Sport, Exercise, and Performance Psychology

Sport, Exercise, and Performance Psychology Mental Skills for Musicians: Managing Music Performance Anxiety and Enhancing Performance Sophie L. Hoffman and Stephanie J. Hanrahan Online First Publication, September 12, 2011. doi: 10.1037/a0025409 CITATION Hoffman, S. L., & Hanrahan, S. J. (2011, September 12). Mental Skills for Musicians: Managing Music Performance Anxiety and Enhancing Performance. Sport, Exercise, and Performance Psychology. Advance online publication. doi: 10.1037/a0025409

Sport, Exercise, and Performance Psychology 2011 American Psychological Association 2011, Vol., No., 000 000 2157-3905/11/$12.00 DOI: 10.1037/a0025409 Mental Skills for Musicians: Managing Music Performance Anxiety and Enhancing Performance Sophie L. Hoffman and Stephanie J. Hanrahan The University of Queensland The aim of the present study was to examine the effects of a short-term mental skills intervention on reducing music performance anxiety and enhancing performance. Thirty-three musicians, including students, amateurs, and professionals, volunteered to participate (ages 19 to 66 years, mean 42.09, standard deviation 15.18). Participants were randomly assigned to a treatment group (cognitive restructuring; N 15) or a wait-list control group (N 18). A provisionally registered psychologist taught participants mental skills strategies in three 1-hr, psychoeducational workshops. Selfreport, behavioral, and physiological indicators of anxiety and performance quality were collected pretest and posttest. Self-report measures were also taken for the treatment group at a 1-month follow-up. We hypothesized anxiety reduction and performance enhancement in the treatment group from pre- to posttest, and that the benefits of treatment would be maintained or strengthened at the 1-month follow-up. Results revealed a significant reduction in self-reported anxiety, a significant increase in performance quality in the treatment group, and a significant decrease in performance quality in the wait-list control group. The follow-up assessment revealed a significant decrease in self-reported anxiety. No other significant differences were observed. Keywords: music performance anxiety, performance enhancement, mental skills, musicians, cognitive restructuring, performance quality The adverse and beneficial effects of anxiety on performance have been widely documented in domains such as public speaking, test taking, and sport (McGinnis & Milling, 2005). Music performance anxiety (MPA), however, is only a relatively new area of research (Kenny, 2005). Several reviews indicate that MPA is a widespread and pervasive problem (Kenny, 2005; Niemann, Pratt, & Maughan, 1993; Steptoe, 2001; Wesner, Noyes, & Davis, 1990). In a survey of 2,212 classical musicians, 40% reported that anxiety interfered with their performances (Kirchner, Bloom, & Skutnick Henley, Sophie L. Hoffman, School of Psychology, The University of Queensland; Stephanie J. Hanrahan, Schools of Human Movement Studies and Psychology, The University of Queensland. We thank Stephanie Clemmet for her assistance with the project. Correspondence concerning this article should be addressed to Sophie L. Hoffman, School of Psychology, The University of Queensland, Saint Lucia QLD 4072, Australia. E-mail: sophie.hoffman@uqconnect.edu.au 2008). Researchers have found that MPA affects instrumentalists and vocalists of all ages and abilities, including students, professionals, amateurs, and children (Brotons, 1994; Kenny, 2006; Liston, Frost, & Mohr, 2003). Some researchers have used the terms stage fright and music performance anxiety interchangeably, while others have characterized stage fright as the most severe form of music performance anxiety (Kenny, 2005; Salmon, 1990). Generally, MPA is considered to be the experience of persisting, distressful apprehension 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 (Salmon, p. 3). Some of the reported symptoms include trembling, hyperventilation, nausea, sweating, negative thoughts (e.g., catastrophizing), increased heart rate, and dry mouth (Lehrer, 1987; Salmon, 1990; Steptoe & Fidler, 1987). A common model used to describe MPA is the Yerkes Dodson model, which states that the relationship between arousal and performance 1

2 HOFFMAN AND HANRAHAN is curvilinear (Kirchner et al., 2008). Low and high levels of arousal hinder performance, and moderate levels of arousal benefit performance (Lehrer, Goldman, & Strommen, 1990). Wolfe (1989) argued that traditional interventions such as relaxation may not be helpful, because relaxation focuses on lowering arousal. Instead, it would be more appropriate to teach strategies that maintained concentration and moderate levels of anxiety while decreasing self-defeating thought patterns. Although the Yerkes Dodson model provides some insight into performance, it does not take into account variables such as cognitions. Many researchers now consider MPA to be an interaction between cognitive, behavioral, and physiological factors (Kenny, 2006). The threesystems model, originally proposed by Lang, states that anxiety is the result of distressing thoughts, autonomic arousal, and behavioral responses (Salmon, 1990). The factors are highly interactive but can operate independently (Craske & Craig, 1984). The three-systems model has obvious parallels to cognitive behavioral theory, and informs the present study. Beck (1976, cited in McLeod, 2009) described self-critical cognitions as automatic thoughts, and he argued that emotional and behavioral difficulties were a result of people s interpretations of the event, rather than the actual event. When clients become aware of their negative thoughts, they are able to decide whether the thoughts are valid, and if necessary, modify these thoughts or introduce new thoughts. Consequently, their behavior will change. In the present study, through targeting musicians unhelpful thoughts about their performances, we aimed to enhance the quality of performance and lower anxiety to a more manageable level. For comprehensive reviews of the literature on treatments for MPA, see Kenny (2005) and McGinnis and Milling (2005). These authors reported several recurring methodological limitations and recommended that future research employ multiple outcome measures (physiological, behavioral, and cognitive), include a measure of performance quality, and a follow-up assessment. Other limitations included inferior designs, such as having no control group or no pretest scores (Kenny, 2005). Brodsky (1996) also argued that samples other than university students should be used. Kenny (2005) recommended that researchers draw on findings from sport psychology. Cognitive interventions that aim to reduce anxiety and enhance performance in athletes are common in the sport psychology literature (Williams & Leffingwell, 2002). Successful athletes have been found to use more effective cognitive strategies than less successful athletes (e.g., self-talk to focus attention and build selfconfidence), indicating that interventions incorporating cognitive strategies are beneficial in enhancing performance (Williams & Leffingwell). Cognitive restructuring has been used successfully to help athletes cope with anxiety, sometimes more so than relaxation techniques (e.g., Haney, 2004; Hanton, Wadey, & Mellalieu, 2008). Our study included a combination of cognitive restructuring and imagery techniques, but tailored to musicians. According to cognitive behavioral theory, we could assume that the common feature underlying the success of these interventions is changing unhelpful cognitions to more helpful cognitions. Few studies have investigated whether a cognitive intervention can reduce anxiety and enhance performance in musicians (Lehrer, 1987; Steptoe & Fidler, 1987). In a review of the literature, Kenny (2005) found only two relevant studies, one of which remains an unpublished dissertation. A search of more recent articles (2006 2011) via ProQuest (search term music performance anxiety ) did not return any recent studies investigating the effectiveness of a purely cognitive intervention in the treatment of MPA; consequently, research in this particular area is needed. Patson s 1996 thesis (cited in Kenny, 2005) had only 17 participants and the intervention was conducted solely by the researcher, who was a musician with no psychology training. The cognitive intervention had no significant effect on anxiety levels. Sweeney and Horan s (1982) study indicated that a cognitive restructuring program may be helpful in the treatment of MPA; their program, featuring cognitive restructuring, significantly reduced anxiety. The results should only be considered preliminary, however, and further research is required (Kenny, 2005). For instance, in Sweeney and Horan s research, the participants were all pianists (undergraduate music students) who were screened for high levels of MPA; thus, significant results may have been easier to find. Also,

MENTAL SKILLS FOR MUSICIANS 3 the authors gave the participants a piece with which they were unfamiliar, perhaps further increasing their anxiety. In many performances, musicians would be familiar with their chosen piece and still experience anxiety. In addition, the program was lengthy and no follow-up assessment was conducted. It seems worthwhile replicating this study in a more diverse sample and addressing its limitations. We aimed to develop and examine the effects of a short mental-skills intervention for reducing MPA and enhancing performance. Past research has focused on combined interventions; however, often these programs run for over 6 weeks and it is unknown which aspects of the intervention are most effective (e.g., Nagel, Himle, & Papsdorf, 1989). There may be components in the combined treatment programs that are not overly helpful in reducing MPA and these components could be eliminated from future programs, saving time and expense. Another important goal of our research was to examine the effects of the program on performance. It is important that treatments actually help performance, as well as reduce anxiety (Kenny, 2006; McGinnis & Milling, 2005). Kenny (2006) suggested that improving performance quality will have a positive, selfreinforcing effect on the musician and enhance confidence in future performances. We hypothesized that the treatment group, as compared with the wait-list control group, would show a significant decrease in selfreported state and performance anxiety, behavioral signs of anxiety, and heart rate, from pre- to posttest. We also hypothesized that performance quality would be enhanced in the treatment group from pre- to posttest and the benefits of treatment would be maintained or strengthened at the 1-month follow-up. Participants Method Participants were 33 volunteers (29 females and four males) with ages ranging from 19 to 66 years (mean [M] 42.09, standard deviation [SD] 15.18). Only one participant dropped out during the course of the study. There have been approximately 10 treatment outcome studies that reported a sample size below 25, seven studies that reported a sample size between 25 and 35, and seven studies that reported more than 35 participants (Kenny, 2005). Consequently, our sample size seemed reasonable as compared with these similar studies, where the number of participants seemed to be highly variable (ranging from 17 to 54). After we obtained institutional ethical approval, participants were recruited through posted advertisements on university notice boards, acquaintances of the researchers, and e-mailing community bands, choirs, members of a music teachers association, and music students from two large Australian universities. Participants contacted the first author by e-mail with their general availabilities. No eligibility criteria were used to screen potential participants; all who were able to participate were included in the study. Participants were randomly assigned to the treatment group or to the wait-list control group. Participants who knew each other were placed in the same group to avoid contamination across groups. Pianists, singers, and other instrumentalists (strings, brass, and woodwind) were involved in the study. Some participants had completed Australian Music Examinations Board examinations (45.45%; grades ranged from 3 8), and participants who had not completed formal examinations indicated how many years they had attended music lessons (54.55%; years ranged from 1 20). Refer to Table 1 for demographics. Design A 2 (group) 2 (time) repeated-measures design was used, with participants randomly Table 1 Demographic Characteristics of the Sample Number Percentage Ages 19 26 8 24.24% 27 44 9 27.28% 45 55 8 24.24% 56 66 8 24.24% Gender Female 29 87.88% Male 4 12.12% Ethnicities Caucasian 32 96.97% Indian 1 3.03% Voice 17 51.51% Instrument 16 48.49%

4 HOFFMAN AND HANRAHAN assigned to a treatment group (N 15) or a wait-list control group (N 18). The treatment group received three sessions over 3 weeks, learning cognitive and imagery strategies to help manage performance anxiety. Each session lasted for approximately 1 hour. Participants in the wait-list control group performed and completed the pre- and postassessments before receiving treatment, with a 3-week gap between their two performances. Participants in the treatment group were asked to complete a follow-up assessment 1 month after their final performances. Materials A Polar Favor heart rate monitor was used to measure heart rate. Participants wore the heart rate monitor underneath their shirts, and the reading was displayed on a watch worn by the experimenter. A JVC hard disk camcorder (GZ-MG135AA) was used to video record the performances. The pianists played on a fullsized Roland digital piano. Other instrumentalists performed on their own instruments that they brought to the testing sessions. Outcome measures took three forms to keep in line with the three-systems-model of MPA. These included two self-report instruments, a physiological measure, and a behavioral measure. We also included a separate measure of performance quality. State Trait Anxiety Inventory (STAI). The STAI is widely used in anxiety research and is considered to be a valid and reliable scale (Kenny, 2006). Spielberger, Gorsuch, Lushene, Vagg, and Jacobs (1983) reported internal consistencies of.92 for the state 20-item subscale and.90 for the trait 20-item subscale. The state subscale measures how people feel at that given moment (e.g., I feel at ease. ). The trait subscale measures how people feel generally (e.g., I lack self-confidence. ). Higher scores indicate greater anxiety (Spielberger et al.). Although trait anxiety was not a dependent variable in our study, we included this scale in case trait anxiety needed to be used as a covariate in the analyses. Performance Anxiety Inventory (PAI). The PAI (Nagel, Himle, & Papsdorf, 1981) is based on the STAI and is a music inventory assessing the three-systems model of anxiety (cognitive, behavioral, and physiological factors; Kenny, 2006). It has been developed specifically for music performance and has been widely used in treatment outcome research (Kirchner et al., 2008; Nagel et al., 1989; Osborne & Franklin, 2002; Stanton, 1994). Nagel et al. (1989) reported acceptable internal consistency of.89. The PAI consists of 20 items and is measured on a 4-point scale, ranging from almost never to almost always. The scores are added together, with higher scores indicating greater MPA, and a score of 39 or less suggests the respondent has few problems with performance anxiety (Nagel et al., 1981). Osborne and Franklin (2002) reported comprehension problems in a pilot study due to differences in American and Australian English. Three problematic items were modified, and internal consistency was still found to be acceptable (Cronbach s alpha.94). We used the modified version to avoid confusion in an Australian sample. Physiological. The researcher took measures of heart rate at 10 min, 5 min, and 1 min prior to the performances and then averaged these. The heart rate monitor did not work on three occasions, so these cases were excluded from the analyses. Behavioral Anxiety Index (BAI). A checklist of overt behavioral signs of performance anxiety was compiled. The checklist was based on the research of Kendrick, Craig, Lawson, and Davidson (1982) and Sweeney and Horan (1982). Signs of anxiety included trembling knees, lifting shoulders, stiff back and/or neck, trembling hands, stiff arms, face deadpan, shaking head, moistening and/or biting lips, distressed facial expressions, and sweating. Two judges, blind to the experimental conditions, independently viewed the digital video discs (DVDs) of the performances and indicated on 7-point scales how present and noticeable each behavioral sign of anxiety was. One judge was a singer and a retired stage director, and the other judge had been singing and playing the piano for approximately 30 years. The judges could watch each performance as many times as they liked, but were required to view each performance at least twice. Interrater reliability was.65 (Time 1) and.52 (Time 2). Performance quality. The criteria for performance were based on a study by Mills (1987). Although the criteria have not been formally assessed for validity or reliability, they

MENTAL SKILLS FOR MUSICIANS 5 can be used to assess all kinds of instrumental and vocal performances, and Mills found that specialists and nonspecialists rated performances similarly using this scale. The criteria were derived from interviewing 11 adjudicators about the underlying constructs they used to assess performances. An overall grade out of 30 is assigned. The criteria consist of 12 statements; for example, The performer s use of tempi was inappropriate/appropriate. Two judges, blind to the experimental conditions and working independently, rated each performer on the twelve 6-point scales, while viewing the DVDs or immediately afterward. To simulate the conditions of a real competition, the judges viewed each performance only once. They did not have the musical scores to follow. One judge had approximately 15 years of experience playing a woodwind instrument, and the second judge was a 4th-year university student studying music education. Interrater reliability was acceptable at.81 (Time 1) and.73 (Time 2). Procedure The provisionally registered psychologist was a psychology graduate student in her final year of study. Working under the supervision of a fully registered psychologist who was also an accredited supervisor, the trainee psychologist conducted the sessions as part of practical requirements for her degree. She had some experience in music performance. Clients attended psychoeducational workshops in small groups ranging in size from four to eight. Working in small groups may help participants normalize the anxiety and see that they are not alone. In addition, in groups participants are able to hear one another s stories and support each other. The first workshop started with a selfawareness exercise, where participants indicated what factors, from a long list, affected how they performed (e.g., having unrealistic expectations or being distracted by other musicians ). Participants were then taught how thoughts, behaviors, and feelings interact and influence performance. They were asked to think of a good performance and a poor performance and try to remember what they were thinking and feeling in each performance. There was a discussion on anxiety and activation levels and participants identified their ideal activation levels. The therapist demonstrated, using a practical exercise, how people waste their energy trying to control uncontrollable factors, thereby impairing performance. The second workshop introduced participants to typical dysfunctional thought patterns (e.g., all-or-nothing thinking ). Participants completed their own thought records where they identified performance situations, their feelings and thoughts about the performances, evidence that supported the thoughts, and evidence that did not support the thoughts. They came up with alternative, more-helpful thoughts, and were given examples if they had difficulty challenging these negative thoughts. This exercise was designed to demonstrate how thoughts can sometimes be irrational and can be changed in light of new evidence. The third and final workshop taught participants how to use self-talk effectively and how to use cues (e.g., telling yourself, stop ) to regain concentration or block out unhelpful thoughts. Participants practiced how to identify negative thoughts, stop the thoughts, and use cues to help them overcome the negative thoughts. The final activity was imagery. The therapist read out an imagery script and asked participants to close their eyes and visualize the situation. They were encouraged to come up with their own imagery script to use in the future. Imagery is a mental exercise that can help athletes maintain concentration, decrease anxiety, and improve confidence; thus, it may also be helpful for some musicians (Gregg & Clark, 2007). After the final workshop, participants were asked to complete an evaluation of the program. The pre- and postassessments followed a similar procedure for participants in the treatment and wait-list control groups. The participants were previously asked to complete the trait subscale of the STAI and bring it along to the first performance. Participants were brought individually into a room where they completed demographic questions. Heart rate was measured while the participants filled out the state subscale of the STAI and the PAI. When the questionnaires were completed, participants wrote down their codes on a piece of paper and held it up to the video camera. The researcher did not look at the code names. This procedure helped to preserve anonymity and allowed the researcher to match participants self-report and physiological data to the judges ratings of the performances. Participants only had to perform

6 HOFFMAN AND HANRAHAN in front of the researcher, but they were reminded that four individuals would be evaluating their performances. Participants selected a performance piece they had not performed before or practiced regularly that was 2 to 4 min in length. Participants in the treatment group had their second performances 1 week after their final workshop. Participants in the wait-list control group waited 3 weeks until their second performance, which was on the same night as their first workshop. The procedure for the second performance was the same as the first for all participants. No activities were arranged for participants in the wait-list control group during the 3-week gap. To reduce the possibility of demand characteristics influencing the results, participants in the wait-list control group were not informed that they had been placed in this group. Waitlist participants were informed that they had two preintervention performances to determine their consistency prior to the intervention. A third performance was arranged after their final workshop so we could explain that we hoped to measure how scores fluctuated over time (before and after completing the workshops). Nonetheless, most participants elected not to do a third performance, so the data were not analyzed. Participants in the treatment group were reminded about the follow-up study that would take place in a month. An online version of the PAI was used in the follow-up. Participants were not asked to complete the state anxiety scale because it measures anxiety levels at that given moment, and participants were not in a performance situation at the time of completing the questionnaire. The link to the online questionnaires was sent to the participants in an e-mail. Data Screening Results Prior to the main analyses, frequencies, descriptive statistics, boxplots, and histograms for each dependent variable were examined to check for accuracy of data entry, missing values, and normality. Missing data occurred when participants did not complete the trait questionnaire (N 3) and when the heart rate monitor failed to work (N 3). Tabachnick and Fidell (2007) suggested that if only a few cases have missing data and they seem to be random, deletion is a good alternative. Deletion from analyses involving heart rate was deemed more appropriate than alternatives, such as mean substitution, which can lead to significant results that are a product of data replacement rather than a real effect (Field, 2005). Similarly, deleting cases that have a lot of missing data is acceptable if the variable is not critical to the analysis (Tabachnick & Fidell, 2007). Trait anxiety was not of interest in our study so the missing cases were excluded from all analyses involving that variable. Trait anxiety was assessed in case it needed to be used as a covariate, but the distribution of scores was found to be normal. Consequently, trait anxiety was excluded from the analyses thereafter. Preliminary Analyses A bivariate correlation was calculated between the BAI and the PAI to check the validity of the BAI. The relationship between behavioral signs of anxiety and the PAI was small and nonsignificant, r.22, p.22. Consequently, due to this result and relatively poor interrater reliability, the BAI was excluded from further analyses. See Table 2 for correlations between all variables. Table 2 Bivariate Correlations Between Outcome Variables (Time 1/Time 2 Difference Scores: R (p-values) PAI STAI-S HR BAI PQ PAI.30 (.093).29 (.120).22 (.216).32 (.069) STAI-S.16 (.410).29 (.094).18 (.319) HR.03 (.891).18 (.330) BAI.30 (.097) Note. PAI Performance Anxiety Inventory; STAI-S State Trait Anxiety Inventory, State Anxiety; HR heart rate; BAI Behavioural Anxiety Index; PQ performance quality.

MENTAL SKILLS FOR MUSICIANS 7 To determine whether significant differences for performance quality would be due to the intervention or practice effects, we asked participants to indicate how many times they had practiced the piece between the first and second performances. Three participants indicated that they had practiced the piece more than six times. We checked the outliers on performance quality to see if the cases matched the participants who had practiced more than six times. One of these participants was an outlier; however, their performance quality (M 28.5) was significantly lower than the group s average (M 54.8). The remaining two participants means (Ms 43, 53.5) were also below the group s average. This result suggests we can be confident the results for performance quality are due to the intervention and not due to practice effects. An alpha level of.05 was used for all statistical analyses; hence the results reported have not had a Bonferroni correction applied. Pernerger (1998) argued that applying a Bonferroni correction is often unnecessary. Furthermore, Bonferroni corrections can be overly stringent and increase the chance of making a Type II error (Field, 2005). In addition, effect sizes are reported for our results; specifically, partial 2, so it is important for the reader to keep in mind that these effects may be overestimates. Nevertheless, Levine and Hullett (2002) pointed out that the discrepancy between partial 2 and 2 is usually smaller in two-way designs. Prior to the main analyses, a number of oneway, between-group analyses of variance (ANOVAs) were conducted to determine whether any significant differences existed between groups at the pretest recital. No significant differences were found between groups on age, gender, musical proficiency, amount of practice, performing experience, or on any of the dependent measures (all p.05). Table 3 summarizes the means, standard deviations, and difference scores for each dependent measure. Main Analyses Self-report measures. A 2 (cognitive restructuring, wait-list control) 2 (Pretest, Posttest) mixed ANOVA examined the effects of group and time on the trait subscale of the STAI. No significant main effect was observed, F(1, 28) 2.52, p.12, partial 2.08, and no significant interaction was revealed, F(1, 28) 2.33, p.14, partial 2.08. Similarly, no significant main effect of time was found for state anxiety, F(1, 31) 1.35, p.25, partial 2.04, or for the Group Time interaction, F(1, 31) 1.12, p.30, partial 2.04. Again, we examined the effects of time and group on the PAI. No significant main effect of time was found, F(1, 31) 1.06, p.31, partial 2.03. Nonetheless, the analysis revealed a significant Group Time interaction, F(1, 31) 8.02, p.05, partial 2.21. We conducted pair-wise comparisons to follow up this interaction, and we found that the treatment group s performance anxiety significantly decreased from pre- to posttest, t(31) 2.62, p.05, an effect that was not observed in the waitlist control group, t(31) 1.34, p.19. Physiological measure. A 2 (cognitive restructuring, wait-list control) 2 (pretest, posttest) mixed ANOVA revealed no significant main effect of time for heart rate, F(1, 28).28, p.60, partial 2.01, and no significant interaction, F(1, 28) 2.11, p.16, partial 2.07. Performance quality. We were interested in whether performance quality would be en- Table 3 Means, Standard Deviations, and Differences for Each Dependent Measure Cognitive restructuring Wait-list control Pre Post Difference Pre Post Difference STAI-S 39.13 (8.37) 39.00 (8.38) 0.13 44.44 (8.41) 41.61 (11.44) 2.83 PAI 54.47 (12.06) 50.07 (9.00) 4.40 51.89 (13.17) 53.94 (11.65) 2.05 HR 90.26 (15.62) 84.88 (11.48) 5.38 86.88 (13.40) 89.38 (12.02) 2.50 PQ 54.13 (16.10) 59.50 (11.05) 5.37 56.11 (12.47) 50.89 (11.12) 5.22 Note. STAI-S State Trait Anxiety Inventory, State Anxiety; PAI Performance Anxiety Inventory; HR heart rate; PQ performance quality. Standard deviations are presented in parentheses.

8 HOFFMAN AND HANRAHAN hanced in the treatment group from pre to posttest as compared with the wait-list control group. No significant main effect was observed in this case, F(1, 31).00, p.95, partial 2.00; however, the analysis revealed a significant interaction, F(1, 31) 19.52, p.05, partial 2.39. We followed up the significant interaction with pair-wise comparisons. Performance quality was significantly enhanced in the treatment group from pre to posttest, t(31) 3.03, p.05. Unexpectedly, the waitlist control group s performance quality significantly declined, t(31) 2.95, p.05. Follow-Up A one-way repeated-measures ANOVA was conducted with the treatment group to determine whether self-reported performance anxiety had decreased from the posttest recital to Time 3 (1 month after the second performance). We found a significant reduction on the PAI, F(1, 11) 4.91, p.05, partial 2.31. Refer to Table 4 for the means, standard deviations, and difference scores at Times 1, 2, and 3. Qualitative Data Participants (N 28) completed an anonymous evaluation form after the last workshop, to help us determine what aspects of the program were most helpful, and what aspects could be improved. The first author examined participants responses with another researcher. First, the evaluation forms were split into two piles and responses were recorded under recurring themes. Second, piles were swapped and the process was repeated. Third, common themes were agreed upon that were representative of participants responses. Table 5 provides a summary of the recurring themes and the number of participants who commented on each theme. A third researcher also examined participant responses and categorized them under recurring themes until agreement was reached. Participants indicated that learning specific techniques was most helpful (N 17). Imagery and controlling the controllables were specifically mentioned seven times. Group discussion was also reported as being most helpful (N 5). Other Data Participants were also asked to rate how they found the workshops on 7-point Likert scales, where 7 was most positive. Descriptive statistics revealed that participants found the workshops enjoyable (M 6.07, SD.80), helpful, (M 5.90, SD 1.05), and had a better awareness of their anxiety at the completion of the study (M 6.00, SD.93). Summary of Results Discussion Past research has focused on lengthy interventions that incorporate both cognitive and behavioral techniques in the treatment of MPA (Nagel et al., 1989; Reitman, 1997; Roland, 1993; Sweeney & Horan, 1982). Our aim was to develop a short mental-skills intervention that reduces MPA and enhances performance. We found mixed results in support of our hypotheses. We predicted that anxiety levels would decrease in the treatment group from pre- to posttest. This hypothesis was partially supported. Specifically, there was a significant reduction on the PAI in the treatment group. Although the participants improved after the intervention, they were still not within the optimal range according to Nagel et al. (1981). Nagel et al. reported that the average preintervention score was 55 and the average postintervention score Table 4 Means, Standard Deviations, and Differences for Performance Anxiety at Times 1, 2, and 3 Time 1 Time 2 Time 3 Difference Difference 2to3 1to3 PAI 54.47 (12.06) 50.07 (9.00) 47.25 (8.58) 4.00 7.22 Note. PAI Performance Anxiety Inventory. Standard deviations are presented in parentheses. p.05.

MENTAL SKILLS FOR MUSICIANS 9 Table 5 Summary of Workshop Evaluation Forms Question Responses Number What aspects of the workshops did you find most helpful? Learning specific tools 17 Group discussion 5 What aspects of the workshops did you find least helpful? Length of course 1 Imagery 1 No response 13 was 38, with a score of 39 or less indicating a person has few problems with performance anxiety. Although the decrease in anxiety was not as large in our study, our participants dropped from the high performance anxiety category to the moderate performance anxiety category (Osborne & Franklin, 2002). We may not have found such a large decline on the PAI because our intervention was conducted over a shorter time frame than most studies (e.g., Nagel et al., 1989). Contrary to our hypothesis, we did not find a significant reduction in anxiety on the state subscale of the STAI. Kendrick et al. (1982) and Nagel et al. (1989) also did not find a significant decrease in state anxiety in their research. This finding could suggest that a questionnaire tailored to musical performance is more useful in MPA research. Although the STAI is a wellvalidated and reliable measure, the questionnaire reflects how people feel at the time of completing it. Hence, it may not be the most accurate reflection of performance anxiety, especially when the performance setting is somewhat atypical. Performance anxiety should be the target of treatment outcome studies, so questionnaires that directly assess performance anxiety may be more appropriate in future research. Further, it was surprising that we found a negative correlation between the PAI and the STAI-S in our preliminary analyses (although nonsignificant); however it was not surprising that there was not a positive correlation. Just as athletes may have high competitive anxiety but low general anxiety, or low competitive anxiety but high general anxiety, musicians may score differently on a general measure of anxiety and a measure that specifically targets musical performance. Contrary to our hypothesis, we did not find any significant decrease in heart rate in the treatment group. We expected a decrease in heart rate because it is a common symptom of MPA (Salmon, 1990; Wesner et al., 1990), yet heart rate may be an unreliable measure because it can be affected by other factors, including excitement or physical exertion (Landers & Arent, 2010). In addition, the intervention may have led to a change in how physiological indicators such as heart rate were interpreted, rather than having a direct influence on the physiological measures themselves. We were not able to analyze the data for the BAI. The measure itself may be problematic, or alternatively, it may not have been the most appropriate measure to use in our study because it was designed for pianists. Some items may not be applicable to other musicians or the measure may lack behavioral signs of anxiety that are typically demonstrated by other performers. The reliability and validity of the BAI should be investigated further before relying on it as a behavioral measure in future treatment outcome research. In support of our hypothesis, performance quality was enhanced in the treatment group from pre- to posttest. It may be worthwhile using the measure developed by Mills ( 1987) in future research, but the psychometric properties need to be investigated further. The decrease in performance quality in the wait-list control group was unexpected. A possible explanation may be that the participants arousal levels were low, thus, having a negative effect on their performance (Lehrer et al., 1990). Alternatively, some research in sport psychology has suggested that performance can deteriorate before it improves, and this may have been the case in our study (Weinberg, 1994). There was a significant decrease in performance anxiety from posttest to the 1-month follow-up, a result similar to Kendrick et al. (1982). Although the mean score for Time 3 was still not within the optimal range, it was

10 HOFFMAN AND HANRAHAN encouraging to see performance anxiety continue to decline. Strengths and Limitations Strengths. Our study addressed some major limitations of past research; specifically, the use of a control group, random assignment to conditions, multiple outcome measures, and a follow-up assessment (Kenny, 2005; McGinnis & Milling, 2005). We contributed to the limited literature that has investigated the effectiveness of cognitive and imagery techniques in the treatment of MPA. Time and expense could be saved if an intervention targeted at cognitions and imagery skills is as effective as a longerterm, combined intervention, potentially making it attractive to musicians. Our participants were amateurs and professionals from the community in addition to university students. Wolfe (1989) pointed out that music is a serious vocation and often part-time profession by a large proportion of the adult population, who regularly perform in community bands and choirs. Wesner et al. (1990) found that MPA is unaffected by age and demonstrated that many older musicians experience ongoing difficulties with performance anxiety unless they are assisted. Obviously, MPA is a problem for middle-aged and older musicians, and it is important not to exclude these groups in research. Consequently, our results are generalizable to the broader population; however, a disadvantage of including such a diverse sample is that we are unable to ascertain who benefits most from our intervention. Furthermore, our intervention may not be useful for individuals who have comorbid disorders, such as generalized anxiety disorder. Limitations. We only included a selfreport measure of anxiety at the 1-month follow-up assessment. Including an objective measure of performance anxiety would have reduced the likelihood of demand characteristics influencing the participants responses. Although we intended to obtain multiple outcome measures of anxiety, we were not able to analyze the behavioral data. Also, no a priori power analysis was conducted and our small sample size may not have had sufficient power to detect other significant effects. Furthermore, it would have been useful to include a third group receiving another kind of treatment, to allow us to compare the success of different interventions. It may be that our intervention was better than no treatment, but no more effective than another intervention involving contact with a therapist. Future Research Standardized behavioral and performance quality measures need to be developed, as well as measures that can be applied to singers and instrumentalists. Standardized outcome measures would allow researchers to better understand and compare the effectiveness of certain treatments. Researchers could consider using the performance quality measure adapted from Mills (1987) study to further test its reliability and validity. The BAI also requires further validation before relying on it in treatment outcome research. The present study mixed groups of musicians, despite Steptoe and Fidler (1987) finding that differences exist between professionals, amateurs, and students. Due to our small sample size, we could not investigate whether a particular group benefited more from the intervention. Future research could investigate this question. Furthermore, it would be useful for researchers to compare different interventions in addition to a wait-list control group, and consider recruiting participants who experience anxiety at varying degrees (Brodsky, 1996; Wesner et al., 1990). Comparing musicians with high and low anxiety could provide more insight into what treatments are best suited for whom. Finally, it would also be important for researchers to report effect sizes for their results, to allow for comparisons across studies and result replicability; currently this does not seem to be common practice in this particular field. In recent years, the importance of reporting effect sizes have been strongly emphasized (Thompson, 2009). Conclusions Our study has provided some promising results in favor of a short mental skills intervention that targets music performance anxiety. Overall, participants indicated that they enjoyed the workshops and found the strategies helpful, suggesting the workshops may be worthwhile investigating in trials in the future. Nevertheless, it is important to remember that our inter-

MENTAL SKILLS FOR MUSICIANS 11 vention may only be effective for individuals who are experiencing milder forms of performance anxiety and who do not have comorbid diagnoses (e.g., a diagnosis of panic disorder). It may be beneficial if future researchers in this area focus on assisting participants to better cope with their anxiety, rather than aiming to significantly decrease anxiety. Participants who were educated about cognitive restructuring scored significantly higher on performance quality, suggesting that these participants were more capable of dealing effectively with their anxiety even if they were still somewhat anxious. Perhaps participants were able to change their perceptions of threat and had a better ability to control their anxiety through techniques such as self talk. MPA is a pervasive problem affecting musicians of all ages and abilities. As compared with the research on mental skills training in athletes, relatively little is known about the assessment, treatment, and theoretical underpinnings of MPA. When an evidence-based treatment for MPA is established, the program could be implemented in universities for the benefit of students and community members. References Brodsky, W. (1996). Music performance anxiety reconceptualized: A critique of current research practices and findings. Medical Problems of Performing Artists, 11, 88 98. Brotons, M. (1994). Effects of performing conditions on music performance anxiety and performance quality. Journal of Music Therapy, 31, 63 81. Craske, M. G., & Craig, K. D. (1984). Musical performance anxiety: The three-systems model and self-efficacy theory. Behaviour Research and Therapy, 22, 267 280. doi:10.1016/0005-7967(84)90007-x Field, A. (2005). Discovering statistics using SPSS. London, U.K.: Sage. Gregg, M. J., & Clark, T. (2007). Theoretical and practical applications of mental imagery. International Symposium on Performance Science, 295 300. Haney, C. J. (2004). Stress-management interventions for female athletes: Relaxation and cognitive restructuring. International Journal of Sport Psychology, 35, 109 118. Hanton, S., Wadey, R., & Mellalieu, S. D. (2008). Advanced psychological strategies and anxiety responses in sport. The Sport Psychologist, 22, 472 490. doi:621695284 Kendrick, M. J., Craig, K. D., Lawson, D. M., & Davidson, P. O. (1982). Cognitive and behavioral therapy for musical-performance anxiety. Journal of Consulting and Clinical Psychology, 50, 353 362. doi:10.1037/0022-006x.50.3.353 Kenny, D. T. (2005). A systematic review of treatments for music performance anxiety. Anxiety, Stress, and Coping, 18, 183 208. doi:10.1080/ 10615800500167258 Kenny, D. T. (2006). Music performance anxiety: Origins, phenomenology, assessment and treatment. Context: Journal of Music Research, 31, 51 64. Kirchner, J. M., Bloom, A. J., & Skutnick-Henley, P. (2008). The relationship between performance anxiety and flow. Medical Problems of Performing Artists, 23(2), 59 65. Landers, D. M., & Arents, S. M. (2010). Arousalperformance relationships. In J. M. Williams (Ed.), Applied sport psychology: Personal growth to peak performance (pp. 221 246). Boston, MA: McGrawHill. Lehrer, P. M. (1987). A review of the approaches to the management of tension and stage fright in music. Journal of Research in Music Education, 35, 143 153. doi:10.2307/3344957 Lehrer, P. M., Goldman, N. S., & Strommen, E. F. (1990). A principal components assessment of performance anxiety among musicians. Medical Problems of Performing Artists, 5, 12 18. Levine, T. R., & Hullett, C. R. (2002). Eta-squared, partial eta-squared, and misreporting effect size in communication. Human Communication Research, 28, 612 625. doi:10.1111/j.1468-2958.2002.tb00828.x Liston, M., Frost, A. A. M., & Mohr, P. B. (2003). The prediction of musical performance anxiety. Medical Problems of Performing Artists, 18, 120 125. McGinnis, A. M., & Milling, L. S. (2005). Psychological treatment of musical performance anxiety: Current status and future directions. Psychotherapy: Theory, Research, Practice, Training, 42, 357 373. doi:10.1037/0033-3204.42.3.357 McLeod, J. (2009). An introduction to counselling (4th ed.). Maidenhead, Berkshire, U.K.: McGraw- Hill. Mills, J. (1987). Assessment of solo musical performance: A preliminary study. Bulletin of the Council for Research in Music Education, 91, 119 125. Nagel, J. J., Himle, D. P., & Papsdorf, J. D. (1981). Coping with performance anxiety. The NATS Bulletin, 37, 26 33. Nagel, J. J., Himle, D. P., & Papsdorf, J. D. (1989). Cognitive-behavioural treatment of musical perfor-

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