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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.