Piloting a New Model for Treating Music Performance Anxiety: Training a Singing Teacher to Use Acceptance and Commitment Coaching With a Student

Acceptance and commitment coaching for music performance anxiety in adolescent singers

Introduction

Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development.

Methods

The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires.

Results

When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes.

Discussion

This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.

The role of psychotherapy apps during teaching solo vocals: The specifics of students' psychological preparation for performing in front of an audience

This study aimed to determine the effectiveness of a self-help application to reduce performance-related excitement in students of solo vocals in higher education institutions. The study participants (n = 219) used the mobile application during 6 weeks. Statistically significant effect of the intervention was achieved by Negative cognitions, Psychological vulnerability, and Anxiety perception constructs. The study also examines the influence of sociodemographic and personal characteristics on anxiety. Gender, graduate status, and self-efficacy were statistically significant variables when using the psychological self-help application. The investigation failed to disclose any significant impact of performance experience. Psychological self-help applications can be used in vocal/music education as a low-threshold intervention to reduce anxiety symptoms. The findings of the study introduce new data into approaches to the treatment of anxiety and expand the understanding of the characteristic features of singer training.

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.

Effects of Psychological Interventions on Performance Anxiety in Performing Artists and Athletes: A Systematic Review with Meta-Analysis

Levels of state and trait anxiety are relevant for performing artists and professional athletes to obtain optimal performance outcomes. However, evidence-based knowledge regarding the effectiveness of psychological interventions on performance anxiety is currently minimal. Thus, the objective of this systematic review with meta-analysis was to characterize, aggregate, and quantify intervention effects on measures of state and trait performance anxiety in performing artists and professional athletes. A systematic search of the literature according to the PRISMA guidelines was conducted on the databases PubMed, Medline, SPORTDiscus, PsycInfo, Embase, and Web of Science from 1 January 1960 to 9 November 2022. The search only included controlled studies employing pre-post measures and excluded performing arts fields that do not depend on fine motor skills. Initially, 1022 articles were identified; after removing duplicates and assessing abstracts and full texts, 20 articles were used to calculate weighted standardized mean differences (SMDs). In terms of state performance anxiety, our results revealed a large overall effect (SMD = 0.88), a medium effect (SMD = 0.62) for studies using scales with total scores (i.e., MPAI-A, STAI), and large effects (cognitive anxiety: SMD = 0.93, somatic anxiety: SMD = 0.92, self-confidence: SMD = 0.97) for studies applying scales with sub-scores (i.e., CSAI-2R)-all in favour of the intervention groups. Regarding trait performance anxiety (e.g., SCAT), we detected a small effect (SMD = 0.32), also favouring the intervention groups. Interventions to reduce performance anxiety in performing artists and professional athletes revealed varying levels of effectiveness ranging from small (trait) to large (state). Therefore, future studies should investigate modalities to increase intervention efficacy, especially for the small-sized changes in trait performance anxiety.

Current Trends in Music Performance Anxiety Intervention

Music performance anxiety (MPA) is a natural, emotional, and physiological response to the stress of public performance. Debilitating forms of MPA are severe and persistent reactions that go beyond the normal adaptive response to music evaluation situations and can negatively impact the quality of musical performance and the musician's life in general. Today, it affects numerous professional performers and can result in an inability to practice their profession, posing a significant threat to their professional activity. Despite its scope, studies exploring this issue and contributing to its resolution are scarce. Thus, this review aims to compile the significant advancements made in the last five years (2018-2023) in the treatment of MPA from a scientific perspective. For this purpose, the PRISMA method was used based on the results obtained from the Web of Science, Scopus, and Google Scholar databases. Reviewed are 10 studies that have made valuable contributions to this matter in this time frame after applying the quality filters using the PRISMA method. It is concluded that, although there are methodological shortcomings and sample limitations in the current research, this field registers advancements that provide valuable information to prevent or solve this problem in professional or aspiring musicians.

The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study

BACKGROUND

Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters.

METHODS

This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation.

DISCUSSION

The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects.

TRIAL REGISTRATION

This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).

Teachers' approaches to music performance anxiety management: a systematic review

Performance anxiety is a widespread issue that can affect musicians across their education and career. It can develop in musicians from a young age leading to short-term and long-term impacts on not only their performance, but also their wellbeing. There is potentially a significant role that music educators hold in the development of their students and how they handle performance anxiety, though it is not clear how, or how often, teachers support their students in this way. Through a PRISMA-based systematic review, this paper explores what is known about the strategies used by music educators to help manage their students' performance anxiety. The paper also discusses the role that instrumental/vocal tutors and school classroom teachers might hold in this area. The findings show that music educators are implementing multiple strategies to assist their students with MPA, with the most common being simulated performance, positive outlook, preparation and breathing. It was found that there is a role for teachers to address MPA management with their students. While some students prefer to receive MPA support from experts in the field of psychology, students still expressed a need to have this support come from their teacher. Though many teachers felt a need for additional training for them to help their students cope with MPA, many of the strategies were found to be multifunctional and embedded into the regular teaching practices or teaching styles of the educator. Although these strategies might be implicit rather than explicit, the findings suggest that music educators could represent a valuable source of support for MPA management.

Effects of tailored interventions for anxiety management in choking-susceptible performing artists: a mixed-methods collective case study

Introduction

Not being able to manage performance anxiety and subsequently experiencing a decline in performance have been called "choking under pressure". High trait anxiety and fear of negative evaluation, as well as low self-efficacy or self-confidence, can put performers especially at risk of experiencing choking. This study, therefore, examined the effects of psychological choking interventions tailored to "choking-susceptible" performing artists individually in a coaching setting.

Methods

We conducted a mixed-methods (QUANT + QUAL) collective case study with nine performing artists, who each received five individual coaching sessions. The tailored choking interventions comprised acclimatization training, goal setting, and pre-performance routines, including elements such as imagery, self-talk, and relaxation techniques. Before and after the 10-week intervention phase, they filled in questionnaires on trait performance anxiety, fear of negative evaluation, and self-efficacy, performed in front of a jury, and were interviewed about their experiences. Transcripts of interviews and coaching sessions were analyzed using thematic analysis. Heart rate measurements, weekly performance videos, and expert evaluations were also part of our comprehensive data.

Results

Quantitative data showed reductions in performance anxiety and fear of negative evaluation, and increases in self-efficacy and performance quality, from before to after the intervention phase. Most participants also had a lower heart rate when performing for the jury. Themes from qualitative analysis comprised managing nervousness and feeling more relaxed, becoming more self-confident, satisfaction with artistic and mental performance, feeling good and enjoying performing, and general positive effects.

Conclusion

Tailoring psychological interventions may provide several benefits for choking-susceptible performing artists.

Effects of Attentional Focus on Motor Performance and Physiology in a Slow-Motion Violin Bow-Control Task: Evidence for the Constrained Action Hypothesis in Bowed String Technique

The constrained action hypothesis states that focusing attention on action outcomes rather than body movement improves motor performance. Dexterity of motor control is key to successful music performance, making this a highly relevant topic to music education. We investigated effects of focus of attention (FOA) on motor skill performance and EMG muscle activity in a violin bowing task among experienced and novice upper strings players. Following a pedagogically informed exercise, participants attempted to produce single oscillations of the string at a time under three FOA: internal (on arm movement), external (on sound produced), and somatic (on string resistance). Experienced players' number of bow slips was significantly reduced under somatic focus relative to internal, although number of successful oscillations was not affected. Triceps electromyographic activity was also significantly lower in somatic compared to internal foci for both expertise groups, consistent with physiological understandings of FOA effects. Participants' reported thoughts during the experiment provided insight into whether aspects of constrained action may be evident in performers' conscious thinking. These results provide novel support for the constrained action hypothesis in violin bow control, suggesting a somatic FOA as a promising performance-enhancing strategy for bowed string technique.

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.

Acceptance and Commitment Therapy Informed Behavioral Health Interventions Delivered by Non-Mental Health Professionals: A Systematic Review

Objectives

Acceptance and Commitment Therapy (ACT) is a third-wave behavioral and cognitive therapy that increases psychological flexibility through mindfulness, acceptance, and value-driven behavior change. ACT has been successfully used to inform a variety of health interventions. Using non-therapists to deliver ACT-based behavioral health interventions offers an opportunity to provide cost efficient and integrated care, particularly among underserved populations experiencing barriers to mental health care, such as inadequate insurance, mental health stigma, and provider shortages. This systematic review aims to: 1) identify ACT-informed behavioral health interventions delivered by laypeople and 2) review the specific characteristics of each intervention including number and duration of sessions, delivery modality, interventionist training, and intervention outcomes.

Methods

Two databases (PubMed and PsycINFO) were systematically searched for relevant literature. To further identify relevant studies, references of included manuscripts were checked, the Association for Contextual Behavioral Science's webpage was examined, and an email was sent to the ACBS Health Special Interest Group listserv. Study abstracts and full texts (in English) were screened, resulting in 23 eligible articles describing 19 different interventions.

Results

A total of 1,781 abstracts were screened, 76 were eligible for full-text review, and 23 were included in a narrative synthesis. There were 19 unique interventions identified and delivered by the following: general healthcare workers (n= 7), trained researchers (n = 5), women/mothers (n= 2), municipal workers (n= 2), and teachers (n = 3). Eleven studies were RCTs and eight utilized alternative study designs. Study quality varied, with two rated as high risk for bias and eight rated to have some concerns. Target populations included clinical and non-clinical samples. There was some consistency in the effects reported in the studies: increases in pain tolerance, acceptance, and identifying and engaging in value driven behavior, improvements in cognitive flexibility, and reductions in psychological distress.

Conclusions

Findings suggest that ACT interventions can be successfully delivered by a variety of laypeople and effectively address psychological distress and increase health behaviors.

Acceptance and Commitment Coaching for Music Performance Anxiety: Piloting a 6-Week Group Course With Undergraduate Dance and Musical Theatre Students

Treatments for students with problematic levels of music performance anxiety (MPA) commonly rely on approaches in which students are referred to psychotherapists or other clinical professionals for individual care that falls outside of their music training experience. However, a more transdisciplinary approach in which MPA treatment is effectively integrated into students' training in music/performing arts colleges by teachers who work in consultation with clinical psychologists may prove more beneficial, given the resistance students often experience toward psychotherapy. Training singing teachers, and perhaps music teachers at large, to use an evidence-based coaching strategy like Acceptance and Commitment Coaching (ACC) to directly manage students' MPA is one such approach. Building on the work of a previous study in which ACC was administered by a singing teacher to a musical theatre student with problematic MPA, we piloted the effectiveness of a six-session, group ACC course for a sample of performing arts students (N = 6) with MPA related to vocal performances, using a mixed-methods design. The coach here was also a singing teacher without a clinical background, and her training in ACC by a clinical psychologist was of a similar duration (8 h) as the previous teacher's (7 h). Similar to the musical theatre student, the students reported being significantly less fused with their MPA-related cognitions, more accepting of their MPA-related physiological symptoms, and more psychologically flexible while performing in general, and these improvements were maintained after 3 months. Furthermore, they appeared to lower their shame over having MPA and change how they thought in relation to one another. Of note, these improvements were similar to those shown by seven vocal students with MPA after they received Acceptance and Commitment Therapy from a clinical psychologist, but with larger reductions in shame and better acceptance of MPA, which suggests a non-clinical, group ACC intervention that includes supportive discussions to normalize MPA and challenges attempts to control it may be more helpful than individual psychotherapy. These results are promising and indicate a brief training in ACC (<10 h) may be sufficient for singing teachers to provide significant benefit for students with problematic MPA.

Quantification of brainstem norepinephrine relative to vocal impairment and anxiety in the Pink1-/- rat model of Parkinson disease

Vocal communication impairment and anxiety are co-occurring and interacting signs of Parkinson Disease (PD) that are common, poorly understood, and under-treated. Both vocal communication and anxiety are influenced by the noradrenergic system. In light of this shared neural substrate and considering that noradrenergic dysfunction is a defining characteristic of PD, tandem investigation of vocal impairment and anxiety in PD relative to noradrenergic mechanisms is likely to yield insights into the underlying disease-specific causes of these impairments. In order to address this gap in knowledge, we assessed vocal impairment and anxiety behavior relative to brainstem noradrenergic markers in a genetic rat model of early-onset PD (Pink1-/-) and wild type controls (WT). We hypothesized that 1) brainstem noradrenergic markers would be disrupted in Pink1-/-, and 2) brainstem noradrenergic markers would be associated with vocal acoustic changes and anxiety level. Rats underwent testing of ultrasonic vocalization and anxiety (elevated plus maze) at 4, 8, and 12 months of age. At 12 months, brainstem norepinephrine markers were quantified with immunohistochemistry. Results demonstrated that vocal impairment and anxiety were increased in Pink1-/- rats, and increased anxiety was associated with greater vocal deficit in this model of PD. Further, brainstem noradrenergic markers including TH and α1 adrenoreceptor immunoreactivity in the locus coeruleus, and β1 adrenoreceptor immunoreactivity in vagal nuclei differed by genotype, and were associated with vocalization and anxiety behavior. These findings demonstrate statistically significant relationships among vocal impairment, anxiety, and brainstem norepinephrine in the Pink1-/- rat model of PD.