Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists

Musical Performance Anxiety and Voice Handicap in Amateur Evangelical Singers

OBJECTIVE

To compare and correlate musical performance anxiety (MPA) and vocal self-perception among amateur evangelical singers, focusing on the interaction between anxiety and aspects of performance in this sample.

METHOD

This study employed a cross-sectional and quantitative approach, involving 75 amateur gospel singers from evangelical churches, aged between 18 and 59 years. Data collection included the administration of a sample identification and characterization questionnaire, the Brazilian Portuguese version of the Kenny Music Performance Anxiety Inventory (K-MPAI), and the Singing Voice Handicap Index (S-VHI). The descriptive analysis used absolute and relative frequencies, measures of central tendency, and dispersion (mean and standard deviation [SD]). To compare the vocal self-assessment protocols and performance aspects, the Kruskal-Wallis test was applied. Spearman's correlation test was used for correlation analysis. All analyses were conducted with a significance level set at 5% (P < 0.05).

RESULTS

Vocal warm-up and cool-down activities, vocal discomfort after performance, and vocal self-assessment were significantly associated with scores on S-VHI, and the variable "instruments louder than voices" was associated with the K-MPAI score. Participants exhibited a mean K-MPAI score of 85.12 points (SD ± 36.6), and the vocal handicap of the sample had a mean score of 45.22 (SD ± 32.3). There was no statistically significant correlation between the protocols.

CONCLUSION

Incorporating vocal warm-up and cool-down activities was significantly associated with lower scores on S-VHI. Conversely, those experiencing postperformance vocal discomfort exhibited higher scores on S-VHI. Moreover, the absence of correlation between the assessment protocols suggests that while significant levels of voice handicap were observed, a direct link to MPA cannot be definitively established. Overall, these findings contribute to a nuanced understanding of the multifaceted factors shaping vocal health and performance among amateur evangelical singers, thereby guiding future research and interventions in this field.

The influence of music performance anxiety on career expectations of early musical career students: self-efficacy as a moderator

Music performance anxiety (MPA) is recognized as a distinct emotional behavior rather than merely a motor control disorder and is influenced by specific conditioning experiences. This study investigates the interrelationships between MPA, self-efficacy, and future career expectations among music students within the Chinese context. The participants of this study were 340 high school students majoring in music education and performance, drawn from three music schools in China. Data were collected using several questionnaires: the MPA Inventory for Adolescents (MPAI-A), the Self-Efficacy Formative Questionnaire, and the Career Futures Inventory (CFI). The findings indicate that MPA is negatively associated with self-efficacy and future career expectations. Additionally, self-efficacy acts as a partial moderator between MPA and career expectations, suggesting that enhancing the self-efficacy of music students can boost their future career aspirations and mitigate the adverse effects of MPA. This research explores the complex relationships among MPA, self-efficacy, and future career expectations, emphasizing the importance of curriculum and pedagogical strategies in music schools. Music students with high levels of self-efficacy may exhibit more confidence and stable performances before audiences. According to the panel regression analysis, self-efficacy significantly positively influences career expectations. An appropriate educational environment and supportive pedagogical approaches to MPA can foster the early career development of musicians.

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).

The role of the acceptance and commitment therapy in the treatment of social anxiety: An updated scoping review

BACKGROUND

Social Anxiety Disorder (SAD) or Social Phobia is characterized by fear and anxiety of social circumstances that negatively impact an individual's occupational and relational life. There are several treatment options for this disorder ranging from pharmacological therapy to psychotherapies. In particular, the Acceptance and Commitment Therapy (ACT), a form of cognitive-behavioral therapy that practices acceptance and awareness strategies with behavior change strategies in order to increase an individual's mental flexibility, has been found to be effective. In this review, we aimed to provide an overview of recent studies that examined ACT's efficacy in SAD, also taking into consideration the comparison with traditional Cognitive-behavioral Therapy (CBT) interventions.

METHODS

A bibliographic search on PubMed, EMBASE and Scopus was conducted from inception to the 3rd of February 2022 of all studies investigating the effect of ACT in SAD individuals without any comorbidity. Among the articles retrieved, 11 met the inclusion criteria.

RESULTS

From the reviewed studies, ACT may be considered a promising treatment of social phobia by improving attentional bias, awareness, emotion regulation, and safety/avoidance behaviors; however, the results have not yet demonstrated a valid alternative to the CBT.

LIMITATIONS

Only four studies considered a follow-up evaluation, which is paramount to exploring the effectiveness of ACT and several studies have a very small sample size. Concerning the review itself we only considered original English articles and we did not measure the risk of publication bias and the risk of bias between studies.

CONCLUSIONS

The results of this study suggest that ACT can be a promising treatment for improving selective psychological problems often observed in SAD. However, larger longitudinal studies further exploring the effectiveness of the behavioral and cognitive "third-wave" psychotherapies, based mainly on acceptance of SAD, are necessary.

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 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 (&lt;10 h) may be sufficient for singing teachers to provide significant benefit for students with problematic MPA.

Emotion Goals in Music Performance Anxiety

Performance anxiety can be debilitating, and so researchers and laypeople alike tend to assume that it is desirable to downregulate this emotion. Yet emerging perspectives in the emotion literature suggest that people sometimes aim to upregulate anxiety to aid performance. The present research investigated the emotion goals that musicians hold when performing. Drawing on a novel framework of emotion goals, the findings suggest that how people want to feel and how they want to appear to feel are determinants of performance anxiety. In Study 1 (N = 44), musicians mostly reported wanting to neither feel nor show anxiety during a performance, although a meaningful subset reported wanting to feel but not show anxiety during a performance. In Study 2 (N = 32), musicians who enacted an emotion goal to neither feel nor show anxiety reported less state unease and greater satisfaction with their performance than musicians who enacted a goal to feel but not show anxiety. This research yields insight into the emotion goals that musicians hold and how these goals influence desired performance outcomes.