • Practice answering questions  (especially the hard ones you hope no one asks)
  • Explain complex information to peers and colleagues

2. Be organized

Take time to thoroughly plan each aspect of the presentation. Often, that means designing PowerPoint slides or other visual aids like videos. Clarify with the organizer what format and technology you’ll be using.

If it’ll be virtual, get your background and room organized, too. This ensures the presentation will go smoothly, in turn reducing stress.  Consider the following preparations:

  • Invite your support network to the event
  • Arrive early to set up tech and get comfortable in the space
  • Practice timing your presentation with the time tracker you’ll use day-of
  • Bring a water bottle and a snack
  • Contact your manager or venue staff to discuss any accessibility or tech concerns

3. Practice, practice, practice

Whether you’re rehearsing in front of a mirror, family member, or pet, you can never practice enough. Ask for feedback about your body language , eye contact , and how loudly you project your voice.

If you’ll be giving the presentation on a video conference, record it on the platform to see how you look and sound.

4. Visualize your success

Thinking through possible outcomes is a great way to prepare — but it can also backfire on you. If you obsess over negative what-ifs, this failing mentality might become a self-fulfilling prophecy. 

The more often you fill your mind with positive thoughts and visualize your success, the more automatic they’ll be. Positive self-talk can make a big difference to your confidence. Run through the presentation — successfully — in your head.

During the presentation:

Businesswoman speaking from a podium to an audience in a conference-how-to-not-be-nervous-for-a-presentation

5. Focus on your material, not the audience

Your audience is there for your presentation — not to assess you. They’ll be looking at your colorful slides and listening to what you’re saying. Don’t let your mind fill with insecurities . 

6 . Don't fear silence

If your mind suddenly goes blank, that’s okay. It may seem like an eternity to you as you try to figure out what to say next, but it’s only a few seconds at most. 

Pausing isn’t a bad thing, anyway. You can use dramatic breaks advantageously to draw attention before the most important bits. 

7 . Speak slowly

Presentation anxiety often causes nervous energy, so we speak faster than normal. This might make you fumble your words or forget important details.

Slow down. Audience members will be thankful since they can understand you , and drawing out your speech will give you time to calm down, ground yourself , and stay organized.

8 . Take deep breaths and drink water

Breathing delivers oxygen to your brain, allowing you to think more clearly. Drinking water ups your energy, and also gives you a moment to pause. 

Smiling is a simple yet effective way to soothe your nerves. Doing so releases endorphins, helping you physically feel more confident. And a friendly face will make the audience more open to what you’re saying. 

10 . Remember the three "audience truths"

These include: 1) for the duration of the presentation, the audience believes you’re the expert, 2) they’re on your side, and 3) they don’t know when you make a mistake. 

After the presentation:

Businessman giving a talk to a group at a convention center lunch-how-to-not-be-nervous-for-a-presentation

11. Recognize your success

Giving a presentation is something worth being proud of — celebrate it! In addition to family, friends, and coworkers, you deserve a high five from yourself, too.

1 2. Collect feedback

Feedback is a wonderful gift if you use it as a tool to help you do even better next time. Ask some of your audience members what they liked and what they didn’t. Remember, you can learn a lot from your mistakes . 

1 3. Don't beat yourself up

You did the best you could, and that’s all anyone — including you — can ask for. 

Nervousness is perfectly normal, but sometimes our symptoms hold us back from doing — and enjoying — scarier tasks. Here are five tips for overcoming nerves:

1. Practice impression management

Impression management requires projecting an image that contradicts how you actually feel. It’s essentially a “fake it ‘til you make it” strategy.  Let’s say you’re about to make a corporate-wide presentation and feel worried you’ll forget important information. You’ll counteract this worry by imagining yourself remembering every detail and delivering it entertainingly.

Learn from this practice by noting the information chosen in your hypothetical and how you expressed it effectively. 

2. Talk to someone

Emotions are contagious. We absorb others’ positive vibes . Chatting with people who are excited about and confident in our presentation abilities rubs off on us. 

Before a presentation, call a cheerleader in your life — someone who’s on your side and understands your nerves. Be specific, discussing which parts of presenting are nerve-wracking and what you need from them.

3. Do breathing exercises

Mindful breathing is when you pay attention to the sensation of inhaling and exhaling while controlling and deepening breath length. Breathwork has several health benefits, including reducing stress and anxiety and improving memory, attention, and focus. 

Before the presentation, find a quiet and solitary space. Breathe deeply for at least a minute, focusing on sensation and depth. This practice brings you into your body and out of your mind (away from nerve-wracking thoughts).

4. Practice reframing 

Reframing is a technique used in cognitive behavior therapy (CBT) to improve negative automatic thought patterns over time. One such pattern is viewing certain emotions as bad, and others as good. Nervousness feels the same in the body as excitement. Instead of panicking even more when realizing you’re nervous, reframe your impression of nerves as excitement for what you’re about to do.

This excitement will propel you forward with confidence and pride for stepping out of your comfort zone and doing something scary.

Here are seven inspirational quotes to help you feel confident and excited when doing something you’re nervous about:

“You can speak well if your tongue can deliver the message of your heart.” John Ford
“ When speaking in public, your message — no matter how important — will not be effective or memorable if you don't have a clear structure. ” Patricia Fripp
“The most precious things in speech are the pauses.”  Sir Ralph Richardson
“The way you overcome shyness is to become so wrapped up in something that you forget to be afraid.” Lady Bird Johnson
“It’s what you practice in private that you will be rewarded for in public.” Tony Robbins
“The worst speech you’ll ever give will be far better than the one you never give.” Fred Miller

Like any other skill, learning how to not be nervous for a presentation takes time and practice. Acknowledging this hurdle is the first step to making a change in the right direction.  Facing your fears will empower you to take on scarier — and more fulfilling — goals and enjoy the experience along the way. You don’t have to start with a TED Talk. Tackle small challenges like presenting an idea to your manager or practicing a short speech with a friend.  We won’t sugarcoat it — it’s hard to change our minds and habits. But if you’re willing to put in the effort, you’ll be rewarded with increased confidence and new experiences.

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Elizabeth Perry, ACC

Elizabeth Perry is a Coach Community Manager at BetterUp. She uses strategic engagement strategies to cultivate a learning community across a global network of Coaches through in-person and virtual experiences, technology-enabled platforms, and strategic coaching industry partnerships. With over 3 years of coaching experience and a certification in transformative leadership and life coaching from Sofia University, Elizabeth leverages transpersonal psychology expertise to help coaches and clients gain awareness of their behavioral and thought patterns, discover their purpose and passions, and elevate their potential. She is a lifelong student of psychology, personal growth, and human potential as well as an ICF-certified ACC transpersonal life and leadership Coach.

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How to prepare and deliver an effective oral presentation

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  • Peer review
  • Lucia Hartigan , registrar 1 ,
  • Fionnuala Mone , fellow in maternal fetal medicine 1 ,
  • Mary Higgins , consultant obstetrician 2
  • 1 National Maternity Hospital, Dublin, Ireland
  • 2 National Maternity Hospital, Dublin; Obstetrics and Gynaecology, Medicine and Medical Sciences, University College Dublin
  • luciahartigan{at}hotmail.com

The success of an oral presentation lies in the speaker’s ability to transmit information to the audience. Lucia Hartigan and colleagues describe what they have learnt about delivering an effective scientific oral presentation from their own experiences, and their mistakes

The objective of an oral presentation is to portray large amounts of often complex information in a clear, bite sized fashion. Although some of the success lies in the content, the rest lies in the speaker’s skills in transmitting the information to the audience. 1


It is important to be as well prepared as possible. Look at the venue in person, and find out the time allowed for your presentation and for questions, and the size of the audience and their backgrounds, which will allow the presentation to be pitched at the appropriate level.

See what the ambience and temperature are like and check that the format of your presentation is compatible with the available computer. This is particularly important when embedding videos. Before you begin, look at the video on stand-by and make sure the lights are dimmed and the speakers are functioning.

For visual aids, Microsoft PowerPoint or Apple Mac Keynote programmes are usual, although Prezi is increasing in popularity. Save the presentation on a USB stick, with email or cloud storage backup to avoid last minute disasters.

When preparing the presentation, start with an opening slide containing the title of the study, your name, and the date. Begin by addressing and thanking the audience and the organisation that has invited you to speak. Typically, the format includes background, study aims, methodology, results, strengths and weaknesses of the study, and conclusions.

If the study takes a lecturing format, consider including “any questions?” on a slide before you conclude, which will allow the audience to remember the take home messages. Ideally, the audience should remember three of the main points from the presentation. 2

Have a maximum of four short points per slide. If you can display something as a diagram, video, or a graph, use this instead of text and talk around it.

Animation is available in both Microsoft PowerPoint and the Apple Mac Keynote programme, and its use in presentations has been demonstrated to assist in the retention and recall of facts. 3 Do not overuse it, though, as it could make you appear unprofessional. If you show a video or diagram don’t just sit back—use a laser pointer to explain what is happening.

Rehearse your presentation in front of at least one person. Request feedback and amend accordingly. If possible, practise in the venue itself so things will not be unfamiliar on the day. If you appear comfortable, the audience will feel comfortable. Ask colleagues and seniors what questions they would ask and prepare responses to these questions.

It is important to dress appropriately, stand up straight, and project your voice towards the back of the room. Practise using a microphone, or any other presentation aids, in advance. If you don’t have your own presenting style, think of the style of inspirational scientific speakers you have seen and imitate it.

Try to present slides at the rate of around one slide a minute. If you talk too much, you will lose your audience’s attention. The slides or videos should be an adjunct to your presentation, so do not hide behind them, and be proud of the work you are presenting. You should avoid reading the wording on the slides, but instead talk around the content on them.

Maintain eye contact with the audience and remember to smile and pause after each comment, giving your nerves time to settle. Speak slowly and concisely, highlighting key points.

Do not assume that the audience is completely familiar with the topic you are passionate about, but don’t patronise them either. Use every presentation as an opportunity to teach, even your seniors. The information you are presenting may be new to them, but it is always important to know your audience’s background. You can then ensure you do not patronise world experts.

To maintain the audience’s attention, vary the tone and inflection of your voice. If appropriate, use humour, though you should run any comments or jokes past others beforehand and make sure they are culturally appropriate. Check every now and again that the audience is following and offer them the opportunity to ask questions.

Finishing up is the most important part, as this is when you send your take home message with the audience. Slow down, even though time is important at this stage. Conclude with the three key points from the study and leave the slide up for a further few seconds. Do not ramble on. Give the audience a chance to digest the presentation. Conclude by acknowledging those who assisted you in the study, and thank the audience and organisation. If you are presenting in North America, it is usual practice to conclude with an image of the team. If you wish to show references, insert a text box on the appropriate slide with the primary author, year, and paper, although this is not always required.

Answering questions can often feel like the most daunting part, but don’t look upon this as negative. Assume that the audience has listened and is interested in your research. Listen carefully, and if you are unsure about what someone is saying, ask for the question to be rephrased. Thank the audience member for asking the question and keep responses brief and concise. If you are unsure of the answer you can say that the questioner has raised an interesting point that you will have to investigate further. Have someone in the audience who will write down the questions for you, and remember that this is effectively free peer review.

Be proud of your achievements and try to do justice to the work that you and the rest of your group have done. You deserve to be up on that stage, so show off what you have achieved.

Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.

  • ↵ Rovira A, Auger C, Naidich TP. How to prepare an oral presentation and a conference. Radiologica 2013 ; 55 (suppl 1): 2 -7S. OpenUrl
  • ↵ Bourne PE. Ten simple rules for making good oral presentations. PLos Comput Biol 2007 ; 3 : e77 . OpenUrl PubMed
  • ↵ Naqvi SH, Mobasher F, Afzal MA, Umair M, Kohli AN, Bukhari MH. Effectiveness of teaching methods in a medical institute: perceptions of medical students to teaching aids. J Pak Med Assoc 2013 ; 63 : 859 -64. OpenUrl

oral presentation of stress

oral presentation of stress

14 Fast Ways For How to Calm Down Before a Presentation

Are pre-presentation jitters making you feel frazzled? Does the thought of giving a speech in front of an audience make you anxious? If you’re like the majority of the population, the answer is probably yes.

In fact, public speaking is one of the #1 fears of most people… But dont worry, there’s hope to overcome this (or at least, calm your nerves)!

Luckily, there are numerous strategies you can use when learning how to calm calm down before a presentation, soothe your nerves and cultivate a sense of calm before taking the stage.

From practical preparation tips to mindset shifts and physical strategies, the path to a stress-free presentation starts with simple yet effective calming techniques.

By exploring these methods, you can navigate the world of public speaking with ease and confidence, ensuring that your next presentation is a success.

Here are 14 ways for how to calm down before a presentation: 

  • Prepare Ahead of Time
  • Practice, Practice, Practice
  • Use Visualization to Imagine Success
  • Repeat Positive Affirmations
  • Strike a Power Pose
  • Practice Breathing Exercises
  • Prioritize Self-Care
  • Do a Venue Walk-Through
  • Get Physical
  • Stay Hydrated
  • Talk to a Loved One
  • Listen to Calming Music
  • Get Grounded
  • Focus on Your Message

#1 – Prepare Ahead of Time

Knowing how to prepare for a speech , and rehearsing multiple times before the real event, can help you feel confident and calm on stage. 

Additionally, preparing for any technical difficulties is also important in case issues arise. Having technical backups in place, such as extra batteries or a backup USB drive, provides a sense of security and preparedness in case of any unforeseen issues. 

#2 – Practice, Practice, Practice

Familiarize yourself with your speech content by practicing it repeatedly. The more comfortable you are with the material, the more confident you’ll feel when delivering it. 

Giving a high-stakes presentation, delivering a speech in front of an audience, or engaging in any other kind of public speaking opportunity, can be scary. You may feel a loss of control or uncertainty – imaging worse-case scenarios, or have a fear of being judged. 

To combat this, it’s essential that you regain your sense of control by doing what you can to rehearse as much as possible. Then, when the real presentation happens, it’ll feel like just another rehearsal!

#3 – Use Visualization to Imagine Success

Take a few moments to visualize yourself giving a successful speech. Imagine yourself speaking confidently, engaging the audience, and receiving positive feedback. 

Visualization exercises can help build your confidence and reduce anxiety, so that you can calm down before the presentation. 

Visualization engages multiple cognitive processes simultaneously, enhancing comprehension and retention. By creating mental images of your success, you can activate your brain’s sensory areas and mimic positive feelings before your presentation.

Boost your confidence and mental attitude before a presentation by recalling past successful presentations and emphasizing the value you offer to the audience.

#4 – Repeat Positive Affirmations

Repeat positive affirmations to yourself to boost your confidence and calm your nerves. Remind yourself of your strengths, past successes, and capabilities as a speaker. 

Affirmations can help shift your mindset from one of anxiety to one of confidence and self-assurance.

Some positive affirmations you can try out are:

  • I am well-prepared and knowledgeable about my topic.
  • I am confident in my abilities to deliver this presentation effectively.
  • My audience is interested in what I have to say, and I will engage them with my words.
  • I am calm, composed, and in control of my nerves.
  • I believe in myself and my message, and I convey it with passion and authenticity.
  • I am grateful for the opportunity to share my ideas and inspire others.
  • I trust in my ability to handle any questions or challenges that may arise during the presentation.
  • I radiate enthusiasm and positivity, which captivates my audience.
  • Each word I speak is delivered with clarity, impact, and conviction.
  • I embrace any feedback as an opportunity for growth and improvement.

#5 – Strike a Power Pose

A quick hack for how to calm down before a presentation is to strike a power pose. This can help you to exude confidence and authority, helping you feel more in control. 

Never heard of the power pose? It’s basically like channeling your inner superhero before diving into something daunting, like a big presentation or a nerve-wracking interview. Think standing tall, hands on hips, chest out – the whole superhero vibe.

Here are a few examples:

  • The Superman/Superwoman: Feet shoulder-width apart, hands on hips, chin up.
  • The Wonder Woman: Legs slightly apart, arms crossed in front of chest.
  • The Victory V: Feet hip-width apart, arms raised in a V shape overhead, with a big smile.
  • The CEO: Lean back in your chair, hands behind your head, legs crossed comfortably.

These poses aren’t just for show; they’re proven to boost confidence and presence. So, next time you’re feeling a bit shaky, strike a power pose and watch your confidence soar!

#6 – Practice Breathing Exercises

Breathing exercises can also aid in reducing anxiety and promoting relaxation.

When you’re feeling those pre-presentation jitters, your body tends to tense up, and your breathing can become shallow and rapid. This can exacerbate feelings of anxiety and make it harder to focus.

However, engaging in intentional diaphramatic breathing exercises can help calm your nervous system, reduce stress, and bring a sense of relaxation.

You can also try certain voice exercises for speakers to strengthen your voice, and avoid any shakiness as you deliver your speech.

Here are some breathing exercises to help you calm down before a presentation:

  • Deep Breathing: Deep breathing, also known as diaphragmatic or belly breathing, involves taking slow, deep breaths that fully expand your lungs and engage your diaphragm. This activates the body’s relaxation response, lowering heart rate and blood pressure.
  • 4-7-8 Breathing: Inhale through your nose for a count of 4, hold your breath for a count of 7, then exhale slowly through your mouth for a count of 8. This technique helps regulate breathing and induces a state of calm.
  • Box Breathing: Inhale deeply for a count of 4, hold your breath for 4 counts, exhale for 4 counts, and then hold your breath again for 4 counts before repeating the cycle. This method encourages rhythmic breathing and can quickly reduce feelings of anxiety.
  • Alternate Nostril Breathing : Close one nostril with your thumb and inhale deeply through the other nostril. Then, close the other nostril with your ring finger and exhale through the first nostril. Repeat this process, alternating nostrils with each breath. This technique balances energy and promotes relaxation.

These breathing exercises can be done discreetly anytime, anywhere, and incorporating them into your routine before a presentation or nerve-wracking event can significantly reduce anxiety and improve your performance. 

#7 – Prioritize Self-Care

Before your presentation, it’s important to prioritize self-care practices. This includes things like getting enough rest, eating well, and staying hydrated to support your overall well-being.

Tip: Limit your intake of caffeine before the presentation, as it can increase feelings of anxiety and nervousness.

#8 – Do a Venue Walk-Through Beforehand (If Possible)

A venue walkthrough allows you to familiarize yourself with the presentation space, reducing potential last-minute stressors.

If time allows, try to schedule a venue walk-through a few days before the event. If time or the situation doesn’t permit this, try to arrive to your speaking event early on the day of. 

If you’re not able to schedule a physical walk-through, try doing an internet search for your venue, so you can watch any videos or observe any photos of what the space might look like.

As you do your walk-through, take note of the following:

  • Layout and Seating Arrangement: Observe the layout of the room and the seating arrangement. Determine where you’ll be positioned during your presentation and how the audience will be seated.
  • Lighting and Visibility: Assess the lighting in the room to ensure that you’ll be clearly visible to the audience. Check for any glare or shadows that could affect visibility, especially how it could effect your Powerpoint or Keynote slides .
  • Stage or Speaking Area: Familiarize yourself with the stage or speaking area, including any podium or lectern, as well as the positioning of chairs or tables.
  • Room Temperature: Take note of the room temperature and adjust it if necessary to ensure comfort for both yourself and the audience.
  • Emergency Exits: Locate the emergency exits and familiarize yourself with the evacuation procedures in case of an emergency.
  • Amenities: Identify the location of amenities such as restrooms, water fountains, and any designated areas for breaks or networking.

#9 – Get Physical

Before your presentation, engaging in physical activities like a brisk walk or quick workout can help release tension and boost endorphins, contributing to a sense of calmness and readiness. 

Additionally, incorporating muscle relaxation techniques, such as stretching or yoga, can help alleviate physical tension before presenting.

Try moving along to this video, which includes yoga poses specifically for calming nerves .

#10 – Stay Hydrated

It’s crucial to prioritize water intake to prevent dry mouth caused by nerves, ensuring optimal vocal performance.

Drinking something hydrating can also help you calm your pre-presentation jitters – so make sure to have a water bottle handy on the day of your presentation!

Remember to avoid consuming caffeine or energy drinks right before the presentation to prevent potential jitters or heightened nervousness.

#11 – Talk to a Loved One

Seek support from your friends, family, or colleagues to boost your confidence and provide encouragement. Having a strong support system can make a significant difference in how you feel before presenting.

By getting support from people you love, you’ll feel less alone and more confident, by boosting your feelings of belonging and having a sense of community. 

#12 – Listen to Calming Music

Listening to calming music can also help relax your mind and body before stepping on stage. 

This is one of the best hacks for how to calm down before a presentation, especially if it’s right before you present. Try listening to calming music right before you go on stage.

Calming music can help by triggering physiological responses in your body that promote relaxation. Slow-tempo music with soft melodies and gentle rhythms can lower heart rate, reduce cortisol levels (the stress hormone), and promote deeper breathing, all of which contribute to a sense of calmness and tranquility.

Additionally, music has the power to distract your mind from anxious thoughts, allowing you to focus on the soothing sounds and creating a more peaceful mental state.

Here’s a calming music playlist you can save for later.

The most calming genres to listen to to calm down before a presentation include:

  • Nature sounds (such as ocean waves, rain, or bird songs)

#13 – Get Grounded

A grounding technique is a mindfulness practice that can help you stay present and centered before your presentation. It involves engaging the senses to focus attention on the physical environment, which can help alleviate feelings of anxiety or nervousness.

By anchoring yourself in the present moment, you can calm nerves before a presentation by reducing the focus on fear of the future.

During a grounding exercise, you may be guided to:

  • Focus on your breath , paying attention to the sensations of inhaling and exhaling.
  • Notice your surroundings , identifying specific objects you can see, touch, hear, or smell.
  • Engage in physical movements, such as tapping your fingers or gently stretching.
  • Use visualization techniques, such as imagining yourself in a peaceful or comforting place, to evoke feelings of calmness and tranquility.

#14 – Focus on the Big Picture

Sometimes we can get tunnel vision when our fear and anxiety take over. Before a presentation, when you find your mind and body wandering and feeling stressed about the upcoming presentation, remind yourself of the big picture. Remember why you are doing this. 

It’s also helpful to shift your focus away from yourself and onto the audience. Remember that they are there to listen to your message and are likely supportive of your efforts. Focus on delivering value to your audience and meeting their needs rather than worrying about your own performance.

Learning how to calm down before a presentation will help you focus on the moment, focus on the moment, and feel accomplished. 

Remember, calming your nerves before a presentation is all about preparation, mindset, and taking care of yourself physically.

By rehearsing, staying positive, and utilizing these coping strategies, you can boost your confidence and feel more at ease.

With these techniques, you’ll be ready to tackle any presentation with confidence and composure.

You got this! 

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An oral presentation causes stress and memory impairments


  • 1 Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Universitätsstr. 150, 44780, Bochum, Germany. Electronic address: [email protected].
  • 2 Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Universitätsstr. 150, 44780, Bochum, Germany.
  • PMID: 30784900
  • DOI: 10.1016/j.psyneuen.2019.02.010

Laboratory experiments revealed the stress hormone cortisol to decrease memory retrieval of emotional material, but a translation to real-life settings is missing so far. In this study, 51 students encoded a list of neutral, positive, and negative words as well as two neutral, biographical notes one day before attendance at a seminar at the university. In the stress condition, students gave a graded oral presentation, whereas they just attended the same seminar in the control condition immediately before retrieval took place. Measures of state anxiety, salivary cortisol and alpha-amylase confirmed the oral presentation to constitute a potent stressor. Importantly, stress significantly impaired retrieval of negative words, but not retrieval of the biographical notes. These results indicate that a real-life stressor decreases memory retrieval for negative items. In contrast, delayed memory retrieval of neutral information and interrelated details of biographical notes seems to be less prone to stress effects. These results have critical implications for educational settings.

Keywords: Glucocorticoids; Memory retrieval; Naturalistic setting; Real-life stress; Stress hormones.

Copyright © 2019 Elsevier Ltd. All rights reserved.

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Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study

  • Theresa Faure 1 ,
  • Imke Weyers 2 ,
  • Jan-Bennet Voltmer 3 ,
  • Jürgen Westermann 2 &
  • Edgar Voltmer 1  

BMC Medical Education volume  24 , Article number:  718 ( 2024 ) Cite this article

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The anatomy dissection course is a major part of the first two years of the traditional medical curriculum in Germany. The vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years of the course of study. Published interventions for specific stress reduction are scarce.

In a randomized, controlled design two intervention groups were compared with a control group (CG) over the whole dissection course (nine measuring points before, during and after first and second semester). The ‘Stress Management intervention (IVSM)’ targeted at the setting of personal standards, the ‘Friendly Feedback intervention (IVFF)’ at the context of frequent testing. Quantitative surveys were distributed at nine measuring points. The questionnaire comprised validated instruments and self-developed items regarding stress, positive and negative affect, anxiety, intrinsic and extrinsic motivation, self-efficacy, and perceived performance.

Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. The experience of stress during the dissection course was significantly higher in the CG than in the IVFF. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation, and self-efficacy were higher than in the CG. For anxiety and negative affect in the IVSM this was especially seen at the end of the second semester. The self-perceived increase in both knowledge and preparedness for the first big oral and written examination did not differ between the study groups. About three quarters of the participants would choose the intervention ‘Friendly Feedback’ if given the choice.


Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance.

Peer Review reports

Medical education has a worldwide reputation of being stressful [ 1 , 2 , 3 ]. In Germany, decreasing proportions of students with a healthy behavior and experience pattern and increasing proportions with risk patterns for overexertion and burnout as well as symptoms of anxiety and depression have been reported especially for the first two years before the first major exam [ 1 , 4 , 5 ]. Performance pressure in the face of frequent testing, a fear of bad grades, and the vast amount of content to be learned are reported as some of the main reasons for stress [ 6 , 7 ].

In Germany, medical studies courses last for six years. In regular programs, after two years a first major exam has to be passed (M1/formerly Physikum, a centrally organized state exam, identical for every (participating) university). Major topics of the first two years with a vast amount of content to be learned include anatomy, biochemistry, and physiology, which are often presented together in the third and fourth semester. At the university of Lübeck, in a first attempt to reduce students’ stress, anatomy has been rescheduled to the first and second semester. In the dissection course, students have to pass an oral examination every week in both semesters. If they fail, they have to retry the examination. The content taught and the mode of examination are practiced in a comparable way in most standard medicine courses in Germany. In some faculties an exam is written at the end of the semester instead of, or in addition to, the tests during the semester. Students are informed that 95% pass the examination. However, the vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years, as seen in the results of the ongoing longitudinal study at Lübeck university (Luebeck University Students Trial, LUST) [ 4 , 5 ]. We chose the dissection course in anatomy for the study because at the university of Lübeck it is the first of the three major subjects that students find particularly stressful in the first two years (preclinical phase). The aforementioned transfer of the course to the first year of study also demonstrates the interest of the Institute of Anatomy (whose director is also the Dean of Medical Studies) in health promotion and stress reduction. We also intended to use the results in anatomy for a comparable approach in the other two stressful topics (biochemistry, physiology) of the preclinical phase.

According to self-determination theory (SDT), frequent testing is a characteristic of a controlling teaching style that may foster extrinsic motivation and impair intrinsic motivation among students [ 8 , 9 ]. According to this model, a teaching style that fosters autonomy and intrinsic motivation in students is characterized by considering and taking interest in the students’ perspective, positive feedback and appreciation, as well as explaining fully the demands and employing a blame-free communication [ 10 , 11 ]. Comparative studies showed that an autonomy-promoting teaching style yielded better results in conceptual learning, and long-term memory, along with reducing stress, than a controlling style [ 12 , 13 ]. It was also positively correlated with vitality and well-being and negatively with feelings of depression or burnout. In contrast, a controlling teaching style was correlated with negative affect and burnout [ 14 ]. Integrated model analyses in students also found a strong relationship between intrinsic motivation and fulfilled basic needs and positive affect and self-efficacy [ 15 , 16 ]. Positive affect and self-efficacy were in turn correlated positively with engagement and academic success [ 16 , 17 , 18 ]. In contrast, negative affect was correlated with increased stress and lower academic performance [ 19 ]. While in a meta-analysis stress in general or related to academia obtained the largest but still small correlations with academic success, students who felt that stress affected their performance had lower academic success and reported more stress [ 20 ].

While tests and exams belong to the external or structural context of a course of study, it should be noted that often high-achieving students tend to cause stress for themselves by setting their personal standards very high [ 21 ]. In particular, maladaptive forms of perfectionism with constant self-criticism and a fear of being judged by others were correlated with stress, anxiety, and depressive symptoms as well as test anxiety [ 22 ]. In a study of medical students, maladaptive perfectionism was consistently associated with distress and symptoms of depression as well as hopelessness regarding academic performance [ 21 ]. Increasing perfectionism was also correlated with declining resilience in medical students [ 23 ]. A high performance-based self-esteem was correlated with emotional exhaustion in a student group with this characteristic [ 24 ]. This may be especially harmful under conditions of a controlling teaching style [ 25 ].

Most of the published interventions addressing stress in the anatomy dissection course focus on the issue of dissecting human bodies or stress in general [ 26 , 27 , 28 , 29 ]. In this study, we compared two interventions in the dissection course aimed at reducing self- or context-generated stress and fostering intrinsic motivation to a control condition with regular teaching and testing. The ‘Stress Management intervention (IVSM)’ is a mindset-oriented program (addisca training) that was targeted at the setting of personal standards. In a pilot study, effects were particularly evident during periods of testing [ 30 ]. The ‘Friendly Feedback intervention (IVFF)’ was based on SDT and comprised principles of autonomy-supportive teaching [ 8 , 31 ]. It was targeted especially at the context of frequent testing (see method section). The research question was: How do the interventions influence the outcome parameters (mental health, self-efficacy, intrinsic/extrinsic motivation, and perceived status of preparation for the first major exam) compared to the control group with the standard program? Our hypotheses, based on reported effects for both interventions, were that in both intervention groups (a) the perception of stress would be lower (in the IVSM particularly at the end of a semester), (b) self-efficacy and intrinsic motivation would be higher than in the control group, while (c) there would be at least no difference in the perceived status of preparation between all study groups.

Interventions and control

Using a randomized, controlled design, two intervention groups were compared with a control group over the whole dissection course (first and second semester).

Stress Management intervention (IVSM): The participants of this group underwent a one-day workshop on stress management before the beginning of the dissection course [(addisca training), 32 ]. The addisca training was initially developed in a clinical context at the Center for Integrative Psychiatry at the University of Lübeck [ 32 ] and is based on a metacognitive approach [ 33 ]. It has also been successfully applied in non-clinical settings (schools, universities, companies), including students [ 30 ]. In this study, students were trained accordingly to deal with unproductive patterns of thinking and in the use of effective learning strategies. As the control group, they were then tested weekly with the option to either pass or fail.

Friendly Feedback intervention (IVFF): The preparation and knowledge of students were checked in a friendly discussion. Feedback was given on whether the preparation seemed satisfactory or further preparation would be recommended. Students were then responsible for how they dealt with the feedback. Based on SDT, the IVFF targeted in particular the attitude of the teachers, focusing on knowledge and not on knowledge gaps, considering students’ perspective, giving feedback on preparation and not on personality, and giving appreciative feedback for good preparation or growth-oriented feedback in the case of gaps [for more detailed description see 14 , 34 ]. Teachers were given instruction on these principles in a preparative session before the start of the dissection course.

Control group (CG): The participants of the control group were tested weekly with the option to either pass or fail.

The first-semester students were personally informed about the study conditions and the voluntary nature of participation in two events before the start of the course. An information sheet was made available online. Students gave their written consent to participate in the study. There were no general exclusion criteria. For the identification of datasets in the longitudinal analyses participants were asked to generate a personal (pseudonymous) identification code and/or provide the matriculation number. The students were informed that the study team had no access to personal data via their matriculation number and that the Student Service Center had no access to the study results.

The participating students were stratified for gender and randomly distributed to the three study conditions. The dissection course was organized in four shifts on two days. A maximum of 51 places were available for students in each shift. To avoid interference effects between the interventions, one shift was reserved for each intervention group. Because there were more than 153 students willing to participate, a slightly larger number of students were randomized to the control group and distributed over two shifts. The randomization was carried out in Excel, using the RAND formula for male and female participants separately. After sorting the participants by random numbers, the same number of participants were assigned to each intervention group up to a maximum of 51, thereby taking the total gender ratio into account. The remaining participants were assigned to the control group.

The evaluation followed a mixed-method approach, with questionnaires being distributed for the quantitative analysis while interviews were used in four focus groups for the qualitative analysis. We report here the results of the main instruments of the quantitative analysis. The detailed report of the qualitative results is beyond the scope of this article and will therefore be provided in a separate article.

Questionnaires were presented to the participating students before starting the course (t0 in paper form), on four occasions during the course in the winter semester (t1 – t4), at a follow-up after the winter semester (t5), and at three measurement points during the summer semester (t6 – t8; except for t0, all via QR Code for Lime Survey). During the semesters, the questionnaires were presented just before the start of the dissection course to capture the experiences and feelings connected to the course. The questionnaire comprised the following, validated instruments and self-developed items:

Experienced stress

A single-item measure probing the degree of subjective feeling of stress in the previous week has been used in several previous studies and was highly correlated with different measures of emotional distress (‘How would you rate your feeling of stress in the past week?’) [ 35 ]. The item was rated on a nine-point Likert scale from 1 - not at all to 9 - very much.

Positive and negative affect scales (PANAS)

The Positive and Negative Affect Scales uses 10 adjectives to examine actual mood state with five items for positive affect and five items for negative affect (e.g., ‘active’, ‘anxious’) [ 36 , 37 ]. Response options are rated on a five-point Likert scale from 1 - not at all, to 5 - extremely. The time frame given was ‘in the last days’.

State-trait anxiety inventory (STAI-SKD)

The German version of the STAI-SKD examines the situational feeling of anxiety [ 38 , 39 ]. The five items (e.g., ‘I am tense’) are scored on a four-point Likert scale from 1 - not at all, to 4 - very much.

Self-efficacy (WIRKSTUD)

The study-specific self-efficacy (WIRKSTUD) was examined using seven items (e.g., ‘If I prepare myself sufficiently, I can achieve a good performance in the test/friendly feedback’) [ 40 , 41 ]. Response scores were rated on a four-point Likert-scale from 1 - not at all to 4 - very much.

Learning motivation

As proposed by Brahm et al. [ 42 , 43 ] intrinsic learning motivation was measured with three items (e.g., ‘I work and learn for my course of study because the learning content interests me’) [ 44 ] as well as extrinsic learning motivation (e.g., ‘most important for me is to get good grades in the course of study’) [ 45 ]. Items were rated on a six-point Likert scale from 1 – does no apply at all to 6 - does apply exactly.


As surrogate parameters for the final grades in M1, at t5 and t8 we applied two items on the perception of preparation for this first major examination: ‘I feel well prepared for the written/oral part of M1’. Response options were rated on a five-point Likert scale from 1 – do not agree at all to 5 – agree completely. Additionally, the participants were asked to estimate their medical and anatomical knowledge in terms of percentage (0-100%) [ 46 ].

Personal preference

At the end of each semester (t5 and t8) students were asked, which condition they would have chosen if given the option.

In terms of demographics, age and sex were integrated. A detailed list of which instruments were used at which time-point in the study can be found in the Additional File 1. In the power analysis, we assumed a willingness to participate by at least 150 students, stratified by gender and randomized to about 50 in each of the three study arms. Assuming a mean effect size ( d  = 0.6) in the comparison between the intervention and control group [ 35 ] at t5, a power of 80% appeared feasible in the selected study design.

Ethical approval

The study protocol has been approved by the Ethics Committee of the University of Lübeck (file number: 21–313).

Statistical analysis

Data analyses were conducted using R and SPSS for Windows, Version 22.0 (IBM Corp., Armonk, NY, USA). In the current study, we collected data across multiple time points on several outcomes of interest. To analyze these data, we used multilevel modeling (MLM) to model the effects of time and other predictors on our outcomes, while accounting for the nonindependence of observations among individuals [ 47 ]. Specifically, we included random intercepts for each participant, allowing for individual differences in baseline levels. The intraclass correlation coefficients (ICC) in our study ranged from 0.003 to 0.230, indicating that there was significant within-subject variability that needed to be accounted for in our analyses [ 48 ]. By using MLM, we were able to appropriately model this variability and obtain accurate estimates of our effects of interest.

We used linear mixed modeling [ 49 ] to investigate the development of the outcome parameters (stress, affect, and anxiety; self-efficacy, motivation; self-perceived performance) over time. Exclusions were limited to participants who were not correctly assigned to one of the three conditions. Using mixed linear modeling, we used all available data points for each participant across different time points, effectively analyzing data from between 132 and 162 participants at each time point. Specifically, we modeled each of the variables described above as an outcome of two predictors, time and study group, as well as the interaction effects between time and study group. This allowed us to test whether the effect of the group on the outcome variables changed over time. If significant interaction effects were detected, we conducted Tukey-adjusted post hoc tests [ 50 ] to explore the specific group differences at each time point.

Overall, this analytical strategy allowed us to investigate the development of the outcome variables over time, while accounting for within-subject variability and testing for group differences in the outcome variables. Additionally, the inclusion of interaction effects between time and study group allowed us to examine whether the effect of group on the outcome variables changed over time.

Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. After randomized distribution to the three study conditions, 65 students participated in the control group (CG), 50 in the Stress Management intervention (IVSM), and 51 students in the Friendly Feedback intervention (IVFF).

Stress and anxiety

The experience of stress reported by participants for the previous week was significantly affected by their study group ( F (2, 163) = 3.09, p  < 0.05, ICC (Model) = 0.409): Specifically, students in the IVFF had an overall lower experience of stress than those in the control group ( t (167) = 2.45, p  < 0.05). Moreover, there was a significant interaction effect between time point and study group ( F (8, 1110) = 3.45, p  < 0.01). Importantly, however, the difference between the study groups differed between time points as indicated by moderation analysis ( F (16, 1116) = 3.88, p  < 0.01): The experience of stress was lower in the IVFF than in the CG at t2, t3, t4, and t6, ps  < = 0.022, and even lower than in the IVSM at t3 and t4, ps  < = 0.015 (Fig.  1 ; Detailed post-hoc comparisons are comprehensively presented in the Additional file 2).

figure 1

Stress scores of students in three study conditions (single item). CG: control group; IVSM: intervention stress management, IVFF: intervention friendly feedback t0 before, t1 - t4 winter semester, t5 semester break, t6 - t8 summer semester

As with stress, course-related anxiety was significantly affected by the study group ( F (2, 165.57) = 10.22, p  < 0.01, ICC (Model) = 0.621). Again, students in the IVFF had a lower course-related anxiety than those in the control group ( t (168) = 4.47, p  < 0.01). This difference and the significant effect of the measurement timepoint ( F (8, 1115) = 24.51, p  < 0.001) were again qualified by an interaction between time and study group: Moderation analysis indicated that study group differed between timepoints ( F (16, 1115) = 10.22, p  < 0.01). Anxiety was significantly lower in the IVFF than in the CG at t2 – t8 ( ps  < 0.01). There was also a significant difference between the CG and the IVSM at t4 ( p  < 0.05; Fig.  2 ; see also Additional file 2).

figure 2

Course-related anxiety (State-trait Anxiety Inventory (STAI-SKD)). CG: control group; IVSM: intervention stress management, IVFF: intervention friendly feedback t0 before, t1 – t4 winter semester, t5 semester break, t6 – t8 summer semester

  • Self-efficacy

Likewise, self-efficacy was also significantly affected by study group ( F (2, 166.57) = 3.76, p  < 0.05, ICC (Model) = 0.646). Specifically, students in the IVFF had significantly higher scale scores than those in the CG ( t (168) = -2.69, p  < 0.05). The effect of study group differed between timepoints ( F (16, 1111.56) = 3.44, p  < 0.01): Perceived self-efficacy was significantly higher in the IVFF than in the CG at t2 – t6 (see also Additional file 2). Descriptively all scores of the IVSM were higher than those in the CG but these differences were not significant (Fig.  3 ).

figure 3

Development of self-efficacy over time (Self-efficacy (WIRKSTUD)). CG: control group; IVSM: intervention stress management, IVFF: intervention friendly feedback t0 before, t1 - t4 winter semester, t5 semester break, t6 - t8 summer semester

Affect and motivation

In contrast to stress, anxiety, and self-efficacy, the differences between study groups regarding positive affect and intrinsic motivation were only qualified by their respective interaction with timepoint: For positive affect, a trend for group differences was visible, with students in IVFF having higher scale scores than those in the CG ( t (168) = -2.32, p  = 0.552, ICC (Model) = 0.453). More importantly, however, the difference between study groups differed between time points ( F (16, 1117) = 3.15, p  < 0.01): Positive affect decreased significantly from t0 to t8 in all study groups. However, the decrease was stronger in the CG than in the intervention groups. Scale scores for positive affect were significantly higher in IVFF than in the CG at t3 and t4 as well as t7 and t8 ( ps  < = 0.02). For negative affect the trend was reciprocal (data not shown; see also Additional file 2).

Likewise, the decrease in intrinsic motivation over time ( F (8, 1105) = 17.10, p  < 0.001, ICC (Model) = 0.554) significantly differed between the study groups ( F (16, 1105) = 2.32, p  < 0.05): In post hoc analysis the scores for intrinsic motivation for the IVFF were significantly higher than those for the CG at t3, t4 and t8 (Fig.  4 ; see also Additional file 2). For extrinsic motivation the differences between study groups were not significant (data not shown).

figure 4

Development of intrinsic motivation (Learning motivation). CG: control group; IVSM: intervention stress management, IVFF: intervention friendly feedback t0 before, t1 - t4 winter semester, t5 semester break, t6 - t8 summer semester

Because there were no gradings in oral examinations and no final written exams at the end of the semesters, we asked the participants at t5 and t8 how they perceived their knowledge in anatomy as well as in all preclinical topics. In addition, students were asked how well prepared they felt for the oral and written part of the M1. From t5 to t8 an increase in perceived knowledge was seen in all study groups (for medical knowledge, F (1, 112) = 30.38, p  < 0.001, for anatomical knowledge, F (1, 130) = 39.10, p  < 0.001). Differences between the intervention groups and the CG were not significant. Likewise, the perceived preparation for the exam increased from t5 to t8 (for the written exam, F (1, 120) = 10.96, p  = 0.001, for the oral exam, F (1, 130) = 29.22, p  < 0.001), but there was no difference in change over time between the study groups (data not shown).

Preferred condition

At t5 and t8 almost three quarters of the participating students (73% and 72% respectively) declared that they would have chosen the study condition ‘Friendly Feedback’ if given the opportunity. Among the students in the IVFF at both time points the percentage was 95%. Among the students in the CG, 20% at t5 and 29% at t8 declared that they would choose the control condition with a weekly mandatory examination. Also in this group, 11% at t5 and 14% at t8 would choose the IVSM. In the IVSM, 54% at t5 and 64% at t8 would choose the IVFF, and 33% at t5 and 27% at t8 would choose their current option (Table  1 ).

In this study in the setting of the dissection course we compared, using a randomized, controlled design, the effect of one intervention aimed at self-generated stress (IVSM) and one aimed at the stress-generating context (IVFF). Summarizing the results regarding our research question, we found that a significantly larger proportion of students in the ‘Friendly Feedback’ intervention group experienced less acute and chronic stress than in the control group. For the ‘Stress Management’ intervention group this was true in the second (summer) semester. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation and self-efficacy were higher than in the CG. Self-perceived academic performance and preparation did not differ between the study groups.

Stress during the dissection course

The dissection course in anatomy is unanimously described as a stressful experience in the initial years of medical education [ 51 ]. One source of stress, at which most published interventions are directed, is the issue of first contact with a dead corpse and the dissection of a human body [ 26 , 52 ]. Another important factor is the vast amount of content to be learned and the common frequent testing. There is a distinct connection between these latter two factors because teachers themselves admit that they do not believe that intrinsic motivation alone would be enough to handle the material, but that examination has to give an additional impulse so that students really engage in the topic. Scott approves this notion when he writes: “As a medical educator who sits at curriculum tables, I often hear calls for testing to ensure that students ‘learn it’; after all, everyone knows that assessment drives learning. Doesn’t it?” [ 53 ]. In contrast, self-determination theory states that people are by nature active and engaged and are interested in fulfilling general psychological needs in terms of competence, autonomy, and relatedness [ 54 ].

Intervention stress management and friendly feedback

The autonomy-supportive teaching style that was developed on the basis of SDT judges tests and examinations critically and emphasizes approaches that acknowledge students’ perspective and appreciates good performance. It has been shown that this teaching style reduces stress, increases intrinsic motivation and fosters conceptual learning [ 31 ]. In line with this and our first hypothesis, a significantly lower proportion of students in the ‘Friendly Feedback’ intervention group that comprised principles of autonomy-supportive teaching, perceived high stress levels, anxiety, and negative affect than among fellow students in the CG. Instead, a higher positive affect and self-efficacy were reported. Other studies confirmed that reduced stress, positive affect, and self-efficacy were closely related to high academic performance [ 17 , 18 ]. It might indicate indirect support for the high stress levels found in the control group that (maybe compensatory) relaxation during the semester break was higher in the CG than in both intervention groups. The decreasing stress scores at t6 and t7 in the CG and in the IVSM group might be interpreted as a certain adaptation to the testing. However, these scores are still higher than those in the IVFF group and at t8 the scores rise again to the levels of the first semester.

In line with our second hypothesis, intrinsic motivation was higher in the IVFF than in the CG at all measurement points. As regards the decreasing intrinsic motivation in all study groups, it should be borne in mind that besides anatomy, several more topics had to be studied, adding to the vast amount to be learned, which may frustrate even the most ambitious students [ 55 , 56 , 57 ]. In contrast, for Brazilian medical students, a curriculum reform that reduced content and implemented elements of autonomy-supportive learning, increased intrinsic and extrinsic learning motivation [ 58 ].

Slightly in contrast to our first hypothesis, for students in the IVSM it was obviously difficult to apply the techniques of the mindset-oriented stress management training during the winter semester. However, in the summer semester and up to the oral and written examinations at the end of the semester, a lower proportion of the IVSM felt highly stressed than in the CG. This is in line with the results of a pilot study with the addisca training, which indicated that these effects were particular evident during periods of testing [ 30 ]. Perhaps the experience of stress related specifically to study is a prerequisite for effectively applying the course content. This was also supported by the fact that a higher percentage would choose this intervention again at t8 than at t5. Studies in the working population affirm that a stress-reducing effect was especially/only seen in those who presented with elevated stress scores at the beginning of the intervention [ 59 , 60 ]. This was also true for self-efficacy [ 61 ].

An interesting result from our study was the fact that even after eliminating a major contextual factor of stress in the IVFF, a smaller but relevant proportion of students in this intervention group still felt severely stressed. It is obviously not only the concern about failing the examination that causes stress but might also be a fear of being seen in an unfavorable light in front of fellow students and teachers. This fear characterizes in particular maladaptive forms of perfectionism, which could be self-oriented, others-oriented or related to the judgment of others [ 22 , 62 ]. For some of the students in the IVFF, these fears seemed to outweigh the relief provided by the omitted tests. Studies in medical students confirm that maladaptive perfectionism is associated with greater distress and symptoms of depression and hopelessness regarding academic performance [ 21 ]. This might be especially true for an extreme form of self-doubt known as ‘imposter phenomenon’ (IP). The IP is a form of distrust in one’s abilities and performance despite evidence of competence, success and positive feedback [ 63 , 64 ]. It is important to note that this is not primarily a problem of underperforming or failing students. On the contrary, it often affects high-achieving individuals at all career stages [ 63 ]. Among medical students and residents proportions of 30−40% are reported, with women being affected to a greater extent than males [ 65 , 66 ]. In contrast, adaptive forms of perfectionism were associated with positive affect and good performance [ 21 ].

  • Academic performance

With regard to academic performance, on the one hand, there is a fear that without testing, students will not learn enough [ 53 ]; on the other hand, many studies show that testing causes anxiety, which in turn negatively affects academic performance [ 67 , 68 ]. Contrary to the apprehensions of the teachers and in line with our third hypothesis, in our study, the perceived readiness of students for the written and oral exams was not significantly different between the intervention and control groups. However, it has to be noted that self-estimation by freshmen students may be flawed by inexperience and may differ significantly to the estimation of teachers or peers (Dunning–Kruger effect) [ 69 , 70 , 71 ]. Because even the standard examination, practiced in the CG and the IVSM, operated on a pass/fail condition (and approximately 95% of students pass the examination), it was not possible to correlate the study groups to objective performance parameters. We therefore intend to examine the correlation of the study group and the anatomy point score in the M1 exam in a consecutive study.

In the context of stress and academic performance, the question of how much stress could be or should be accepted or tolerated may be of interest. In view of the performance-enhancing effect of a certain physiological activation [ 72 , 73 ], a no-stress policy probably seems neither realistic nor desirable. In the current study, a certain level of stress was accepted by teachers to promote intensive learning. However, the results of our study demonstrate that there might be options to reduce unnecessary high stress levels.

Strengths and limitations

A major strength of our study was the randomized, controlled design and the high number of students, who were willing to participate. However, with three study groups and the slightly varying participation numbers per measuring point in the longitudinal design, the number of participants was too small to execute gender-specific analyses. To compare intervention versus non-intervention could be criticized because an effect might be too expected. However, we were particularly interested in a comparison of the two interventions with the standard procedure. With two interventions, there was also more than one option for comparison with the control. The study was only conducted at one university. However, considering comparable content and examination elements at other universities, the results appear to be at least partially applicable to other study locations. To date, we have only been able to measure performance via self-perception. Especially in freshmen students, this might be limited by inexperience (Dunning–Kruger effect, see above). It is planned to survey students after M1 and correlate the grades in the anatomy part of this examination as objective parameters with the intervention groups.

In summary it needs to be questioned, whether students at the beginning of their course of study have to be coerced to learn an overwhelming amount of content by the use of frequent examinations. On the basis of the SDT and autonomy-supportive learning that have been applied in the IVFF, an empowering approach seems to be much more promising, because it reduces stress and anxiety, fosters self-efficacy and intrinsic motivation and leads to at least similar results regarding perceived academic performance. Based on a review and meta-analysis, Richardson et al. [ 20 ] state that ‘teachers’ behaviors are likely to be important for boosting and maintaining students’ self-efficacy. Setting graded tasks, providing feedback on successful performance, and lowering students’ anxiety and stress about coursework, exams, and presentations promote mastery experiences and thereby increase self-efficacy’. They also suggest that interventions early in students’ university career may be most effective because the strongest correlates identified in their review, namely performance self-efficacy and grade goals, were likely to be more fluid during the early stages of skills development. [ 20 ].

Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect, and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance. A review of performance based on objective criteria appears to be important for future studies. If this confirms the current findings, a regular offer of a revised stress management course and an adjustment of the course delivery with the aim of reducing unnecessary stress would appear appropriate.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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T.F. made substantial contributions to the conception and design of the study and the acquisition and analysis of data; she was also involved in drafting the manuscript and revising it critically for important intellectual content.I.W. was involved in the conception and design of the study, the acquisition of data and in drafting the manuscript and revising it critically for important intellectual content.J.-B.V. made a substantial contribution to the analysis and interpretation of data; he was also involved in drafting and revising the manuscript critically for important intellectual content.J.W. was involved in the conception and design of the study, made substantial contributions to fostering its implementation, and was involved in revising the manuscript critically for important intellectual content.E.V. made substantial contributions to the conception and design of the study and the analysis and interpretation of data; he also led the drafting and revising of the manuscript for important intellectual content. All authors read and approved the final manuscript.

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Faure, T., Weyers, I., Voltmer, JB. et al. Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study. BMC Med Educ 24 , 718 (2024). https://doi.org/10.1186/s12909-024-05640-7

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