A Pilot Study Evaluating the Physiological Parameters of Performance-Induced Stress in Undergraduate Music Students

Exploring a multimodal approach for utilizing digital biomarkers for childhood mental health screening

Background

Depression and anxiety are prevalent mental health concerns among children and adolescents. The application of conventional assessment methods, such as survey questionnaires to children, may lead to self-reporting issues. Digital biomarkers provide extensive data, reducing bias in mental health self-reporting, and significantly influence patient screening. Our primary objectives were to accurately assess children's mental health and to investigate the feasibility of using various digital biomarkers.

Methods

This study included a total of 54 boys and girls aged between 7 to 11 years. Each participant's mental state was assessed using the Depression, Anxiety, and Stress Scale. Subsequently, the subjects participated in digital biomarker collection tasks. Heart rate variability (HRV) data were collected using a camera sensor. Eye-tracking data were collected through tasks displaying emotion-face stimuli. Voice data were obtained by recording the participants' voices while they engaged in free speech and description tasks.

Results

Depressive symptoms were positively correlated with low frequency (LF, 0.04-0.15 Hz of HRV) in HRV and negatively associated with eye-tracking variables. Anxiety symptoms had a negative correlation with high frequency (HF, 0.15-0.40 Hz of HRV) in HRV and a positive association with LF/HF. Regarding stress, eye-tracking variables indicated a positive correlation, while pNN50, which represents the proportion of NN50 (the number of pairs of successive R-R intervals differing by more than 50 milliseconds) divided by the total number of NN (R-R) intervals, exhibited a negative association. Variables identified for childhood depression included LF and the total time spent looking at a sad face. Those variables recognized for anxiety were LF/HF, heart rate (HR), and pNN50. For childhood stress, HF, LF, and Jitter showed different correlation patterns between the two grade groups.

Discussion

We examined the potential of multimodal biomarkers in children, identifying features linked to childhood depression, particularly LF and the Sad.TF:time. Anxiety was most effectively explained by HRV features. To explore reasons for non-replication of previous studies, we categorized participants by elementary school grades into lower grades (1st, 2nd, 3rd) and upper grades (4th, 5th, 6th).

Conclusion

This study confirmed the potential use of multimodal digital biomarkers for children's mental health screening, serving as foundational research.

Health consultations at a performing arts health centre among classical music students based on electronic health record data: a cross-sectional study

Physical and mental health problems in music students are usually identified using self-reported data. The use of an Electronic Health Record database can avoid biases to give an overview of the extent of health problems in this population. Therefore, the aim of this study is to gain insight into both physical and mental health related issues in classical music students using this type of data collection. An Electronic Health Record database including five years of data from a Performing Arts Health Centre (PAHC) of a university or the arts, was used to analyze the number and characteristics of health consultations in music students. The total number of students, health consultations and the average number of visits per health consultation were calculated over five years. Furthermore, numbers and percentages of both physical and mental health consultations were registered. Also, the number and percentage of health consultations per instrument group were compared to the proportion of each instrument group within the specific sample. Over a period of five years, 230 students visited the PAHC and 417 health consultations were reported. 43.5% of the students who visited a health professional indicated at least one physical health consultation, 29.1% at least one mental health consultation and 27.4% at least one in both categories. An injury was the most frequently registered physical health consultation (40.2%), followed by performance improvement (9.8%) and stress (9.6%). Voice students registered relatively most health consultations. As far as we know, this is the first cross-sectional study using Electronic Health Record data from a PAHC to gain insight into both physical and mental health related issues in a population of classical music students. Looking at the variety of health consultations registered in the database, a multidisciplinary team and multidisciplinary approach are necessary to meet the needs of the students in terms of physical and mental health support and performance improvement.

The Kenny music performance anxiety inventory (K-MPAI): Scale construction, cross-cultural validation, theoretical underpinnings, and diagnostic and therapeutic utility

I commenced my academic exploration of music performance anxiety in a study with opera chorus artists from Opera Australia in 2004. I subsequently postulated a new theory of the aetiology of music performance anxiety and began the development of the Kenny Music Performance Anxiety Inventory (K-MPAI) to assess the hypothesized theoretical constructs underpinning its diverse clinical presentations. I proposed a new definition of music performance anxiety in 2009 and revised the item content of the K-MPAI from 26 to 40 in 2011. Over the ensuing years, many researchers have used the K-MPAI in studies on a wide variety of musicians, including vocalists and instrumentalists, popular and classical musicians, tertiary music students, and professional, solo, orchestral, ensemble, band, and community musicians. To date, the K-MPAI has been reported in more than 400 studies and has been translated into 22 languages. It has been the subject of more than 39 dissertations. In this paper, I examine the research that has used the K-MPAI to assess the theory and to ascertain how well the assessment tool, and its cross-cultural validation have provided evidence for its factorial structure, robustness, and utility. The evidence indicates that the factorial structure remains consistent across cultures and different populations of musicians. It has good discriminative ability and utility for diagnostic purposes. I conclude with some reflections on how the K-MPAI can guide therapeutic interventions and with some thoughts on future directions.

Measuring emotional variables in occupational performance: A scoping review

BACKGROUND: As interest in job-related psychology increased, the need to focus on understanding workplace stress was emphasized. Negative emotional states such as anxiety and stress permeate the organization and, if uncontrolled, can negatively impact the health and work performance of workers. Therefore, attempts to analyze various signals to understand human emotional states or attitudes may be important for future technological development. OBJECTIVE: The purpose of this study was to identify what biological variables can discriminate emotions that can significantly affect work results. METHODS: Databases (Embase, PsychINFO, PubMed, and CINAHL) were searched for all relevant literature published as of December 31, 2019. RESULTS: Brain activity (BA) and heart rate (HR) or heart rate variability (HRV) are adequate for assessing negative emotions, while BA, galvanic skin response (GSR), and salivary samples (SS) can confirm positive and negative emotions. CONCLUSION: In the future, researchers should study measurement tools and bio-related variables while workers perform tasks and develop intervention strategies to address emotions associated with work. This may enable workers to perform tasks more efficiently, prevent accidents, and satisfy clients.

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.

Getting Into the Zone: A Pilot Study of Autonomic-Cardiac Modulation and Flow State During Piano Performance

BACKGROUND

Music performance anxiety is a common experience among elite and professional musicians and impedes performers from achieving flow state, or a state of focused, sustained engagement that promotes optimal performance.

OBJECTIVE

The aim of this study was to use heart rate variability (HRV) to determine the psychophysiological underpinnings of optimal music performance.

METHODS

We assessed HRV to study how autonomic-cardiac modulation was associated with flow during piano performance. Twenty-two pianists (15-22 years) with at least a Grade 8 Royal Conservatory of Music certification prepared two standardized pieces and a self-selected piece. Performer heart rate data were measured with a Polar 800 watch in 5-min periods immediately before performances, during performances and post-performance. HRV was employed to assess autonomic modulation of cardiac intervals. HRV indices of sympathetic and parasympathetic modulation of the heart were analyzed in 2.5-min segments to monitor short-term autonomic adjustments using the Kubios HRV Software. Flow state was measured using the 36-item Flow State Scale (FSS). Relationships were analyzed using zero-order correlations and multiple linear regressions.

RESULTS

Our sample consisted of 22 RCM Grade 8 certified pianists. Participants achieved the highest level of flow during performance of the Bach piece. Decreased HRV was observed during performance, as indicated by a significant drop in total power. Flow state was positively associated with High Frequency (HF) power during the pre-performance phase, and inversely associated with Low Frequency (LF) power during performance.

CONCLUSION

Inverse association of flow with LF-HRV during performance affirms the importance of vagal-HR modulation for achievement of flow state. Increased HF-HRV and reduced LF-HRV immediately prior to performance suggests that flow state may be shaped as much by physiological preparation during pre-performance as it is by physiologic responses during performance. Further research is required to validate the correlation between autonomic modulation of the heart and flow state. Evidence of this correlation between autonomic modulation of the heart and achievement of flow state may pave the way for further research on enhancing musical performance and targeting MPA through HRV-based interventions.

Applications of deep learning methods in digital biomarker research using noninvasive sensing data

Introduction: Noninvasive digital biomarkers are critical elements in digital healthcare in terms of not only the ease of measurement but also their use of raw data. In recent years, deep learning methods have been put to use to analyze these diverse heterogeneous data; these methods include representation learning for feature extraction and supervised learning for the prediction of these biomarkers. Methods: We introduce clinical cases of digital biomarkers and various deep-learning methods applied according to each data type. In addition, deep learning methods for the integrated analysis of multidimensional heterogeneous data are introduced, and the utility of these data as an integrated digital biomarker is presented. The current status of digital biomarker research is examined by surveying research cases applied to various types of data as well as modeling methods. Results: We present a future research direction for using data from heterogeneous sources together by introducing deep learning methods for dimensionality reduction and mode integration from multimodal digital biomarker studies covering related domains. The integration of multimodality has led to advances in research through the improvement of performance and complementarity between modes. Discussion: The integrative digital biomarker will be more useful for research on diseases that require data from multiple sources to be treated together. Since delicate signals from patients are not missed and the interaction effects between signals are also considered, it will be helpful for immediate detection and more accurate prediction of symptoms.

The Digital Neurologic Examination

Digital health has been rapidly thrust into the forefront of care delivery. Poised to extend the clinician's reach, a new set of examination tools will redefine neurologic and neurosurgical care, serving as the basis for the digital neurologic examination. We describe its components and review specific technologies, which move beyond traditional video-based telemedicine encounters and include separate digital tools. A future suite of these clinical assessment technologies will blur the lines between history taking, examination, and remote monitoring. Prior to full-scale implementation, however, much more investigation is needed. Because of the nascent state of the technologies, researchers, clinicians, and developers should establish digital neurologic examination requirements in order to maximize its impact.

The Effects of Visual Displays in Attenuating Discrepancies Between Self-Reported and Physiological Indexes of Stress

Abstract. This study examined whether the relationship between subjective and physiological outcomes of stress, and the responsivity to stressors, are affected by whether participants can see a visual display of their physiological output. Participants were randomly assigned to have a visible view of their physiological output readings, or to a condition in which physiological output readings were out of view. Participants individually completed a 30-min laboratory study including the modified Trier Social Stress Task. Both physiological markers of stress (heart rate and blood pressure) and subjective evaluations of stress (visual analog scale) were measured. Results found little congruency across subjective and physiological measures of stress. The visible visual display condition had elevated physiological arousal, while no group differences were observed in self-reported stress. Findings from the study provide insight into the use of visual physiological displays and hold practical implications for both the measurement of stress in research, and the development of wearable technologies without accompanying response strategies.

"A Bed of Nails": Professional Musicians' Accounts of the Experience of Performance Anxiety From a Phenomenological Perspective

Most investigations of musical performance anxiety have employed quantitative methodologies. Whereas such methodologies can provide useful insights into the measurable aspects of the experience in a larger group of participants, the complexity, subtlety and individuality of the emotional experience and the importance of the individual’s interpretation of it are often overlooked. This study employed a phenomenological approach to investigate the lived, subjective experience of performance anxiety, as described in professional musicians’ narratives. Semi-structured interviews with four professional musicians (two males, two females) specializing in Western classical and jazz music genres were conducted and analyzed using Interpretative Phenomenological Analysis (IPA). The analysis revealed the presence of four overarching themes: (1) Intensity of performance anxiety experience, (2) perceived effects, (3) development of coping strategies, and (4) achieving release from anxiety. Findings suggest that the lived experience of performance anxiety is multifaceted, characterized by a physical and a psychological dimension. Interpretative Phenomenological Analysis is a useful research tool that can facilitate our understanding of the subjective experience of performance anxiety (how it is felt and understood at an individual level) and can thus be useful in the development of tailor-made intervention programs for musicians.