The analysis of performance anxiety
Performance anxiety, commonly known as ‘stage fright’, is an age-old problem, but interest in its nature, causes and cures has intensified over the last fifteen years with the burgeoning of clinics, conferences and journals devoted to performing arts medicine. Music performance anxi-ety has been defined as ‘the experience of persisting, distressful apprehen-sion about[,] and/or actual impairment of, performance skills in a public context, to a degree unwarranted given the individual’s musical aptitude, training, and level of preparation’.1 Notable sufferers have included Maria Callas, Enrico Caruso, Pablo Casals, Leopold Godowsky, Vladimir Horowitz, Ignacy Paderewski and Sergei Rachmaninoff. A number of surveys have indicated that performance anxiety is a serious problem for a substantial proportion of musicians. In one large-scale study of American orchestras,2 stage fright was the most frequently reported performance problem, with 24 per cent of players claiming to be affected by it, and 15 per cent finding it severe. It is ameliorated by age and experience,3 though whether this is due to the beneficial effects of exposure or to ‘survival of the fittest’is not clear.
The symptoms of performance anxiety are well known and are of three kinds: physiological, behavioural and mental. The physiological symptoms of increased heart rate, palpitations, shortness of breath, hyperventilation, dry mouth, sweating, nausea, diarrhoea and dizziness are the result of over-arousal of the autonomic nervous system. This flight–fight response, which assisted our hunter–gatherer forebears in fleeing large animals, is highly detrimental to musicians requiring dexterity and fine muscular control over their instruments. Trembling limbs and slippery fingers are likely to hinder rather than help the performer. In addition, this autonomic arousal may have become associated with fear as a result of past experience. Increased arousal generally leads to a narrowing of the focus of attention, which may also be deleterious. The behavioural symptoms of performance anxiety may take the form either of signs of anxiety, such as shaking, trembling, stiffness
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and dead-pan expression, or of impairment of the performance itself. The mental symptoms are subjective feelings of anxiety and negative thoughts about performing. Rather than fear of performance per se, it is fear of public performance that is at issue, with the risk of negative evaluation and consequent loss of self-esteem. This fear may be the result of too close an identification of self-esteem with performance perfection, even the belief that self-worth is conditional upon success. Negative thinking has a bad effect on performance quality. Worry leads to poor concentration, diverting attention and wasting valuable resources, possibly also acting as a cue to increase anxiety further.
One variant of negative thinking is ‘catastrophising’, the irrational exag-geration of the likelihood of disaster – for example, ‘I am almost sure to make a dreadful mistake and that will ruin everything’. It is more likely to be associated with high levels of performance anxiety in professionals, students and amateurs, whereas realistic appraisal – recognising the inevitablity of mistakes, the generally tolerant nature of audiences and the need to concen-trate on technical and interpretative aspects of music – is associated with moderate levels of stage fright.4
Another variant is ‘self-handicapping’,5 where a performer deliberately sets up situations to serve as excuses for poor performance, such as failure to practise, staying up late the night before, damaging equipment and so on. These can become self-fulfilling prophecies and run the risk of actu-ally sabotaging performance. They are intended to locate the blame for bad performance on external factors but to claim extra credit for good perfor-mance, which occurred despite the adverse circumstances. However, these strategies are essentially destructive since they avoid the situation, which often makes matters worse. They may arise where there is over-concern with competence, perhaps because it has been made a condition of deserv-ing parental love, or where perceived self-competence is fragile, perhaps where a level of performance which has previously been achieved cannot be maintained.
A comprehensive account of performance anxiety thus needs to include physiological factors (such as heart rate and blood pressure), behavioural measures (of anxiety and the quality of performance) and self-reports (of thoughts and feelings). The reactions of these three systems may not be correlated.6 In particular, it is common to have physiological symptoms without either of the others. Correlation is more likely to occur in states of high anxiety. Craske and Craig7 found that relatively anxious pianists performing in a stressful situation before an audience showed anxiety in all three systems, whereas relatively non-anxious pianists exhibited only physiological symptoms. This also raises the question of whether treatment
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should match symptoms, for example, drug treatment for physiological symptoms and psychological treatment for mental ones. The evidence is not clear-cut on this.
Several questionnaire studies have identified different components of music performance anxiety, not all of which may be negative. A survey of about 200 musicians, mainly professionals, isolated four factors:
nervousness/apprehension; confidence/competence; self-consciousness/
distractibility; and an arousal/intensity factor.8 A similar-sized but more wide-ranging sample distinguished five independent components: worry about anxiety and its effects; fear of evaluation, that is, concern with the re-actions of others to performance; judgemental attitudes about performing abilities; distraction and memory problems; and the deliberate cultivation of techniques to cope with anxiety. Of these, worry was most closely associated with debilitating performance anxiety, but all except the last have negative consequences for performance.9
It is important to distinguish between beneficial and detrimental kinds of anxiety – or to be more precise, between reactive, maladaptive and adaptive anxiety. Reactive anxiety, the result of inadequate preparation, is realistic and is best dealt with by music analysis and rehearsal. Anxiety is widely regarded as deleterious, but every performer knows that a certain amount of arousal is beneficial to performance. Performance is generally best at moderate levels of arousal: if arousal is too low, the performance will be dull and lifeless; if it is too high, the performer and the performance may come to pieces. This can be represented in the shape of an inverted U (plot-ting quality of performance as a function of arousal) and is known as the Yerkes–Dodson law (see Figure 12.1).10 Steptoe11 confirmed this pattern for student and professional singers by asking them to rate their emotional tension and performance quality in different situations. For both groups, performance quality was judged to peak at an intermediate level of emo-tional tension, after which it plummeted. For students the optimal situation was a lesson; for professionals (happily) it was a public performance. Fazey and Hardy12 have argued that it is necessary to distinguish the mental, or cognitive, component of anxiety (fear of failure and its consequences) from the bodily, or somatic, component (physiological responses to stress).
This requires a three-dimensional model of the relation between anxiety and performance (see Figure 12.2). They go on to argue that when cogni-tive anxiety is low, the relation between arousal and performance follows the Yerkes–Dodson function (represented at the back of Figure 12.2), but when it is high it follows the catastrophe model: as arousal increases, per-formance is liable to a catastrophic decline, from which it is difficult to recover. The reason is that worries and ruminations lead to a vicious spiral
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Figure 12.1 The Yerkes–Dodson function, showing the hypothesised relation between arousal and performance quality
Figure 12.2 Catastrophe model of the relation between anxiety and performance ( c 1996 John Wiley & Sons Limited; reproduced with permission from Lew Hardy, Graham Jones and Daniel Gould, Understanding Psychological Preparation for Sport: Theory and Practice of Elite Performers (Chichester: John Wiley & Sons Limited, 1996), 151)
of negative thoughts, causing the performer to go ‘over the top’and collapse.
Hardy and Parfitt13have provided evidence for this model from work with athletes. Wilson14 has suggested that it may apply equally well to music performance.
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Causes
Three factors contribute to performance anxiety: the person, the task and the situation. Wilson has represented these in a three-dimensional extension of the Yerkes–Dodson model (see Figure 12.3).15A high level of one can be compensated for by a low level of another. Hence, a naturally anxious person would do best to select a relatively easy or well-rehearsed piece for a demanding occasion such as an audition; conversely, experi-enced performers may need more challenging situations than do novices to perform at their best.16
People differ substantially in the responsiveness of their autonomic sys-tems and their sensitivity to both internal types of arousal and critical judge-ment by others. There is evidence that musicians are more anxious than the general population17and that orchestral musicians may be more suscepti-ble to anxiety than other performing artists (such as singers, dancers and actors).18Music performance anxiety is related to other forms of anxiety, particularly neuroticism and social phobia.19
The more difficult the task, the more anxious the performer is likely to be.
With increasing levels of skill and task mastery, it will take a correspondingly more difficult task to produce the same level of anxiety, as noted above.
A number of studies have demonstrated the effect of the situation. LeBlanc et al.20found that self-reported anxiety in high school band players increased
Figure 12.3 Wilson’s (1994) extension of the Yerkes–Dodson model, illustrating three factors contributing to performance anxiety (reproduced by permission of Glenn Wilson and Jessica Kingsley; all rights reserved)
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significantly across three performance situations: playing a solo alone in a practice room; in a practice room with one researcher present; and in a rehearsal room with four researchers and fifteen to nineteen peers present.
Leglar21found that playing from memory to a large audience generally pro-duced the most debilitating effect on performance and the maximum auto-nomic response in organists. Abel and Larkin22observed increases in heart rate, blood pressure and self-reported anxiety when college music students played before a jury. Interestingly, males showed greater increases in blood pressure, whereas females showed greater increases in feelings of anxiety, illustrating both gender differences and the fact that different manifesta-tions of anxiety often do not correspond. Brotons23found it did not matter whether the jury was open, where performers and judges are in full view of each other (as is common in college auditions for performance courses), or blind, where the performer is behind a screen so that performers and judges are unaware of each other’s identity (as is common in job auditions).
These three factors – the person, the task and the situation – mutually interact: the effect of one depends on the level of the others. A study by Cox and Kenardy24demonstrates the interaction between personality character-istics and the situation. Performers with social phobias were much more anxious than non-socially phobic ones in a solo setting, whereas there was little difference between them in group or practice situations. The interac-tion between task and situainterac-tion can be illustrated by reference to a study carried out by Hamann and Sobaje.25The improvement in performance in an enhanced anxiety condition (where a jury evaluated performance) over a reduced anxiety condition (where performance took place in a room with only tape recording equipment present) was greater for more experienced performers, that is, those with more years of formal study and presumably greater levels of skill. Anxiety facilitated performance more for those with a greater degree of task mastery.
Cures
Brodsky and Sloboda26list the following methods of dealing with performance anxiety: Alexander and Feldenkreis techniques, aerobic exer-cise, anxiety management training, attention focusing, autogenic training, cognitive systematic desensitisation, development of interests and hobbies outside music, exposure to performance situations, mental rehearsal, mus-cle tension and finger temperature feedback, nutrition therapy, positive self-statements, prayer, relaxation training, self-hypnosis, stress inocula-tion therapy, systematic rehearsal and yoga. This offers a wide range of possibilities, to say the least. Hanser27draws a useful distinction between
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‘instrumental’techniques aimed at changing the environment or the self, and palliative measures which aim to regulate emotions and responses to stress.
Eighty-four per cent of a sample of professional and amateur musicians, asked to describe effective coping stategies for performance anxiety, reported using at least one each. Of the 478 strategies suggested, two-thirds focused on emotions, for example, ‘I try to sit quietly and pray for calmness before I sing’; one-third focused on problems, for instance, ‘be well-prepared – have no unmastered technical difficulties in the music’. Musicians whose predominant coping style was emotion-focused reported feeling greater confidence and competence and less self-consciousness and distractibility than those employing balanced or predominantly problem-focused styles.
On the other hand, the problem-focused group recalled experiencing fewer disruptive thoughts during their most recent performance.28This supports the idea that different strategies may deal with different aspects of perfor-mance anxiety.
The following evaluation of the efficacy of treatments for performance anxiety will begin with the more physical and proceed to the more psycho-logical. Of course, many techniques combine elements of both.29
Physical techniques
Relaxation, induced by deep breathing or by Jacobson’s technique of progressive relaxation whereby muscles are alternately tensed and re-laxed, is the most commonly used technique.30In one study, six sessions of progressive relaxation training proved effective in reducing heart rate and self-reported anxiety in anxious instrumentalists.31
Biofeedback is sometimes used to provide information about tension and to aid training in relaxation. Violinists were trained to reduce unnecessary left-hand tension by having electrodes attached to the muscles in their hand that controlled the thumb movement. The electrodes were connected to a machine which emitted a sound when the level of tension exceeded a given level. This level was systematically decreased as individuals learned to relax.32Similar techniques have been used to reduce tension in the forearms of violinists and clarinettists, the laryngeal muscles of singers and the facial muscles of wind players. One drawback with biofeedback is that performers cannot take the apparatus with them onto the concert platform.
Twenty-two per cent of a sample of London orchestral players reported taking alcohol and 12 per cent sedatives to deal with performance anxiety.
These figures are likely to underestimate actual consumption, although other studies33 have reported minimal usage. The problems with these general depressants are that they impair function and judgement, possibly leading
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players to believe their performance is better than it is, and that they may have undesirable side effects and can be addictive if taken habitually in high doses, leading to a downward spiral and deterioration in general health.
Sedatives may appear beneficial in the short term but prevent the develop-ment of more adequate long-term coping strategies.34
However, ‘beta-blockers’ (beta-adrenoceptor blocking agents), which act on the peripheral autonomic nervous system without pronounced effects on the central nervous system, have attracted much attention. A large-scale American survey indicated that they were taken by over 20 per cent of professional players, in many cases without medical supervision.35Inderal (propanolol) has become the drug that many musicians turn to. A European survey indicated occasional use by 15 per cent of orchestral players. A num-ber of carefully controlled studies36 have demonstrated the effectiveness of beta-blockers in relieving physiological symptoms of anxiety (increased heart rate and blood pressure), behavioural symptoms (tremor) and self-rated anxiety, as well as improving performance quality. The most marked benefits are in reducing tremor in string players, with improved evenness of vibrato and regularity of fast trills.37However, there have also been reports of deterioration in rhythmic control and more monotonous dynamics,38 feeling unnerved, memory slips and impaired concentration.39It is impor-tant to stress that these drugs can have potentially dangerous side effects and therefore should only be taken under medical supervision. The consensus is that they are suitable for occasional rather than habitual use.
Physical and mental techniques
Many of the techniques that can be applied to combating per-formance anxiety combine physical relaxation with mental alertness, espe-cially those derived from the East, such as yoga and tai chi, or the effortless concentration of the ‘Inner Game’.40A therapeutic package incorporating hypnotic relaxation suggestions, breathing induction, visual imagery and verbal suggestions linking the images to increased mental control decreased performance anxiety in music conservatoire students with stage fright im-mediately after treatment and at a six-month follow-up, whereas discussion sessions had no effect.41
The Alexander technique is employed by many musicians and others to maintain an appropriate balance between different parts of the body and to reduce unnecessary tension. In one study,42it was shown to be almost as effective as, and preferable to, beta-blockers in reducing blood pressure in orchestral players prior to performance. In another,43music students who had undergone a course of lessons in the technique showed improvements, relative to those who had not, on overall musical and technical quality,
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heart-rate variance, self-reported anxiety and positive attitude towards per-formance. However, these benefits were generally confined to relatively less stressful class contexts and did not generalise to the high-stress recital sit-uation. Nor were the effects associated with improvements in bodily ‘use’
as rated by Alexander experts; thus their locus remains unclear. However, all students who had lessons reported an increase in their awareness of ten-sion and ability to relax, and most said they would recommend lessons to others.
Psychological techniques
Behaviour therapy is based on principles drawn from the psychol-ogy of learning. In systematic desensitisation, a person is taught to maintain a calm, relaxed state during progressive exposure to a feared stimulus, re-laxation being incompatible with fear. This has been demonstrated to be an effective treatment for performance anxiety as shown by physiological, performance and self-report measures in many studies. In one,44systematic desensitisation combined with practice in ‘live’situations was found to be more effective in reducing subjective anxiety than either score analysis or no training; it also reduced heart rate. In another,45systematic desensitisation led to a greater reduction in technical errors and anxious verbal responses than either training in improvisation and cognitive skills or no treatment.
Positive thinking is a frequently recommended46and well-tried method.
Research has demonstrated that its modern counterpart, cognitive behaviour therapy, is the most effective technique for performance anxiety, but it is the least used by musicians who tend to prefer more physical methods such as relaxation and drugs.
It is therapeutically beneficial to accept anticipatory anxiety as a natural element of performing and to use the consequent tension to mobilise one’s preparation. The idea behind stress inoculation47is to accept but re-appraise anxiety symptoms, turning them to positive account. An anxiety-provoking
It is therapeutically beneficial to accept anticipatory anxiety as a natural element of performing and to use the consequent tension to mobilise one’s preparation. The idea behind stress inoculation47is to accept but re-appraise anxiety symptoms, turning them to positive account. An anxiety-provoking