Treatment and prevention of music performance anxiety

Design and Evaluation of a Collective Preventive Program for Musical Performance Anxiety (ConfiDance)

Musical performance anxiety (MPA) is considered a subtype of social phobia and affects musicians who must face musical exposure in public, potentially severely affecting their emotional stability and significantly impairing the quality of their performance. This research has utilized previous scientific knowledge on the issue and a qualitative approach to musicians' needs through focus groups in order to design a collective preventive program for MPA that could be implemented within the training curriculum of professional musicians. To evaluate the adequacy of the preventive program 'ConfiDance', a pilot test was conducted with a sample of 17 professional musicians in training, all post-graduate students in classical music performance. For the pilot test, a quasi-experimental model with a repeated measures methodology (pre-post and one-year follow-up after application) was carried out. The results indicate a significant decrease in MPA after the program implementation, with a notable improvement in effect one year post-application, demonstrating an even greater positive impact over time. These data should be interpreted cautiously due to sample limitations but represent an opportunity for the future implementation of a program that can prevent and treat MPA in music education centers.

It's not a virus! Reconceptualizing and de-pathologizing music performance anxiety

Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.

Dispositional and performance-specific music performance anxiety in young amateur musicians

Introduction

Research on Music Performance Anxiety (MPA) among amateur musicians is of great interest due to inconsistent results in literature. In addition, amateur music represents an important part of musical culture in Germany. Accordingly, the performance experiences of young wind players represent a relevant issue for research and musical practice.

Methods

In the present study, 67 young amateur musicians of a brass choir were examined. Using two different questionnaires, both the dispositional MPA (K-MPAI) and the performance-specific MPA during a joint concert (Performance-specific Questionnaire for Musicians, PQM) were assessed. The PQM measures the symptoms of MPA, functional coping with MPA and self-efficacy before, during and after a specific performance. The PQM was completed by the musicians via an app directly after the concert.

Results

Results showed that about 90% of the young amateur musicians had a low dispositional MPA, but about 10% showed high values. For the concrete performance, however, musicians with high dispositional MPA also experienced a very moderate to low MPA in the concert. On average, the musicians were quite nervous before the performance. After the performance, they showed low levels of MPA. Three types of MPA found in previous studies could be confirmed among the amateur musicians, with three quarters being assigned to the positive type, showing low levels of symptoms associated with consistently high levels of self-efficacy and positive functional coping.

Discussion

The results provide a differentiated picture of different expressions of MPA in young amateur musicians. They also raise further questions about the correlation between dispositional and performance-specific assessment of MPA in musicians in general.

Exploring the Synergy of Music and Medicine in Healthcare: Expert Insights into the Curative and Societal Role of the Relationship between Music and Medicine

Our study aimed to investigate the correlation between medicine, health perception, and music as well as the role of music in the healthcare setting. To gain insights into the dynamics between these two fields, we gathered opinions from attendees and presenters at an international conference on music medicine, musicians' health, and music therapy. A team of six interviewers conducted a total of 26 semi-structured interviews. The interview guide focused on four predetermined themes: (1) "music in medicine", (2) "performing arts medicine", (3) "music for the individual", and (4) "music for society". The responses were analyzed using grounded theory methods as well as thematic and content analysis. To enhance the analytical strength, investigator triangulation was employed. Within the predefined themes, we identified several subthemes. Theme 1 encompassed topics such as "listening and performing music for treating diseases and establishing non-verbal relationships", "the value of music in specific disorders, end-of-life care, and pain management", and "the design of sound spaces". Theme 2 explored aspects including the "denial and taboo surrounding physical and mental health issues among musicians", "the importance of prevention", and an antithesis: "pain and suffering driving creativity". Theme 3 addressed the "mental role of music in ordinary and extraordinary life" as well as "music's ability to enable self-conditioning". Lastly, Theme 4 examined the role of music in "cultural self-identification" and "development and education for children". Throughout the interviews, participants expressed a lack of knowledge and awareness regarding interdisciplinary research and the fields of music and medicine. Our findings affirm the significance of music therapy and performing arts medicine as well as the broader relationship between music and medicine. They highlight the potential benefits of perception and experiential pathways for individuals and, consequently, for human society.

Development of Flow State Self-Regulation Skills and Coping With Musical Performance Anxiety: Design and Evaluation of an Electronically Implemented Psychological Program

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people's health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. Musicians are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State (t = -2.41, p = 0.02, d = 0.36), and Sense of Control (t = -2.48, p = 0.02, d = 0.47), and decreased Music Performance Anxiety (t = 2.64, p = 0.01, d = 0.24), and self-consciousness (t = -3.66, p = 0.00, d = 0.70) of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables (especially in situations of performance and public exposure), such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed.

Preliminary Assessment of Individual Zone of Optimal Functioning Model Applied to Music Performance Anxiety in College Piano Majors

Individual zone of optimal functioning (IZOF) is a psychological model studied and applied to quantify athletes’ anxiety and predicts their achievement in sports competitions. This study aimed to determine the application of the IZOF model to evaluate music performance anxiety (MPA) in pianists because the causes of anxiety in athletes and musicians may be similar. A total of 30 college-level piano-major students were included in the study, and the anxiety level in performance was scored by the Competitive State Anxiety Inventory-2 questionnaire. In the first phase, participants recalled and self-scored the four important performances in the past year. Notably, seven piano teachers scored the performances. Both results were combined to identify the individual IZOF zone. Each student showed different anxiety scores for cognitive state anxiety (CA), somatic state anxiety (SA), and self-confidence (SC). In the second phase, all participants scored their anxiety level 1 day before the final performance, and the same judges evaluated the performance immediately afterward. A total of 60% of the participants who had at least two subscales inside the IZOF received performance scores greater than 90. In conclusion, the IZOF model provides information for both piano teachers and pianists to help review their anxiety intensity and predict their performance scores to some extent.

Back to feedback: aberrant sensorimotor control in music performance under pressure

Precisely timed production of dexterous actions is often destabilized in anxiogenic situations. Previous studies demonstrated that cognitive functions such as attention and working memory as well as autonomic nervous functions are susceptible to psychological stress in skillful performance while playing sports or musical instruments. However, it is not known whether the degradation of sensorimotor functions underlies such a compromise of skillful performance due to psychophysiological distress. Here, we addressed this issue through a set of behavioral experiments. After artificially delaying the timing of tone production while playing the piano, the local tempo was abnormally disrupted only under pressure. The results suggest that psychological stress degraded the temporal stability of movement control due to an abnormal increase in feedback gain. A learning experiment further demonstrated that the temporal instability of auditory-motor control under pressure was alleviated after practicing piano while ignoring delayed auditory feedback but not after practicing while compensating for the delayed feedback. Together, these findings suggest an abnormal transition from feedforward to feedback control in expert piano performance with psychological stress, which can be mitigated through specialized sensorimotor training that involves piano practice while volitionally ignoring the artificially delayed provision of auditory feedback.

In order to establish if the degradation of sensorimotor functions underlies the stress-associated disruption of skilful performance, Furuya et al examined participants undergoing a piano playing task under stress. Their data suggests the occurrence of a stress-induced transition from feedforward to feedback control, which can be mitigated through sensorimotor training involving piano practice while volitionally ignoring the artificially delayed provision of auditory feedback.

Live Music Performance: The Relationship Between Flow and Music Performance Anxiety

Most studies exploring the relation between flow and Music Performance Anxiety (MPA) have focused on the disposition of generally experiencing flow and the occurrence of MPA. Little is known about the connection between experiencing flow and MPA as it relates to a specific performance. In this study, flow and MPA have been investigated in 363 orchestral musicians in relation to a particular live music performance. The musicians were asked to fill out a questionnaire immediately after a concert. Flow experience during the performance was measured using the Flow Short Scale. The Performance-specific Questionnaire on MPA (PQM) was used for MPA. The PQM addresses particular aspects of MPA and refers retrospectively to the time before and during the performance as well as to the moment of filling out the questionnaire after the performance. Using three scales, the functional coping, the perceived symptoms of MPA and self-efficacy were determined for each time point of the performance. The results showed that experiencing flow was on average higher among orchestral musicians compared to a sample of the general population. However, there were differences between the professional and non-professional musicians. All PQM scales showed significant correlations with the global flow scale. Regression analysis on the global flow score found that regarding the time before the performance the PQM scale symptoms of MPA were diametrically connected with the flow experience. The PQM scale functional coping was shown to be positively related to the flow during the performance. Moreover, high self-efficacy was found to be closely related with stronger flow experience. Furthermore, flow seems to have positive effects on functionally coping with MPA and the self-efficacy after the performance. These findings confirm the negative relationship between flow and symptoms of MPA, offering further approaches in understanding the relationship especially for live music performances.

Classifying Different Types of Music Performance Anxiety

Music performance anxiety (MPA) is a commonly present topic among musicians. Most studies on MPA investigated effects of a more general occurrence of MPA on performances. Less is known about individual variations of MPA within a performance, more specifically at the times before, during, and after the performance. This study used a questionnaire to investigate these performance times in order to find out if there occur different types in the variation of the perceived MPA across the performance. The study was performed with 532 musicians; 27% of them being professional orchestra musicians, 45% non-professional orchestra musicians, and 28% non-professional choir singers. The musicians were asked to fill in the Performance-specific Questionnaire for Musicians (PQM) immediately after a performance. The questionnaire contains three scales regarding symptoms of MPA, functional coping with MPA and performance-related self-efficacy. A cluster analysis was performed on the PQM scales to identify systematic variations. Findings indicate that there are three different types of MPA in the sample studied. Type 1 describes musicians who have few symptoms of MPA throughout the performance, show functional coping with MPA, and have a stable and well-developed self-efficacy. Type 2 describes musicians who begin their performance with rather high symptoms of MPA but can positively reduce these by the end of the performance and show high values in self-efficacy and in functional coping. Type 3 contains musicians who begin their performance with some symptoms of MPA, which increase to the end of the performance. The values of self-efficacy and functional coping in this type are rather low. Of the total sample, half of the musicians were assigned to Type 1 and approximately a quarter each to Type 2 (27%) and Type 3 (23%). In accordance with the literature, the results confirm the importance of self-efficacy and functional coping for a positive performance experience.

Performing Arts Medicine

Performing artists are a unique subset of athletes. With the highly repetitive nature of performance training, emphasis on proper technique, ergonomics, and preventive cross-training is vital, as many injuries are due to overuse or poor technique. There are novel medical concerns in performers, including ENT problems, mental health concerns and substance use risks. While music is central to performances, it is also a treatment modality to address cognitive, sensory, and motor dysfunctions in certain neurological conditions. Due to this wide array of issues, it is imperative to understand the specific needs and risks of performers to provide optimal medical care.

Impact of Exercises and Chair Massage on Musculoskeletal Pain of Young Musicians

Due to the occurrence among musicians of musculoskeletal problems associated with playing a musical instrument, it is necessary to use prophylaxis. The aim of the study was to compare the effectiveness of two physioprophylaxis methods: chair massage and an original set of exercises. The study lasted four weeks and consisted of eight 15-min meetings (chair massage/exercises). The study was conducted on 44 music students assigned to three groups (chair massage/exercise program/control group). The algometric measurements and questionnaire were conducted. Health problems associated with playing an instrument was reported by 86.4% of the participants. The largest changes in pain threshold concerned the trigger points of the muscles with the highest pain sensitivity, i.e., upper part of trapezius ones, and reached 25-34% in relation to the initial values. For the trigger points of the levator scapulae and lower part of trapezius, the increase in the pain threshold was between 20 and 28%. Raising the pain threshold was observed both after each session and meeting by meeting, and these differences were most visible in the massage group. This effect was particularly visible from the fourth treatment. Chair massage and exercise should be used regularly, and significant results can be obtained after two weeks.

State anxiety disorganizes finger movements during musical performance

Skilled performance, in many situations, exposes an individual to psychological stress and fear, thus triggering state anxiety and compromising motor dexterity. Suboptimal skill execution in people under pressure affects the future career prospects of trained individuals, such as athletes, clinicians, and musicians. However, it has not been elucidated in what manner state anxiety affects multijoint movements and thereby degrades fine motor control. Using principal component analysis of hand kinematics recorded by a data glove during piano performances, we tested whether state anxiety affects the organization of movements of multiple joints or merely constrains the amplitude of the individual joints without affecting joint movement coordination. The result demonstrated changes in the coordination of movements across joints in piano performances by experts under psychological stress. Overall, the change was characterized by reduction of synergistic movements between the finger responsible for the keypress and its adjacent fingers. A regression analysis further identified that the attenuation of the movement covariation between the fingers was associated with an increase in temporal error during performance under pressure. In contrast, neither the maximum nor minimum angles of the individual joints of the hand were susceptible to induced anxiety. These results suggest that degradation of fine motor control under pressure is mediated by incoordination of movements between the fingers in skilled piano performances. NEW & NOTEWORTHY A key issue in neuromuscular control of coordinated movements is how the nervous system organizes multiple degrees of freedom for production of skillful motor behaviors. We found that state anxiety disorchestrates the organization of finger movements so as to decrease synergistic motions between the fingers in musical performance, which degrades fine motor control. The findings are important to shed light on mechanisms underlying loss of motor dexterity under pressure.