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59% of musicians in symphony orchestras reported performance anxiety severe enough toimpair their professional and/or personal functioning.

A recent study indicated that MPA is not limited to orchestralmusicians, showing that opera chorus artists are also prone to high levels of performanceanxiety

However, since not allperformers suffer the same degree of MPA, or indeed report the same levels of occupationalstress, individual differences in a range of psychological characteristics are likely to accountfor variations in the degree to which musicians experience symptoms

A large number of treatment modalities (e.g., behavioral, cognitive, pharmacological andcomplementary) has been developed for music performance anxiety (MPA)

However, areview of this literature indicates that the field is still in its infancy with respect to theconceptual and theoretical formulations of the nature of MPA and its empiricalinvestigation.

Anxiety may be triggered by conscious,rational concerns or by cues that trigger, unconsciously, earlier anxiety producingexperiences or somatic sensations.

These findings suggest that multi-modal interventions are needed toaddress the multiple difficulties experienced by test anxious individuals.

with some focusing on behavioral change, some on cognitivechange, others on reduction of physiological symptoms through the use of pharmacotherapy,and some on idiosyncratic formulations

For drug studies, the keywords were beta-blocker [Beta blockers block the effect ofadrenaline (the hormone norepinephrine) on the body’s beta receptors. This slows downthe nerve impulses that travel through the heart. As a result, the resting heart rate is lower,the heart does not have to work as hard and requires less blood and oxygen

Brodsky (1996) and Nube´(1991) were most useful.

The interventionsassessed included systematic desensitization, progressive muscle relaxation, awareness andbreathing and behavioural rehearsal

In summary, behavioral treatments do appear to be at least minimally effective in thetreatment of MPA, although the heterogeneity of the treatment approaches employedmakes it difficult to isolate consistent evidence for the superiority of any one type ofbehavioral intervention

Two studies (see Tables II and IV) assessed the therapeutic effect of cognitive techniquesalone on MPA.

A dissertation by Patston (1996) reported a comparison of cognitive (e.g.positive self-talk, etc.) and physiological strategies in the treatment of MPA. No significantimprovements on vocal and visual manifestations of performance anxiety were found foreither treatment or control groups. However, the sample consisted of only 17 operastudents who were not specifically selected on the basis of their MPA severity, and theintervention was conducted by the author, a singer and teacher, who had no training inpsychology.

Three studies (see Table III) assessed the therapeutic effect of cognitive-behavioralstrategies on MPA. Harris (1987), Roland (1993), and Kendrick et al. (1982) all reportedthat standard CBT techniques were effective in the treatment of MPA in studentsspecifically selected for study because of the severity of their MPA.

Harris (1987) and Roland(1993) reported that CBT led to reductions in state anxiety as measured by the STAI,although Kendrick et al. (1982) failed to find a significant difference between treatment andcontrol groups on this measure.

The evidence for improvements in MPA following CBT is quite consistent, althoughfurther studies with larger samples are needed to confirm this evidence.

Beta-blockers have become increasingly popular among performers in recent years. Forexample, Lockwood (1989), in a survey of 2,122 orchestral musicians, found that 27% usedpropranolol to manage their anxiety prior to a performance; 19% of this group used thedrug on a daily basis.

Nube´ (1991) identified nine studies examining the effects of various beta-blockers(Atenolol, Metopolol, Nadolol, Oxprenolol, Propranolol, Pindolol) on MPA.

The findings regarding the effects of beta blockers on otheroutcome measures were less conclusive.

A rigorous definition of MPA is needed to advance treatment. However, defining MPA as asocial anxiety (social phobia) using criteria set out in DSM-IV-TR (APA, 2000) as theinclusion criteria may be too restrictive, particularly if the musician presenting for treatmentexperiences MPA as a focal anxiety (ie does not meet other criteria for social anxiety).

Few ofthe intervention studies reviewed acknowledged that performers need a certain amount ofarousal or anxiety to maximise their performance.

None of the studies could be pooled in a meta-analysis primarily because too fewprovided sufficient data to calculate effect sizes, use of diverse subject groups andtreatments, duration and intensity of treatment, and use of disparate outcome measures

In conclusion, the literature on treatment approaches for MPA is fragmented, incon-sistent, and methodologically weak. These limitations make it difficult to reach any firmconclusions about the effectiveness of the various treatment approaches reviewed. Forsignificant progress to be made, future research will require a clear definition of MPA,consistency and strength in methodology, and the development of robust and appropriateoutcome measures.

did notreturn any recent studies investigating the effec-tiveness of a purely cognitive intervention in thetreatment of MPA; consequently, research inthis particular area is needed

Past re-search has focused on combined interventions;however, often these programs run for over 6weeks and it is unknown which aspects of theintervention are most effective (e.g., Nagel,Himle, & Papsdorf, 1989)

State–Trait Anxiety Inventory (STAI).The STAI is widely used in anxiety researchand is considered to be a valid and reliable scale(Kenny, 2006).

The PAI (Nagel, Himle, & Papsdorf, 1981) isbased on the STAI and is a music inventoryassessing the three-systems model of anxiety

heart rate at 10 min, 5

Signs of anxiety included trem-bling knees, lifting shoulders, stiff back and/orneck, trembling hands, stiff arms, face deadpan,shaking head, moistening and/or biting lips, dis-tressed facial expressions, and sweating.

Nagel et al.reported that the average preintervention scorewas 55 and the average postintervention scorewas 38, with a score of 39 or less indicating a

person has few problems with performance anx-iety

Researchers have found that MPA af-fects instrumentalists and vocalists of all agesand abilities, including students, professionals,amateurs, and children (Brotons, 1994; Kenny,2006; Liston, Frost, & Mohr, 2003)

Few studies have investigated whether a cog-nitive intervention can reduce anxiety and en-hance performance in musicians (Lehrer, 1987;Steptoe & Fidler, 1987)

Few studies have investigated whether a cog-nitive intervention can reduce anxiety and en-hance performance in musicians (Lehrer, 1987;Steptoe & Fidler, 1987

The cognitive intervention had no significanteffect on anxiety levels. Sweeney and Horan’s(1982) study indicated that a cognitive restruc-turing program may be helpful in the treatmentof MPA; their program, featuring cognitive re-structuring, significantly reduced anxiety.

d it is unknown which aspects of theintervention are most effective (e.g., Nagel,Himle, & Papsdorf, 1989)

The STAI is widely used in anxiety researchand is considered to be a valid and reliable scale

Performance Anxiety Inventory (PAI)

cognitive, behavioral, and physiological fac

and has beenwidely used in treatment outcome research

Behavioral Anxiety Index (BAI)

igns of anxiety included trem-bling knees, lifting shoulders, stiff back and/orneck, trembling hands, stiff arms, face deadpan,shaking head, moistening and/or biting lips, dis-tressed facial expressions, and sweating

Participants were then taught howthoughts, behaviors, and feelings interact andinfluence performance

practical exercise, how people waste their en-ergy trying to control uncontrollable factors,thereby impairing performance

This exercise wasdesigned to demonstrate how thoughts cansometimes be irrational and can be changed inlight of new evidence

how to use self-talk effectively and how touse cues

Participants practiced how to identify negativethoughts, stop the thoughts, and use cues to helpthem overcome the negative thoughts.

Imagery is a mentalexercise that can help athletes maintain concen-tration, decrease anxiety, and improve confi-dence; thus, it may also be helpful for somemusicians (Gregg & Clark, 2007).

Participants in the wait-list controlgroup waited 3 weeks until their second perfor-mance, which was on the same night as theirfirst worksho

MPA is a pervasive problem affecting musi-cians of all ages and abilities. As compared withthe research on mental skills training in athletes,relatively little is known about the assessment,treatment, and theoretical underpinnings ofMPA

Kenny (2006) suggested that improving perfor-mance quality will have a positive, self-reinforcing effect on the musician and enhanceconfidence in future performances.

We predicted that anxiety levels would de-crease in the treatment group from pre- to post-test. This hypothesis was partially supported.Specifically, there was a significant reductionon the PAI in the treatment group. Although theparticipants improved after the intervention,they were still not within the optimal rangeaccording to Nagel et al. (1981

Although the decrease in anxiety was notas large in our study, our participants droppedfrom the high performance anxiety category tothe moderate performance anxiety category

The process of enactive listening is a pathway to the performance of music. The goal of this third level of a listening pedagogy is to continue ear training with a strong musicianship program by allowing the listening act to guide musicians to stylistically appropriate performance.[ 6] Not only can students learn the music of oral cultures aurally, but they can also effectively learn the nutated music of literate cultures by listening. In attempting to perform a musical selection, students gain from opportunities to hear a recording that allows them to concentrate on timbrai qualities, the dynamic How of a piece, its melodic and rhythmic components, and the interplay of its parts. Notation alone, whether from composed or transcribed works, can never fully depict all the musical nuances of a piece, and so listening is a helpful guide to performance.

Enactive listening takes time. It can be frustrating for those who have learned to use and value notation as an important means for music's transmission.

Young musicians can learn songs for solo or unison voices — as well as multipart songs and selections for percussion ensembles, strings groups, and gatherings of wind players — by ear.

mixing visual cues with auditory explanations (in math and science classrooms, in particular) are essential and effective

delivering content in a conversational tone will increase learning