Music performance anxiety from the challenge and threat perspective: psychophysiological and performance outcomes.

BACKGROUND: Although many musicians perceive music performance anxiety (MPA) as a significant problem, studies about the psychobiological and performance-related concomitants of MPA are limited. Using the biopsychosocial model of challenge and threat as theoretical framework, we aim to investigate whether musicians' changes in their psychobiological responses and performance quality from a private to a public performance are moderated by their general MPA level. According to the challenge and threat framework, individuals are in a threat state when the perceived demands of a performance situation outweigh the perceived resources, whereas they are in a challenge state when the perceived resources outweigh the perceived demands. The resources-demands differential (resources minus demands) and the cardiovascular challenge-threat index (sum of cardiac output and reverse scored total peripheral resistance) are the main indices of these states. We postulate that the relationship between general MPA level and performance quality is mediated by these challenge and threat measures. METHODS: We will test 100 university music students reporting general MPA levels ranging from low to high. They will perform privately (i.e., without audience) and publicly (i.e., with an audience) on two separate days in counterbalanced order. During each performance session, we will record their cardiovascular and respiratory activity and collect saliva samples and self-reported measures. Measures of primary interest are self-reported anxiety, the resources-demands differential, the cardiovascular challenge-threat index, sigh rate, total respiratory variability, partial pressure of end-tidal carbon dioxide and the salivary biomarkers cortisol, dehydroepiandrosterone, and alpha-amylase. Both, the participants and anonymous experts will evaluate the performance quality from audio recordings. DISCUSSION: The results of the planned project are expected to contribute to a more comprehensive understanding of the psychobiology of MPA and of the processes that influence musicians' individual reactions to performance situations. We also anticipate the findings of this project to have important implications for the development and implementation of theory-based interventions aimed at managing musicians' anxiety and improving performance quality. Thanks to the use of multimethod approaches incorporating psychobiology, it might be possible to better assess the progress and success of interventions and ultimately improve musicians' chance to have a successful professional career. TRIAL REGISTRATION: Not applicable.

Respiratory Variability, Sighing, Anxiety, and Breathing Symptoms in Low- and High-Anxious Music Students Before and After Performing.

Music performance anxiety (MPA) is a major problem for music students. It is largely unknown whether music students who experience high or low anxiety differ in their respiratory responses to performance situations and whether these co-vary with self-reported anxiety, tension, and breathing symptoms. Affective processes influence dynamic respiratory regulation in ways that are reflected in measures of respiratory variability and sighing. This study had two goals. First, we determined how measures of respiratory variability, sighing, self-reported anxiety, tension, and breathing symptoms vary as a function of the performance situation (practice vs. public performance), performance phase (pre-performance vs. post-performance), and the general MPA level of music students. Second, we analyzed to what extent self-reported anxiety, tension, and breathing symptoms co-vary with the respiratory responses. The participants were 65 university music students. We assessed their anxiety, tension, and breathing symptoms with Likert scales and recorded their respiration with the LifeShirt system during a practice performance and a public performance. For the 10-min periods before and after each performance, we computed number of sighs, coefficients of variation (CVs, a measure of total variability), autocorrelations at one breath lag (ARs(1), a measure of non-random variability) and means of minute ventilation (V'E), tidal volume (VT), inspiration time (TI), and expiration time (TE). CVs and sighing were greater whereas AR(1) of V'E was lower in the public session than in the practice session. The effect of the performance situation on CVs and sighing was larger for high-MPA than for low-MPA participants. Higher MPA levels were associated with lower CVs. At the within-individual level, anxiety, tension, and breathing symptoms were associated with deeper and slower breathing, greater CVs, lower AR(1) of V'E, and more sighing. We conclude that respiratory variability and sighing are sensitive to the performance situation and to musicians' general MPA level. Moreover, anxiety, tension, breathing symptoms, and respiratory responses co-vary significantly in the context of music performance situations. Respiratory monitoring can add an important dimension to the understanding of music performance situations and MPA and to the diagnostic and intervention outcome assessments of MPA.

The mediating role of mood in the relationship between perseverative cognition, sleep and subjective health complaints in music students.

OBJECTIVE: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations. DESIGN: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day. MAIN OUTCOME MEASURES: Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m. RESULTS: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality. CONCLUSION: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.

Predictors of Return to Work 12 Months After Solid Organ Transplantation: Results from the Swiss Transplant Cohort Study.

Background Return to work with or after a chronic disease is not a very well understood process, influenced by a variety of personal, professional, societal and medical factors. The aim of this study is to identify predictors for return to work 12 months after a solid organ transplant applying a bio-psycho-social model. Methods This study is based on patients included in the Swiss Transplant Cohort Study, a national prospective multicentre cohort, who underwent a first solid organ transplant (kidney, liver, heart, lung). Bio-psycho-social factors were tested and predictors of return to work identified using logistic regression models. Results Among the 636 patients included in the study, 49.8% (317) were employed 12 months post-transplant. The major predictor for returning to work 12 months posttransplant was pre-transplant employment status (OR 10.8). Accordingly, the population was stratified in employed and not employed pre-transplant groups. Age, self-perceived health (6 months post-transplant) and the transplanted organ were significantly associated with post-transplant employment status in both groups. Return to work was influenced by education, depression (6 month post-transplant) and waiting time in the employed pre-transplant group and by invalidity pension in the not employed pre-transplant group. Conclusion Employment status pre-transplant being highly associated with employment status post-transplant, the process promoting return to work should be started well before surgery. Biomedical, psychological and social factors must be taken into account to promote return to work in transplanted patients.

Prolonged performance-related neuroendocrine activation and perseverative cognition in low- and high-anxious university music students.

Music performances are social-evaluative situations that can elicit marked short-term neuroendocrine activation and anxious thoughts especially in musicians suffering from music performance anxiety (MPA). The temporal patterns of neuroendocrine activity and concert-related worry and rumination (perseverative cognition, PC) days before and after a concert in low- and high-anxious musicians are unknown. The first goal of the present study was to investigate the prolonged effects of a solo music performance and the effects of trait MPA on salivary cortisol (sC), alpha-amylase (sAA), and concert-related PC. The second goal was to investigate whether concert-related PC is associated with neuroendocrine activity and mediates the effects of measurement day and trait MPA on neuroendocrine responses. Seventy-two university music students collected saliva samples and reported their PC for seven consecutive days. On the fifth day, they performed solo. Measurement day and trait MPA were tested as main predictors of the diurnal area under the curve with respect to ground (sC AUCg, sAA AUCg), awakening responses, and PC. SC AUCg, sAA AUCg, and concert-related PC were highest on concert day. SC AUCg decreased only partially on post-concert days. SAA AUCg remained elevated on the first post-concert day among students with moderate to very high trait MPA. Throughout the assessment period, trait MPA was associated with smaller sC AUCg and higher concert-related PC. Concert-related PC showed significant positive associations with sC AUCg and sAA AUCg but did not mediate the effects of measurement day and trait MPA on these measures. These findings suggest that solo music performances have prolonged neuroendocrine effects and that trait MPA is an important factor having specific effects on university music students' hypothalamic-pituitary-adrenal axis, autonomic nervous system, and cognitive activity.

Physicians' psychophysiological stress reaction in medical communication of bad news: A critical literature review.

INTRODUCTION: Stress is a common phenomenon in medical professions. Breaking bad news (BBN) is reported to be a particularly distressing activity for physicians. Traditionally, the stress experienced by physicians when BBN was assessed exclusively using self-reporting. Only recently, the field of difficult physician-patient communication has used physiological assessments to better understand physicians' stress reactions. METHOD: This paper's goals are to (a) review current knowledge about the physicians' psychophysiological stress reactions in BBN situations, (b) discuss methodological aspects of these studies and (c) suggest directions for future research. RESULTS: The seven studies identified all used scenarios with simulated patients but were heterogeneous with regard to other methodological aspects, such as the psychophysiological parameters, time points and durations assessed, comparative settings, and operationalisation of the communication scenarios. Despite this heterogeneity, all the papers reported increases in psychological and/or physiological activation when breaking bad news in comparison to control conditions, such as history taking or breaking good news. CONCLUSION: Taken together, the studies reviewed support the hypothesis that BBN is a psychophysiologically arousing and stressful task for medical professionals. However, much remains to be done. We suggest several future directions to advance the field. These include (a) expanding and refining the conceptual framework, (b) extending assessments to include more diverse physiological parameters, (c) exploring the modulatory effects of physicians' personal characteristics (e.g. level of experience), (d) comparing simulated and real-life physician-patient encounters and (e) combining physiological assessment with a discourse analysis of physician-patient communication.

Employment 12 months after kidney transplantation: An in-depth bio-psycho-social analysis of the Swiss Transplant Cohort.

BACKGROUND: Return to work with or after a chronic disease is a dynamic process influenced by a variety of interactions between personal, work, societal and medical resources or constraints. The aim of this study was to identify predictors for employment 12 months after transplantation in kidney patients, applying a bio-psycho-social model. METHODS: All kidney patients followed in the Swiss Transplant Cohort between May 2008 and December 2012, aged 18 to 65 were assessed before, 6 and 12 months after transplantation. RESULTS: Of the 689 included patients, 56.2% worked 12 months post- transplantation compared to 58.9% pre-transplantation. Age, education, self-perceived health (6 months post- transplantation), pre- transplantation employment and receiving an organ from a living donor are significant predictors of employment post- transplantation. Moreover, while self-perceived health increased post- transplantation, depression score decreased only among those employed 12 months post- transplantation. Pre- transplantation employment status was the main predictor for post- transplantation employment (OR = 18.6) and was associated with sex, age, education, depression and duration of dialysis. An organ from a living donor (42.1%) was more frequent in younger patients, with higher education, no diabetes and shorter waiting time to surgery. CONCLUSION: Transplantation did not increase employment in end-stage kidney disease patients but helped maintaining employment. Pre-transplantation employment has been confirmed to be the most important predictor of post-transplantation employment. Furthermore, socio-demographic and individual factors predicted directly and indirectly the post-transplantation employment status. With living donor, an additional predictor linked to social factors and the medical procedure has been identified.

[Multidisciplinary consultation "Suffering at work": an experience in western Switzerland]. / Consultation pluridisciplinaire "Souffrance au travail": une expérience romande.

Mental health problems at work constitute a challenge in the clinical feld, as well in the professional, the economic and the public health perspective. The total costs they generate in Switzerland are equivalent to 3.2% of the Swiss gross domestic product and they very often lead to dismissal. The vast majority of people are treated by their primary care physician. The Institute for Work and Health features a specialized consultation on the topic of suffering at work, offering the primary care physicians a pluridisciplinary advice or support, in a collaborative care prospect. Its action, adapted to each situation's needs, goes from an advice to a referral to specialists that can strengthen the network on a long-term basis (mental health follow-up, supported employment program, legal or social advice).

Psychophysiological activation during preparation, performance, and recovery in high- and low-anxious music students.

The present study provides a comprehensive view of (a) the time dynamics of the psychophysiological responding in performing music students (n = 66) before, during, and after a private and a public performance and (b) the moderating effect of music performance anxiety (MPA). Heart rate (HR), minute ventilation (VE), and all affective and somatic self-report variables increased in the public session compared to the private session. Furthermore, the activation of all variables was stronger during the performances than before or after. Differences between phases were larger in the public than in the private session for HR, VE, total breath duration, anxiety, and trembling. Furthermore, while higher MPA scores were associated with higher scores and with larger changes between sessions and phases for self-reports, this association was less coherent for physiological variables. Finally, self-reported intra-individual performance improvements or deteriorations were not associated with MPA. This study makes a novel contribution by showing how the presence of an audience influences low- and high-anxious musicians' psychophysiological responding before, during and after performing. Overall, the findings are more consistent with models of anxiety that emphasize the importance of cognitive rather than physiological factors in MPA.

Hyperventilation in anticipatory music performance anxiety.

OBJECTIVES AND METHODS: Self-report studies have shown an association between music performance anxiety (MPA) and hyperventilation complaints. However, hyperventilation was never assessed physiologically in MPA. This study investigated the self-reported affective experience, self-reported physiological symptoms, and cardiorespiratory variables including partial pressure of end-tidal CO(2) (Petco(2)), which is an indicator for hyperventilation, in 67 music students before a private and a public performance. The response coherence between these response domains was also investigated. RESULTS: From the private to the public session, the intensity of all self-report variables increased (all p values < .001). As predicted, the higher the musician's usual MPA level, the larger were these increases (p values < .10). With the exception of Petco(2), the main cardiorespiratory variables also increased from the private to the public session (p values < .05). These increases were not modulated by the usual MPA level (p values > .10). Petco(2) showed a unique response pattern reflected by an MPA-by-session interaction (p < .01): it increased from the private to the public session for musicians with low MPA levels and decreased for musicians with high MPA levels. Self-reported physiological symptoms were related to the self-reported affective experience (p values < .05) rather than to physiological measures (p values > .17). CONCLUSIONS: These findings show for the first time how respiration is stimulated before a public performance in music students with different MPA levels. The hypothesis of a hyperventilation tendency in high-performance-anxious musicians is supported. The response coherence between physiological symptoms and physiological activation is weak.

Hyperventilation complaints in music performance anxiety among classical music students.

OBJECTIVE: Despite the importance of respiration and hyperventilation in anxiety disorders, research on breathing disturbances associated with hyperventilation is rare in the field of music performance anxiety (MPA, also known as stage fright). The only comparable study in this area reported a positive correlation between negative feelings of MPA and hyperventilation complaints during performance. The goals of this study were (a) to extend these previous findings to the period before performance, (b) to test whether a positive correlation also exists between hyperventilation complaints and the experience of stage fright as a problem, (c) to investigate instrument-specific symptom reporting, and (d) to confirm gender differences in negative feelings of MPA and hyperventilation complaints reported in other studies. METHODS: We assessed 169 university students of classical music with a questionnaire comprising: the State-Trait Anxiety Inventory for negative feelings of MPA, the Nijmegen Questionnaire for hyperventilation complaints, and a single item for the experience of stage fright as a problem. RESULTS: We found a significant positive correlation between hyperventilation complaints and negative feelings of MPA before performance and a significant positive correlation between hyperventilation complaints and the experience of stage fright as a problem. Wind musicians/singers reported a significantly higher frequency of respiratory symptoms than other musicians. Furthermore, women scored significantly higher on hyperventilation complaints and negative feelings of MPA. CONCLUSION: These results further the findings of previous reports by suggesting that breathing disturbances associated with hyperventilation may play a role in MPA prior to going on stage. Experimental studies are needed to confirm whether hyperventilation complaints associated with negative feelings of MPA manifest themselves at the physiological level.

Stage fright: its experience as a problem and coping with it.

PURPOSE AND METHOD: This questionnaire survey of 190 university music students assessed negative feelings of music performance anxiety (MPA) before performing, the experience of stage fright as a problem, and how closely they are associated with each other. The study further investigated whether the experience of stage fright as a problem and negative feelings of MPA predict the coping behavior of the music students. Rarely addressed coping issues were assessed, i.e., self-perceived effectiveness of different coping strategies, knowledge of possible risks and acceptance of substance-based coping strategies, and need for more support. RESULTS: The results show that one-third of the students experienced stage fright as a problem and that this was only moderately correlated with negative feelings of MPA. The experience of stage fright as a problem significantly predicted the frequency of use and the acceptance of medication as a coping strategy. Breathing exercises and self-control techniques were rated as effective as medication. Finally, students expressed a strong need to receive more support (65%) and more information (84%) concerning stage fright. CONCLUSION: Stage fright was experienced as a problem and perceived as having negative career consequences by a considerable percentage of the surveyed students. In addition to a desire for more help and support, the students expressed an openness and willingness to seriously discuss and address the topic of stage fright. This provides a necessary and promising basis for optimal career preparation and, hence, an opportunity to prevent occupational problems in professional musicians.