Being tired makes it worse. Too much coffee makes it worse (I'm interested to see that this has been others' experience as well). So if I have to do any public speaking on a particular day, I lay off the caffeine. Stress *can* make it worse -- though if I have a real adrenaline rush, it can sometimes go away entirely. Anti-anxiety medication has helped to an extent, though that's not the reason I take it. But there are times when I do everything "right" and it still leaps out and surprises me, LOL. ETA: I forgot to mention that low blood sugar can make it worse as well - that probably goes under 'being tired'. So again, if I have to do any public speaking, I make sure I've eaten something first. (I have to speak to audiences sometimes; I think the largest so far has probably been several hundred people. And yes, the first few times I was terrified out of my mind, and yes, I've stuttered in front of an audience -- badly at times. But hey, life goes on.)