International Journal of Recent Innovations in Academic E-ISSN: 2635-3040; P-ISSN: 2659-1561

Research Homepage: https://www.ijriar.com/

This work is licensed under a Creative Commons Attribution 4.0 Volume-8, Issue-8, August-2024: 30-36
International License [CC BY 4.0]

Research Article

Effective Psychological Therapies for Alleviating Performance Anxiety

Kaylin Lee

Seoul Innovation Research Institute, South Korea

Email: [email protected]

Received: July 20, 2024 Accepted: August 10, 2024 Published: August 18, 2024

Abstract
This study examined existing treatment methods for alleviating music performance anxiety (MPA) and
proposed a new therapeutic approach based on these methods. Existing treatments primarily included
pharmacotherapy, cognitive behavior therapy (CBT), and rational emotive behavior therapy (REBT). Music
therapy techniques were investigated in conjunction with these established psychological therapies, utilizing
methods such as songwriting, improvisation, and music imagery. Building on this foundation, the Neo MPA
therapy method was proposed as a new approach to alleviate MPA. The Neo MPA therapy method consists of
the following steps: First, the treatment is structured as group therapy. Second, muscle relaxation and
meditation techniques from the existing systematic desensitization method are retained, but must
incorporate guitar music. Third, the REBT technique is applied to songwriting, facilitating group songwriting
sessions. Fourth, a group concert employing the exposure and response prevention (ERP) technique is
organized. This study presented a new therapeutic method with supporting arguments for alleviating MPA,
and it holds potential as a resource for future research and practical application in therapeutic settings.
Keywords: Music Performance Anxiety (MPA), Performance, Anxiety, Desensitization, Music Therapy.

1. Introduction
The stage can be both a place to shine and a place of terror for performers. Many performers experience
anxiety on stage, which can range from mild to severe levels that might qualify as social anxiety disorder
according to the DSM-5 (2013). While a certain level of tension and anxiety can enhance performance and
lead to positive outcomes, excessive anxiety can lead to complete immobilization. MPA can create a vicious
cycle of anticipating mistakes, leading to actual errors and post-event rumination, thereby embedding a
sense of failure. This anxiety does not only affect performances but can also result in depression and low
self-esteem, deeply impacting one's psychological well-being (Jin-hee, 2020). While music performance can
be a source of beauty for enthusiasts, for professionals or students striving for excellence, the stress and
anxiety from competitive environments can be overwhelming. Despite the prevalence of MPA symptoms
among performers, the root causes of their anxiety are often unrecognized, and appropriate treatment is
seldom sought (Kim, 2008). This research aims to explore existing methods for alleviating MPA and propose
new approaches to support individuals experiencing this condition.

2. Concept of Music Performance Anxiety (MPA)

MPA (musical performance anxiety) is an experience that almost every performer has encountered to
varying degrees. MPA refers to the fear and anxiety experienced when performing in front of an audience,
which can prevent the performer from showcasing their full skill and diminish the quality of their
performance. The resulting distress can be overwhelming. MPA manifests as fear and anxiety in performance
situations, affecting emotions, cognitive distortions, physical symptoms, and behavior. This disruption can
lead performers to give subpar performances compared to their usual abilities and develop negative
experiences related to performance settings. Salmon (1990) defines MPA as “persistent and distressing
anxiety about performing in public and/or actual impairment that occurs at abnormally low levels of
performance considering the individual’s musical talent, training, and preparation” (Jin-hee, 2020, citing
Salmon, 1990). Extreme MPA can be viewed as an anxiety disorder that prevents individuals from fulfilling
their duties during performance. Anxiety disorders include various subtypes such as separation anxiety
disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, and
generalized anxiety disorder (DSM-5, 2013).

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MPA shares characteristics with anxiety experienced in public speaking, evaluations, and exams, showing
similarities with social anxiety disorder. Social anxiety disorder involves intense fear and anxiety in social
situations where one is closely observed (DSM-5, 2013). Such social situations include public speaking, being
the focus of attention, and receiving evaluations, often leading to a misinterpretation of possible negative
outcomes. Individuals who feel anxiety only in performance contexts but not in other social situations
experience anxiety specifically related to being observed or evaluated (Jin-hee, 2020). Similarly, performers
experience MPA differently depending on the situation. For instance, I have found that my level of MPA is
significantly higher during an actual performance in front of an audience compared to during a rehearsal.
This indicates that the presence of evaluators or an audience affects the level of tension experienced by the
performer.

3. Symptoms of Performance Anxiety

MPA symptoms manifest differently among individuals, primarily appearing as physical, cognitive, and
psychological symptoms.

Firstly, physical symptoms of MPA include trembling hands and feet, excessive sweating as if it were raining,
sudden chills, and cardiovascular imbalances. As anxiety is experienced, the body's autonomic nervous
system becomes activated, leading to symptoms such as chest tightness, increased heart rate, elevated blood
pressure, rapid and shallow breathing, disruptions in breathing patterns, dry lips, and changes in body
temperature. In severe cases, symptoms may include muscle rigidity and sensory abnormalities (Nam and
Han, 2017). For example, my friend A experiences chest tightness and difficulty breathing as soon as the
performance begins. Another friend, B, becomes so extremely nervous upon stepping onto the stage that
they forget the pieces they are supposed to play. Subsequently, their hands sweat excessively, causing them
to drop their instrument.

Secondly, performers experiencing performance anxiety often feel a sense of shame stemming from a
perception of inferiority. They typically exhibit low self-esteem, and as they make frequent mistakes due to
anxiety on stage, they tend to evaluate themselves harshly, leading to feelings of guilt and shame (Nam and
Han, 2017).

Thirdly, cognitive symptoms include excessive worry about events that have not yet occurred, discomfort
from intrusive thoughts, decreased concentration, and irrational beliefs about needing to be perfect. The
desire to gain approval from parents, teachers, and peers drives a focus on flawless, error-free performances,
leading to an intolerance for even minor mistakes that others might not notice. This belief that the audience
will judge the performance critically can cause severe nervousness and lead to a repetitive thought pattern
of constantly ruminating over what might go wrong, which in turn creates a vicious cycle (Nam and Han,
2017).

In my own experience, a malfunction with the monitor speakers during rehearsal prevented me from tuning
properly, resulting in pitch issues during high notes when singing. This made me anxious about the
upcoming performance. As I waited for my turn, my heart raced, and I had trouble focusing, which led me to
repeat the mistakes from the rehearsal. MPA induces cognitive distortions, increasing anxiety, and fear of
failure, gradually leading to irrational and negative thinking. According to American psychiatrist Aaron Beck,
cognitive distortions include errors such as all-or-nothing thinking, overgeneralization, mental filtering,
minimization and maximization, personalization, mislabeling, mind reading, and fortune telling. These
cognitive errors distort or exaggerate reality in a negative direction, leading to negative emotions and
behaviors (Kwon, 2012).

4. Known Methods for Alleviating Anxiety

Several methods are used to alleviate MPA and performance anxiety, including pharmacotherapy, CBT,
REBT, psychoanalytic counseling, meditation, yoga, and music therapy. Among these, pharmacotherapy is
the most frequently used method for reducing anxiety.

A. Pharmacotherapy
Individuals who experience anxiety symptoms affecting their performance in presentations, exams, and
musical performances often try various methods to alleviate these symptoms. The most common and
frequently used method is medication. They might obtain prescriptions from a doctor or purchase
medication from a pharmacy based on the pharmacist’s recommendations to alleviate MPA. According to an
interview with pharmacist Yoon Jeong-wan of the Hannam-dong Moon Pharmacy, medication cannot

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guarantee its effectiveness for everyone, and its suitability can be uncertain. Most anxiety-reducing
medications work by stabilizing the sympathetic nervous system, which dulls the nerves. Depending on the
individual, side effects such as drowsiness, decreased concentration, nausea, dizziness, and blurred vision
can occur, potentially interfering with performance. Although medication can be an effective treatment, its
side effects can be significant, and it has limitations in continuously controlling psychological symptoms
related to performance anxiety.

B. Cognitive Behavior Therapy

While medication can provide a temporary solution, it has side effects and is limited in its ability to control
the psychological symptoms of MPA in the long term. As a result, non-pharmacological treatments such as
cognitive behavior therapy (CBT), yoga, meditation, and music therapy are being implemented to replace
drug therapy. According to the National Center for Mental Health, “CBT (cognitive behavioral therapy) is a
treatment that helps correct distorted thoughts and behaviors caused by pathological anxiety, enabling
individuals to respond to anxiety symptoms in a rational and appropriate manner. CBT is particularly
effective for treating anxiety disorders such as panic disorder and social anxiety disorder.” CBT is a diverse
approach used to address mental health and behavioral issues, with different methods selected based on the
individual’s specific problems, symptoms, needs, and circumstances. Among various CBT techniques,
systematic desensitization is noted to be suitable for patients who have appropriate coping skills but exhibit
severe anxiety in specific situations.

Systematic desensitization is a behavioral therapy that involves developing a hierarchy of fear-inducing

situations, ranging from those that provoke minimal fear to those that provoke the most fear. The process
involves helping individuals overcome their fear at each stage of the hierarchy, ultimately enabling them to
confront and overcome the most fear-provoking situation. This method involves inducing a state of
relaxation in response to fear and anxiety-inducing stimuli, and then exposing the individual to these stimuli
according to the established anxiety hierarchy. The goal is to reduce and desensitize the anxiety or fear
response triggered by aversive stimuli (wikipedia.org-1). Systematic desensitization is a behavioral
modification technique developed by South African psychiatrist Joseph Wolpe in the 1950s. He exposed a cat
to anxiety-inducing stimuli in a mild manner and then provided the cat with positive stimuli such as food.
Through this method, he succeeded in reducing the cat's anxiety by helping it respond positively to the
anxiety-provoking elements (Basics of Understanding Behavioral Management, Sigmapress, p. 14).

The first stage of systematic desensitization involves inducing relaxation through techniques such as muscle
relaxation, deep breathing, or meditation. This step is crucial because relaxation is incompatible with
tension, helping to desensitize the individual to anxiety. The second stage involves creating a hierarchical list
of anxiety-inducing stimuli, ranging from the least to the most anxiety-provoking. This hierarchy is later used
in treatment to systematically desensitize the individual. The final stage involves exposing the individual to
the anxiety-inducing stimuli, starting from the lowest level of the hierarchy and gradually progressing to the
highest, allowing them to overcome their anxiety. For instance, someone with a fear of dogs might start by
imagining encountering a dog on the street, then progress to seeing a dog from a distance of ten meters, then
five meters, and finally one meter, before eventually touching and spending time with the dog. This step-by-
step approach helps the individual overcome their fear of dogs (Naver Encyclopedia, Systematic
Desensitization).

C. Rational Emotive Behavior Therapy

Rational emotive behavior therapy (REBT) is a comprehensive and proactive psychological therapy with
philosophical and empirical foundations, designed to resolve emotional and behavioral problems and
improve quality of life. Created and developed by American psychiatrist and psychologist Albert Ellis, REBT
draws inspiration from the teachings of Asian, Greek, Roman, and modern philosophers. It is a form of
cognitive behavior therapy (CBT) first described by Ellis in the mid-1950s. REBT posits that human
emotions stem from thoughts, and it aims to address problems by focusing on human cognition, as thoughts
lead to emotions and actions (Kwon, 2012). While CBT emphasizes thoughts and emotions, REBT considers
cognition and emotion as critical elements in behavioral change. Ellis's theoretical model is commonly
known as the ABCD model. In this model, A stands for activating event, which refers to any event or situation
that triggers emotional turmoil or behavior. B represents the belief system, which includes the individual's
attitudes or belief systems in response to environmental stimuli such as events or actions. These beliefs can
be rational or irrational. C stands for consequence, which is the emotional and behavioral outcome that
results from interpreting the activating event through one's belief system. Rational or irrational beliefs can
lead to different outcomes. Consequences of irrational belief systems include excessive anxiety, depression,

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anger, guilt, hurt, jealousy, and shame. Lastly, D stands for dispute, which involves challenging and
questioning one's distorted thoughts and beliefs about external reality, encouraging the individual to
reconsider whether their thoughts are rational (Kwon, 2012).

For example, hearing from family members, "You have always been the most inadequate child in our family.
You must succeed at all costs to gain recognition," is an activating event. The belief, "I must strive to be
recognized as a competent person, so I must perform perfectly. I must excel in any given role, and if I fail, it
will be catastrophic, proving that I am always incompetent and worthless," is the belief system. The resulting
emotions, such as anxiety, panic, depression, despair, avoidance of situations, and feelings of worthlessness,
are the consequence. D can be explained as the dispute received from a therapist or psychologist, challenging
the irrational belief system.

5. Existing Methods for Alleviating Performance Anxiety Using Music Therapy

A. Systematic Desensitization and Music Therapy
There are cases where systematic desensitization is combined with music in therapy. Music used as a tool in
music therapy is considered effective for addressing the problems of individuals experiencing anxiety and is
deemed useful for alleviating performance anxiety, leading to its application in various academic fields (Jin-
hee, 2020). Although music can be a source of anxiety for performers experiencing music performance
anxiety (MPA), forming a love-hate relationship, Dileo-Maranto (1992) suggests that musicians respond to
music both physically and psychologically differently from non-musicians due to their musical training (Kim,
2008, citing Dileo-Maranto, 1992). Thus, these responses to music can enhance its effectiveness as a
therapeutic modality. Moreover, music therapy has proven to be significantly effective in treating general
stress and anxiety, and since music is a familiar and easily accessible medium for musicians, music therapy
has garnered interest as an alternative treatment for performance anxiety. Juncos and Markman (2016)
implemented desensitization techniques and progressive muscle relaxation training using music. They
exposed individuals who fear musical situations to performance scenarios repeatedly, without avoidance, to
reduce performance anxiety. These researchers identified the physical and psychological reactions
experienced by performers in front of an audience and exposed them to actual performance situations to
help them confront and manage their anxiety (Jin-hee, 2020, citing Juncos and Markman, 2016).

B. Desensitization and Progressive Muscle Relaxation Training

Kim (2008) conducted desensitization training and progressive muscle relaxation (PMR) training by having
participants imagine anxiety-inducing scenes and then listening to music to induce relaxation. The music
used in conjunction with muscle relaxation featured slow-tempo, lyrical soundtracks. Additionally,
improvisation using the piano was employed to intervene in the participants' negative emotions towards
rigid music education. For participants with obsessive rumination, positive language chants were used after
performances to help them overcome self-doubt.

C. Music Imagery and Songwriting through Listening to Music

Choi and Kang (2018) used music listening to induce music imagery, allowing individuals to explore and
cognitively restructure their irrational thoughts related to performance anxiety before engaging in
performance activities. Music imagery is a deep psychological therapy technique that explores the inner
world of individuals by experiencing various imagery through listening to music that is suitable for
therapeutic goals (Jung, 2006). By exploring their irrational thoughts through music listening, individuals
prepare for the main activities focused on cognitive restructuring. The main activities include songwriting
and improvisational performance using percussion instruments and vocals. Songwriting can vary according
to the cognitive level, response, and preferences of the individual and may include activities such as fill-in-
the-blank, rewriting lyrics, song variation, and creating rap (Jung, 2006). In addition to songwriting, Choi and
Kang (2018) encouraged improvisational performances, providing a free and creative experience within the
music. Continuous exposure to performance situations aimed to create successful experiences, thereby
alleviating performance anxiety.

6. Further Connection: The Neo MPA Therapy Method

In this study, we aim to propose a new method for alleviating MPA symptoms by referencing existing
research. The most notable aspect of the Neo MPA therapy method is its use of group dynamics and energy
in the treatment. Additionally, it incorporates muscle relaxation and meditation, which were part of the
existing systematic desensitization techniques, as they are performed in the same way. Furthermore, the
REBT technique is applied to songwriting, leading to group songwriting sessions. REBT posits that human
emotions originate from thoughts, which then influence feelings and behaviors. Thus, by focusing on

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changing faulty thoughts and creating songs with the group that address these erroneous thoughts, the
effectiveness of the therapy is enhanced. We aim to overcome MPA by holding a group music session using
an enhanced ERP technique that builds upon systematic desensitization.

A. Group Therapy
Above all, the treatment for MPA should be in the form of group therapy rather than individual therapy. A
group can instill hope in its members that their issues can be improved, and this hope itself can have
therapeutic effects. Additionally, members can find comfort in knowing that their current symptoms are not
unique to them, but that others have similar conflicts and problems. They can acquire necessary information,
gain a clear understanding of their issues, and receive direct or indirect guidance, suggestions, and advice
from other group members, which is expected to boost their confidence. It is believed that openly expressing
one's anxious emotions in front of others is a crucial process for MPA treatment. Through interactions with
group members, individuals may gain insight that others will not only view them as objects of evaluation
when on stage but will also recognize and appreciate their performance. This insight provides a platform to
test the belief that they can fully express their desired skills as performers.

B. Guitar Music for Relaxation

Music carries meaning beyond the sounds we hear and can be used in various ways for human benefit.
Guitar music is considered one of the best choices for muscle relaxation and meditation, and it will be used
for this purpose. The guitar is a type of stringed instrument that produces sound by plucking the strings with
the fingers or a pick. It typically has six strings and, while not as wide-ranging as a piano, it can cover a
considerable range of notes and play melodies. It has been said that the warm tones produced by the
acoustic guitar can lower blood pressure, reduce heart rate, relax muscles, and decrease stress hormones
such as cortisol. A guitar technique called strumming creates repetitive rhythms with predictability, which
helps us unwind (breakthroughguitar.com).

Stringed instruments, like the guitar, can be played using various tools or directly with the hands. However,
even when using different tools, the method of producing sound differs from that of bowed instruments.
While bowed instruments produce sound through the friction of the bow against the strings, plucked
instruments create sound by strumming or plucking the strings. Plucked instruments, such as guitars and
harps, produce vibrations that create a gentle and smooth sound, which is often perceived as more relaxing
compared to the continuous and intense sounds of bowed instruments. The sound of plucked instruments
fades more quickly, creating a more peaceful auditory experience ideal for relaxation. On the other hand,
bowed instruments sustain sound longer, which can be less relaxing (en.wikipedia.org-2). Instruments like
the guitar and harp are frequently used in therapeutic settings due to their ability to produce calming and
peaceful tones, whereas bowed instruments might evoke a broader range of emotions rather than solely
relaxation (classicalcompass.org).

C. Group Songwriting
Through songwriting, individuals naturally express their unconscious emotions and conflicts, allowing them
to examine their own feelings (Jung, 2006). Songwriting can help individuals become aware of their negative
thoughts and reframe them into positive language, aiding in the correction of these negative thoughts. This
process utilizes music as a form of projective identification, where individuals reflect on and internalize the
behaviors and emotions of others as if they were their own. For example, adolescents might listen to a
popular singer's song and change their behavior, engage in deviant actions, use songs to facilitate learning,
or sing to maximize group cohesion during rallies (Jung, 2006). In particular, group songwriting activities
are believed to be highly effective as they allow the group to collaboratively create and perform lyrics that
help overcome MPA, potentially enhancing the therapeutic benefits many times over.

D. Improvisation: Playing with One’s Major Instrument

Improvisation involves creating music spontaneously during performance rather than playing from pre-
composed sheet music. As group members collaboratively create music in real-time, this activity facilitates
emotional awareness, understanding of others, consideration for others, and active self-expression.
Improvisation is an active rather than passive activity, focusing more on creating and expressing music
rather than merely listening. As noted by Dileo-Maranto (1992), music can form a complex, ambivalent
relationship with performers experiencing MPA, potentially acting as a risk factor. However, musicians, due
to their musical training, may respond to music physically and psychologically differently from non-
musicians. Based on this, using one’s major instrument, which can form a complex relationship with the
musician, for improvisation might offer a new approach. This method could leverage the musician's

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immediate physical and psychological responses to their instrument, potentially providing a more effective
means of addressing MPA compared to non-specialists.

E. Holding an ERP Concert

In behavioral therapy, exposure and response prevention (ERP) is known to be one of the most effective
methods for overcoming anxiety. This approach involves inhibiting escape responses and exposing
individuals to their feared stimuli (e.g., dirty substances) or thoughts (e.g., thinking that germs are on their
hands) while preventing compulsive behaviors (e.g., hand washing). Through this method, patients learn not
only to endure the feared stimuli and thoughts without engaging in compulsive behaviors but also to
understand that the feared outcomes (e.g., contracting an illness) do not occur even without performing the
compulsive actions (Kwon, 2012; Abramowitz et al., 2019). Building on this concept, we propose organizing
a concert where group members alternate between being performers and audience members. This event
provides an opportunity for participants to adapt to the stage and the situation. When a performer
experiences MPA on stage, the performance will continue and be repeated until the anxiety diminishes.
Meanwhile, the other group members will act as the audience, assuming the role of critical evaluators who
provide intense feedback and assessments of the performer.

7. Conclusion
Musicians are prone to perfectionism, which serves as a driving force for continually improving their
performances. They also tend to have a high self-image, which makes them fearful of criticism and judgment
from others. This fear of disappointing those who have high expectations, combined with the fear of failure,
leads to the onset of performance anxiety. This study aimed to review the current methods for alleviating
performance anxiety and to propose future directions for such treatments. We investigated a range of
approaches, including counseling techniques, relaxation through meditation, and music-based therapies,
without restricting ourselves to any specific method, and sought to develop new approaches based on this
review.

The conclusions are as follows:

1) Cognitive behavioral therapy (CBT), which originated from behavioral psychology, was predominantly
used as a therapeutic tool for alleviating anxiety. Subtypes of CBT, such as systematic desensitization and
rational emotive behavior therapy (REBT), were utilized.

2) In conjunction with these therapeutic techniques (CBT, Systematic Desensitization, REBT), music
therapy techniques were employed. The music used included methods for physical relaxation, music
listening, songwriting, and improvisation.

Performance anxiety ultimately stems from the act of performing music, but music therapy techniques are
actively used to alleviate this anxiety for the following reasons: Although music can create a complex and
ambivalent relationship with performers experiencing performance anxiety, musicians respond to music
both physically and psychologically in ways that differ from non-musicians due to their musical training.
They engage more deeply and actively compared to other media. Existing treatments typically adopted only
one technique per therapy. However, the Neo MPA therapy method proposes a combined approach,
integrating systematic desensitization and REBT techniques. Additionally, it presents the use of ERP
techniques through concerts as a therapeutic method. The most crucial aspect is the provision of group
therapy involving a therapist and multiple participants, leveraging the dynamics and energy of the group.
Furthermore, the effectiveness of guitar tones for relaxation was demonstrated, and improvisation with the
musician's most beloved or ambivalent instrument was utilized.

A limitation of this study is that the proposed method could not be practically applied and tested. This study
aims to present this method as a resource for therapists and psychological counselors dealing with
performance anxiety.

Declarations
Acknowledgments: I wish to thank Seoul Innovation Research Institute.
Author Contribution: The author confirms sole responsibility for the following: study conception and
design, data collection, analysis and interpretation of results, and manuscript preparation.
Conflict of Interest: The author declares no conflict of interest.
Consent to Publish: The author agrees to publish the paper in International Journal of Recent Innovations
in Academic Research.

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Data Availability Statement: The datasets used or analyzed during the current study are available from the
corresponding author on reasonable request.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Research Content: The research content of manuscript is original and has not been published elsewhere.

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Citation: Kaylin Lee. 2024. Effective Psychological Therapies for Alleviating Performance Anxiety.
International Journal of Recent Innovations in Academic Research, 8(8): 30-36.
Copyright: ©2024 Kaylin Lee. This is an open-access article distributed under the terms of the Creative
Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
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