Music performance anxiety (MPA) is a natural, emotional, and physiological response to the stress of public performance. Debilitating forms of MPA are severe and persistent reactions that go beyond the normal adaptive response to music evaluation situations and can negatively impact the quality of musical performance and the musician\'s life in general. Today, it affects numerous professional performers and can result in an inability to practice their profession, posing a significant threat to their professional activity. Despite its scope, studies exploring this issue and contributing to its resolution are scarce. Thus, this review aims to compile the significant advancements made in the last five years (2018-2023) in the treatment of MPA from a scientific perspective. For this purpose, the PRISMA method was used based on the results obtained from the Web of Science, Scopus, and Google Scholar databases. Reviewed are 10 studies that have made valuable contributions to this matter in this time frame after applying the quality filters using the PRISMA method. It is concluded that, although there are methodological shortcomings and sample limitations in the current research, this field registers advancements that provide valuable information to prevent or solve this problem in professional or aspiring musicians.

Musical training has been linked to enhanced interoceptive abilities and increased resting-state (RS) functional connectivity (FC) within the interoceptive brain network. We aimed to replicate and extend these findings with a unique cross-sectional and longitudinal study design. Professional musicians and matched individuals with no prior musical experience (training group) were recruited. Participants underwent RS fMRI scans and completed heartbeat counting and discrimination tasks outside of the scanner (time point 1). The training group additionally had RS scans and interoception tests repeated after a 6-month-long keyboard course training (time point 2). We found no evidence for increased interoceptive abilities in professional musicians relative to non-musicians, nor did we observe any improvements in interoception over the course of musical training. RS FC analysis revealed increased FC within the sensorimotor network in professional musicians compared to the training group at the first time point with no change in FC over time in the Training group. These findings challenge the view that musical training may improve interoceptive abilities. Yet, the results suggest that musical training is related to increased communication within the sensorimotor RS network, which consists of some hubs important for interoceptive processing (namely pre- and postcentral gyri and supplementary motor area).

UNASSIGNED: During their career, musicians need to undergo intense periods of training to master musical instruments and become accomplished artists. Dysfunctional practice behaviors and anxiety are often mentioned among the possible risk factors for playing-related injuries in musicians. However, the mechanism through which these might lead to the onset of these injuries is still unclear. The present study aims at overcoming this limitation by investigating the relationship between quantitative measurements of anxiety, practice behaviors and music performance quality.
UNASSIGNED: The experiment consisted in monitoring practice behaviors in 30 pianists practicing a short musical task.
UNASSIGNED: Most self-report anxiety measurements were positively correlated with practice time, especially those collected right before the practice sessions. Similar correlations were identified between anxiety and the number of repetitions of the musical task. Physiological markers of anxiety were only weakly related to practice behaviors. Subsequent analyses showed that high levels of anxiety were associated with poor quality of music performances at baseline. Nevertheless, the interaction between participants\' learning rate and anxiety measures showed no association with performance quality scores. Moreover, anxiety and performance quality co-developed during practice sessions, showing that pianists who improved their playing were also less anxious in the latter part of the experiment.
UNASSIGNED: These findings suggest that anxious musicians are likely at higher risk of developing playing-related injuries related to overuse and repetitive strains. Future directions and clinical implications are discussed.

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Most studies exploring the relation between flow and Music Performance Anxiety (MPA) have focused on the disposition of generally experiencing flow and the occurrence of MPA. Little is known about the connection between experiencing flow and MPA as it relates to a specific performance. In this study, flow and MPA have been investigated in 363 orchestral musicians in relation to a particular live music performance. The musicians were asked to fill out a questionnaire immediately after a concert. Flow experience during the performance was measured using the Flow Short Scale. The Performance-specific Questionnaire on MPA (PQM) was used for MPA. The PQM addresses particular aspects of MPA and refers retrospectively to the time before and during the performance as well as to the moment of filling out the questionnaire after the performance. Using three scales, the functional coping, the perceived symptoms of MPA and self-efficacy were determined for each time point of the performance. The results showed that experiencing flow was on average higher among orchestral musicians compared to a sample of the general population. However, there were differences between the professional and non-professional musicians. All PQM scales showed significant correlations with the global flow scale. Regression analysis on the global flow score found that regarding the time before the performance the PQM scale symptoms of MPA were diametrically connected with the flow experience. The PQM scale functional coping was shown to be positively related to the flow during the performance. Moreover, high self-efficacy was found to be closely related with stronger flow experience. Furthermore, flow seems to have positive effects on functionally coping with MPA and the self-efficacy after the performance. These findings confirm the negative relationship between flow and symptoms of MPA, offering further approaches in understanding the relationship especially for live music performances.

The situational context within which an activity takes place, as well as the personality characteristics of individuals shape the types of strategies people choose in order to regulate their emotions, especially when confronted with challenging or undesirable situations. Taking self-regulation as the framework to study emotions in relation to learning and performing chamber music canon repertoire, this quasi-experimental and intra-individual study focused on the self-rated emotional states of a professional classical cellist during long-term sustained practice across 100-weeks. This helped to develop greater awareness of different emotions and how they vary over artistic events (9 profiled concerts and 1 commercially recorded album). Data analysis included traditional psychometric measurements to test the internal consistency of the time series data as well as the relationship between variables (artistic events). The study mapped the cellist\'s flexible regulation of 17 different positive and negative emotions empirically linked to learning and achievement while practicing within the social context of performing music publicly at a high level. Findings arising from the study help with understandings of how to support musicians to maximize their artistic potential by reducing emotion dysregulation and strengthening the types of adaptive methods that enable them to manage their own emotions.

Experts in domains such as music or sports often start training early. It has been suggested that this may reflect a sensitive period in childhood for skill acquisition. However, it could be that familial factors (e.g., genetics) contribute to the association. Here, we examined the effect of age of onset of musical training on musical aptitude and achievement in professional musicians (n = 310) and twins (n = 7,786). In line with previous literature, results showed that an earlier age of onset was associated with higher aptitude and achievement in both samples. After we adjusted for lifetime practice hours, age of onset was associated only with aptitude (p < .001; achievement: p > .14). Twin analyses showed that the association with aptitude was fully explained by familial factors. Thus, these findings provide little support for a sensitive period for music but highlight that familiar factors play an important role for associations between age of onset of training and skills in adulthood.

Most investigations of musical performance anxiety have employed quantitative methodologies. Whereas such methodologies can provide useful insights into the measurable aspects of the experience in a larger group of participants, the complexity, subtlety and individuality of the emotional experience and the importance of the individual\'s interpretation of it are often overlooked. This study employed a phenomenological approach to investigate the lived, subjective experience of performance anxiety, as described in professional musicians\' narratives. Semi-structured interviews with four professional musicians (two males, two females) specializing in Western classical and jazz music genres were conducted and analyzed using Interpretative Phenomenological Analysis (IPA). The analysis revealed the presence of four overarching themes: (1) Intensity of performance anxiety experience, (2) perceived effects, (3) development of coping strategies, and (4) achieving release from anxiety. Findings suggest that the lived experience of performance anxiety is multifaceted, characterized by a physical and a psychological dimension. Interpretative Phenomenological Analysis is a useful research tool that can facilitate our understanding of the subjective experience of performance anxiety (how it is felt and understood at an individual level) and can thus be useful in the development of tailor-made intervention programs for musicians.

BACKGROUND: Working memory refers to the cognitive system responsible for the temporary storage and maintenance of information, but it remains controversial whether overlapping processes underlie the temporary retention of verbal and musical information such as words and tones.
METHODS: Participants with little or no musical training (n = 22) and professional musicians (n = 21) were administered four memory tasks. Two tasks (tone sequence recognition and pseudoword sequence recall) aimed at comparing groups\' performance for tonal or phonological material separately. Other two memory tasks investigated pseudoword and tone recognition under three conditions during the retention interval (silence, irrelevant words, or irrelevant tones).
RESULTS: Musicians were better than nonmusicians in tone sequence recognition but not in pseudoword sequence recall. There were no interference effects of irrelevant tones or words on pseudoword recognition, and only irrelevant tones significantly interfered with tone recognition.
CONCLUSIONS: Our results offer further support that tone recognition is specifically impaired by irrelevant tones, but irrelevant words did not disrupt pseudoword or tone recognition. Although these results do not reflect a double-dissociation pattern between phonological and tonal working memory, they provide evidence that temporary retention of tonal information is subject to specific tonal interference, indicating that working memory for tones involves specific processes.

BACKGROUND: Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety.
METHODS: Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session.
METHODS: The \'case\' was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition.
RESULTS: The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety.
CONCLUSIONS: Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.