When Anxiety Takes the Joy out of Performing

September 1, 2024

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Music performance anxiety (MPA) is a natural, emotional, and physiological response to the stress of public performance. Debilitating forms of MPA are severe reactions that go beyond the normal adaptive performance responses. They can have dire implications for a professional musician’s life.

Studies show between 60% to 80% of professional musicians suffer from debilitating forms of MPA, according to the National Institutes of Health (NIH). One study involving 570 musicians and 60 teachers, aged 10-54, found that one in three musicians suffers from MPA. Moreover, 20% of students who choose to leave their musical careers do so because of performance anxiety.

Unlike pop or jazz that have more improvised structures and greater interpretive freedom, classical music demands utmost precision. Given the extremely high demands and pressures that exist in professional classical music, it is no surprise that it is the musical genre with the highest incidence of MPA among performers.

The weight of anxiety can be overwhelming. Most musicians feel alone in their despair. Contributing factors can be deep, going back to childhood experiences. There are systemic issues as well. Musicians, particularly those with limited resources and few opportunities, may identify with the negative maxim: “You’re only as good as your last performance.” Some experts say that performance anxiety may be evolutionary, summoning our primal fight-or-flight instincts.

How do most musicians treat their MPA? Not very well. In fact, standard treatments for performance anxiety—cognitive behavioral therapy (CBT) and relaxation techniques borrowed from sports psychology—have mixed results when applied to musicians.

For this reason, many performers have relied on beta-blocker medications. And while some medication is generally effective at reducing physiological activation of the heart, it does not eliminate the other categories of MPA symptoms—emotional, cognitive, psychological, and behavioral—that can impair performance.

Recent findings in neuroscience and clinical psychology provide a better understanding of what causes MPA and how to treat it. Joseph LeDoux, a professor of neural science at New York University, focuses on survival circuits, including their impact on emotions, such as fear and anxiety. He notes that the body’s threat detection system unleashes a barrage of symptoms (up to 50) that go far beyond the simple activation of the sympathetic nervous system.

With music, as soon as you begin to think about it, you veer off course, out of the groove, he explains, because you’ve introduced thought, and it’s trying to take over. Often, thinking introduces problems rather than solutions.

Exposure-based treatments, coupled with brain-based techniques, including the time-limited use of beta-blockers, offer the quickest path to symptom reduction. Musicians must learn how to self-regulate their anxiety to manageable levels. Mastering this skill, while being exposed to increasingly challenging performance situations, degrades symptom intensities. This comprehensive treatment strategy offers significant, long-term relief from anxiety—without an over-reliance on beta-blockers.

Negative performance experiences are often encoded in the brain as trauma. One brain-based treatment is Eye Movement Desensitization and Reprocessing (EMDR). EMDR accesses the implicit memory system in the hippocampus that stores emotional learning, desensitizes traumatic reactions to the old performance, and installs new mental scripts that model optimal performance.

Another promising treatment for MPA is virtual reality. It involves using a headset that provides realistic 360-degree visual immersion into a performance situation. Combining simple CBT and relaxation techniques while experiencing a virtual performance, without the stress of an audience, desensitizes the psycho-physiological activation that produces MPA symptoms.

Cognitive Work

Could you imagine that your performance anxiety is not evil with an explicit wish to destroy you? Could you imagine that it’s the unconscious part of you assigned the task of keeping you safe? These are examples of reframing by radically changing unhelpful thought habits.

Mindfulness practices on a meditation cushion, or in the practice room, can help you metabolize overwhelming emotional content, regain presence in your body when it seems to be out of control, and hone in on the flow, presence, and the exhilarating aspects of performance.

Somatic Resources

Many musicians have experimented with grounding during performances: locating and deeply sensing the floor, seat, and contact points. If the anxiety is showing up in the fingers as an uncontrollable tremor, focus on another part of the body, like the feet, helps to distract the mind from panicking.

Once the body is activated, the tendency is to evaluate the physical sensations as something negative and disruptive—and that’s usually where the problem starts. Fixating on altered physical sensations, such as shaking, sweating, and a racing heart, can be a large part of the problem. The body can help an overactive mind ground itself, taking the lightning bolts of nervousness and putting them into the ground, where they might even provide some positive performance energy.

Likewise, practices such as Feldenkrais Method, Alexander Technique, body mapping, yoga, qigong, and other body-based practices can help alleviate performance anxiety.

Musical Preparation

Often, performance anxiety is a way for the subconscious to let you know that it doesn’t feel prepared, that it has not integrated the music in a holistic way. There are many ways to absorb music from the page into the body: through muscle memory, audiation (inwardly hearing the music), deep understanding of the compositional framework (thinking like a composer), visualization of the score, and mnemonic practices.

Pharmacological Interventions

Adrenaline-blocking pills, once prescribed for heart conditions and high blood pressure, can help musicians regain their musical expression, but there is a potential downside. Many musicians describe difficulties with rhythm control and a flattening of emotional engagement when taking the medications. Singers and wind players should be careful because of a decreased ability to exert the respiratory system.

The takeaway is that MPA is treatable. Musicians with severe and persistent MPA should be aggressive in their treatment strategies. If symptoms are not sufficiently managed, it is difficult to take your performance to the next level. Like any condition, MPA needs to be adequately treated in order to realize sustained relief.

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