Music performance anxiety (MPA) is one of the most common disorders among professional musicians, nevertheless, little is known about the disease. With this systematic review, prevalence, risk factors and treatment procedures for MPA were assessed, and for the first time, quality assessments were carried out for all studies using standardized assessment tools. A systematic literature search was conducted via search algorithms in the databases MEDLINE, EMBASE, CINAHL, PsycArticles, PsycInfo and ERIC. Included were case reports, case–control, cohort, cross-sectional and intervention studies examining professional musicians with MPA. For quality assessment, adapted tools of the National Heart, Lung, and Blood Institute were used. A total of 43 studies were included (10 case reports, 21 intervention, 11 cross-sectional, one cohort study). Quality ratings ranged from −11 to 6 out of a maximum of 15/16 points for cross-sectional/cohort studies and −4 to 11 out of 18 points for intervention studies. The prevalence of MPA was between 16.5% and 60%. More women than men were affected and musicians older than 45–50 years reported less MPA than younger musicians. Regarding treatment cognitive behavioural therapy (CBT) and β-blockers were most often researched with beneficial results for CBT. However, studies with adequate control groups for CBT interventions are needed to clarify its efficacy. Studies showed methodological weaknesses, especially in the selection of participants, recording of influencing factors, blinding of interventions, randomization of participants and analysis of comorbidity. Recommendations for further research are made.

Performance anxiety in professional musicians: a systematic review on prevalence, risk factors and clinical treatment effects

Context and aims: Many musicians suffer for their art, and health is often compromised during training. The Health Promotion in Schools of Music (HPSM) project has recommended that health education should be included in core curricula, although few such courses have been evaluated to date. The aim of the study was to design, implement and evaluate a compulsory health education course at a UK conservatoire of music.

Methods: The course design was informed by a critical appraisal of the literature on musicians' health problems and their management, existing health education courses for musicians, and the HPSM recommendations. It was delivered by a team of appropriately-qualified tutors over 5 months to 104 first-year undergraduate students, and evaluated by means of questionnaires at the beginning and end of the course. Thirty-three students who had been in their first year the year before the course was introduced served as a control group, completing the questionnaire on one occasion only. Items concerned: hearing and use of hearing protection; primary outcomes including perceived knowledge and importance of the topics taught on the course; and secondary outcomes including physical and psychological health and health-promoting behaviors. The content of the essays written by the first-year students as part of their course assessment served as a guide to the topics they found most interesting and relevant.

Results: Comparatively few respondents reported using hearing protection when practicing alone, although there was some evidence of hearing loss, tinnitus, and hyperacusis. Perceived knowledge of the topics on the course, and awareness of the risks to health associated with performing music, increased, as did self-efficacy; otherwise, there were negative effects on secondary outcomes, and few differences between the intervention and control groups. The topics most frequently covered in students' essays were managing music performance anxiety, and life skills and behavior change techniques.

Conclusion: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.

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Health Education for Musicians.

Values are a guiding principle in Acceptance and Commitment Therapy (ACT), and a vital element of both ACT research and clinical assessment. This systematic review aimed to evaluate the current evidence for the utility and efficacy of quantitative survey measures that assess values within an ACT study framework. Online databases were searched using key words to identify research articles administering values-based assessments. A thorough database search yielded 65 separate articles that met inclusion criteria, and eight validated scales measuring values. Value-scale psychometric studies that met inclusion criteria were assessed for content validity, internal consistency, and construct validity. Results provide information to guide future researchers regarding the most psychometrically sound and appropriate measures that assess values across multiple criteria. While the measures vary significantly in psychometric properties, the Valuing Questionnaire, the Engaged Living Scale (either short or long form), and the Valued Living Scale appear to have the strongest methodological support. Important future directions include further psychometric studies across all measures to assess their utility in more diverse contexts (e.g., randomized controlled trials, time-lagged, and other controlled studies of ACT treatment) and populations (e.g., age, health, race, ethnicity, nationality, etc.) with consideration of a measure's definition of values within an ACT context.

A systematic review of values measures in acceptance and commitment therapy research

Students are arriving in higher education more stressed and anxious than previously, so there is a clear benefit for institutions to provide evidence-based health and well-being interventions. Mindfulness is a widely available popular intervention, and its efficacy has been demonstrated in the clinical field and increasingly in the educational field. However, the potential benefits of teaching mindfulness to music students have not yet been explored sufficiently. 
This thesis reports the effects of teaching targeted 8-week mindfulness courses to singers and instrumentalists in two studies run over two years at two conservatoires and a university. Both studies used a predominantly qualitative mixed methods approach. Levels of mindfulness were measured using the Five Facet Mindfulness Questionnaire (FFMQ: Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006), and a specially designed Mindfulness for Musicians questionnaire. The instrumentalists’ quantitative study was quasi-experimental; the singers’ study utilised controls and randomised controls. Qualitative methods comprised of semi-structured interviews for both studies, and the singers’ study included longitudinal interviews, an anonymous diary, and a teachers’ blind study. 
Quantitative results showed increased levels of mindfulness among vocal and instrumentalist participants over the interventions. Participants reported a greater ability to learn instrumental technique, improved teacher/pupil relationships, more efficient and effective music practice, and enhanced communication skills in rehearsal and ensembles. Mindfulness-naive vocal teachers who taught 136 students across two institutions identified nineteen of the 31 experimental participants in the blind study. Results demonstrated predicted positive impacts on performance anxiety, but a key finding was that mindfulness was also beneficial in enhancing aspects of participants’ performances, improving their experience and increasing performance enjoyment. The evidence presented in this thesis demonstrates the clear benefit of targeted mindfulness interventions in the field of higher music education. Mindfulness training enhances the whole musician both in student learning and as a preparation for professional life.

Mindfulness for musicians: The effects of teaching 8-week mindfulness courses to student musicians in higher education

The purpose of this study was to investigate the relational changes between music performance anxiety (MPA), self-efficacy, performance quality, and behavioural anxiety in five adolescent piano stu...

Exploring music performance anxiety, self-efficacy, performance quality, and behavioural anxiety within a self-modelling intervention for young musicians

This study investigated the use of Acceptance and Commitment Therapy (ACT) as a treatment for music performance anxiety (MPA) in an uncontrolled pilot design. ACT is a newer, "third-wave" therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT "Hexaflex." A small group of student vocalists (N = 7) from an elite choral college were recruited using objective criteria for evaluating MPA. Participants received 12 ACT sessions, and their baseline functioning served as a pre-treatment control. Treatment consisted of an orientation to ACT, identifying experientially avoidant behaviors, facilitation of Hexaflex processes, group performances in which valued behaviors were practiced in front of one another, meditations, homework, and completion of self-report measures before, during, and after treatment (at a 1- and 3-month follow-up). Improvements were observed in participants' cognitive defusion, acceptance of MPA symptoms, and psychological flexibility at post-treatment and follow-ups. Students also appeared to improve their performance quality and reduce their shame over having MPA. These results add to existing research suggesting ACT is a promising intervention for MPA, while also highlighting how vocal students may be less impaired by physical MPA symptoms.

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Evan Kalkus

Papers

Acceptance and Commitment Therapy for the Treatment of Music Performance Anxiety: A Pilot Study with Student Vocalists