Imagery-Based Interventions for Music Performance Anxiety: An Integrative Review.

Many musicians experience debilitating music performance anxiety (MPA). Outside music performance, imagery-based interventions have been incorporated into treatment protocols to help individuals, including athletes and those with social anxiety, manage heightened levels of anxiety in order to excel in performance-based domains. Despite the frequent use of mental imagery in MPA interventions and its importance as a mental rehearsal technique for musicians, no existing reviews have examined the literature on imagery-based interventions for MPA. The primary aim of this review was to analyze the existing MPA literature in order to summarize what is known about the efficacy and mechanisms of pre-performance mental imagery exercises. A literature search yielded eight studies that used imagery-based interventions for MPA, in both student and professional musicians, which included three dissertations and five peer-reviewed journal articles. In extant MPA treatment research, pre-performance imagery is often used in conjunction with other techniques in order to alleviate anxiety. Arousal imagery refers to imagining one's state of arousal during performance and has been incorporated into MPA interventions in various ways that guide musicians to anticipate the heightened arousal that accompanies performance, predominantly through imagery-based relaxation techniques. However, methodological limitations make it impossible to determine whether imagery is itself an active ingredient of treatment that underlies symptom changes, or whether relaxation imagery is the most effective use of pre-performance imagery for all musicians. There is much need for future well-controlled studies to examine whether and how imagery affects MPA independent of the other therapy components and techniques with which it is commonly combined.

Saving Time Under Pressure: Effectiveness of Standardizing Pediatric Resuscitation Carts.

BACKGROUND: Resuscitation situations are high risk and high stress, and delays in care can have significant influences on outcomes. Standardization of care protocols and equipment is postulated to decrease some of the stress and risk. The objective of this study was to document increased efficiency in finding resuscitation equipment in a standardized resuscitation cart. METHODS: A new standardized resuscitation cart design was created, and a multimedia education program addressing the new design was launched. A goal was set to find required equipment in <15 seconds. Five cohorts of 10 nurses were timed at finding randomly chosen items 1, 12, 49, 152, and 351 days after new cart launch. t tests were used to compare estimated acquisition times of requested items using the new cart system to the old cart system (baseline), and a separate regression analysis was used to model skill degradation. RESULTS: All pairwise comparisons showed significant decreases in mean acquisition time compared with baseline. One day after launch, the mean time to find items was reduced by 46%. Mean time to find requested items was below the goal of 15 seconds 12, 49, and 152 days after launch. This effect was lost by 351 days from launch. Regression analysis predicted the time to find items would exceed 15 seconds 287 days after launch. CONCLUSIONS: Standardizing the resuscitation cart design greatly reduced time to find items and was accomplished with reduced financial cost. Skill degradation did occur over time, and refresher training was required.

Test Anxiety: Evaluation of a Low-Threshold Seminar-Based Intervention for Veterinary Students.

Veterinary students are confronted with a high workload and an extensive number of examinations. However, the skills students gained in high school cannot serve as satisfactory coping strategies during veterinary training. This disparity can lead to test anxiety, as frequently reported by international surveys. In response, a pilot study was carried out to evaluate the effects of a newly developed training seminar to prevent and/or reduce test anxiety. The seminar was offered on a voluntary basis as a low-threshold intervention to first- and second-year veterinary students at three different veterinary schools in Germany. The intervention was offered in two different designs: in either a block or in a semester course containing cognitive and behavioral approaches as well as skill-deficit methods. By conducting a survey and interviews among the participants it was determined whether the contents of the seminar were perceived as helpful for counteracting test anxiety. The potential of the intervention was evaluated using a German test anxiety questionnaire (PAF). The contents of the training seminar were all assessed as beneficial but evaluated slightly differently by first- and second-year students. The results indicate that the seminar prevents and reduces test anxiety significantly compared to the control group students. The greatest effects were achieved by offering the intervention to first-year students and as a block course. As the participants benefit from the intervention independent of the extent of test anxiety, these results suggest that it may be profitable to integrate a workshop on coping strategies in the veterinary curriculum.

[Corrective effect of aromatherapy on indices of heart rate variability in students under exam stress conditions].

There were investigated changes in indices of the activity of regulatory mechanisms of heart rhythm in student under exam stress conditions and the possibility of their correction with aid of aromatherapy. The examination stress was established to be accompanied by pronounced shifts of integral and spectral indices of heart rhythm in students, indicating to the activation of the sympathetic circuit of Autonomic Nervous System in conditions of examination stress. A positive, relaxation impact of the essential oil of orange on the investigated indices was also recorded. The latter is expressed by weakly pronounced changes or lack of them in data of integral and spectral heart rate indices in students from the experimental group, that indicates to the stabilizing effect of used ethereal oil on the psycho-physiological state of students in conditions of exam stress

[The Effect of Audiovisual Stimulation on Psychological and Physiological Functions in Athletes].

We studied the psychophysiological status (cognitive, psychoemotional and neurodynamic parameters), the power spectrum of EEG and heart rate variability of 18-23-year-old athletes, before and after a course of audiovisual stimulation (AVS) (experimental group) in comparison with sportsmen who did not receive AVS (control group). It was shown that a course of AVS (experimental group) has positive effect on psycho-emotional parameters (the levels of anxiety and neuroticism decreased; motivation to make progress and the level of hardiness increased), cognitive and neurodynamic parameters (the capacity of mechanical memory, the speed of attention switching and of a simple sensor-motor response increase; the range of fluctuation of reactions to a moving object is reduced). We also observed an increase in the power of α2 rhythm of EEG, the activity of parasympathetic nervous system and the influence of autonomic circuit of regulation in the experimental group; resting cardiac performance was more conservative as compared with the control group. We concluded that a course of AVS has positive effect on psychophysiological parameters and the mechanisms of autonomic heart regulation in athletes.

Virtual Reality Exposure Training for Musicians: Its Effect on Performance Anxiety and Quality.

Music performance anxiety affects numerous musicians, with many of them reporting impairment of performance due to this problem. This exploratory study investigated the effects of virtual reality exposure training on students with music performance anxiety. Seventeen music students were randomly assigned to a control group (n=8) or a virtual training group (n=9). Participants were asked to play a musical piece by memory in two separate recitals within a 3-week interval. Anxiety was then measured with the Personal Report of Confidence as a Performer Scale and the S-Anxiety scale from the State-Trait Anxiety Inventory (STAI-Y). Between pre- and post-tests, the virtual training group took part in virtual reality exposure training consisting of six 1-hour long sessions of virtual exposure. The results indicate a significant decrease in performance anxiety for musicians in the treatment group for those with a high level of state anxiety, for those with a high level of trait anxiety, for women, and for musicians with high immersive tendencies. Finally, between the pre- and post-tests, we observed a significant increase in performance quality for the experimental group, but not for the control group.

The interplay of parental support, parental pressure and test anxiety--Gender differences in adolescents.

This study examined gender-specific relationships between adolescents' perceptions of school-related support/pressure from their parents and test anxiety. A sample of German students (N = 845; Mage = 15.32; SD = .49) completed questionnaires that measured their perceived parental support/pressure (for mother and father separately) as well as the four main components of test anxiety (worry, interference, lack of confidence, and emotionality). Gender-specific relations were identified using multigroup structural equation modeling: For girls, perceived maternal pressure was positively associated with emotionality and interference; for boys, perceived father pressure and father support were positively associated with interference and worry, respectively. For both genders, perceived mother pressure and support were related to lack of confidence. Our findings suggest that adolescents' perceptions of maternal attitudes are associated with students' self-confidence irrespective of the child's gender, whereas the remaining facets of test anxiety follow same-sex trajectories between perceived parental attitudes and adolescents' test anxiety.

Distonía del músico: fenomenología y desencadenantes vinculados a la ejecución musical / Focal dystonia in musicians: Phenomenology and musical triggering factors

Las distonías se definen como una contracción conjunta, sostenida e involuntaria de músculos agonistas y antagonistas, que puede causar torsión, movimientos involuntarios anormales repetitivos y/o posturas anormales. Un grupo especial de distonías son las conocidas como ocupacionales, que incluyen trastornos distónicos desencadenados por una actividad motora repetitiva, relacionada con la actividad profesional o tarea específica. Los músicos son una población especialmente vulnerable a este tipo de distonías que se presentan como una pérdida de coordinación y control motor voluntario de movimientos altamente entrenados en la interpretación musical. Nuestro objetivo es describir una serie clínica de distonías focales en músicos evaluados y tratados en nuestro centro. Pacientes y métodos: Se presentan los datos de una serie clínica de 12 músicos con distonía ocupacional; se describen sus antecedentes y fenomenología, así como su evolución después de de la terapia. Resultados: Antecedentes demográficos: edad promedio 34,8 ± 11,8 años, 10 hombres (83,3%) y 2 mujeres (16,7%). Antecedentes médicos: antecedentes traumáticos en segmento distónico, 6 pacientes (50%); antecedentes familiares de enfermedades neurológicas en parientes de primer grado, 6 pacientes (50%); antecedentes laborales según categoría musical, 8 pacientes (66,6%) eran músicos clásicos y 4 pacientes (33,3%) eran músicos populares. Fenomenología: El cuadro distónico se caracterizó por presentarse a una edad promedio de inicio de 28,2 ± 11,3 años (rango 18-57 años). En 11 pacientes el segmento afectado fue la mano (91,7%). De todos los músicos consultados, un total de 9 (75%) recibió terapia. En la mayoría de los pacientes se describen desencadenantes específicos de la ejecución musical, asociados a requerimientos de control motor fino. Cabe mencionar que el 50% de los músicos tratados mantuvo su actividad laboral o puesto en la orquesta a la que pertenecía. Conclusiones: La mayoría de nuestros hallazgos fenomenológicos son coherentes con la literatura actualmente disponible. Sin embargo, nos parece destacable la presencia de desencadenantes atribuibles a requerimientos específicos de la ejecución musical, ligados a la participación del control motor fino

Dystonias are defined as a joint sustained and involuntary contraction of agonist and antagonist muscles, which can cause torsion, repetitive abnormal involuntary movements, and/or abnormal postures. One special group of dystonias are those known as occupational, which include dystonia disorders triggered by a repetitive motor activity associated with a specific professional activity or task. Musicians are a population particularly vulnerable to these types of dystonia, which are presented as a loss of coordination and voluntary motor control movements highly trained in musical interpretation. Our aim is to describe a clinical series of focal dystonias in musicians evaluated and treated in our centre. Patients and methods: Data is presented on a clinical series of 12 musicians with occupational dystonia. Their history and phenomenology are described, as well as well as their outcome after therapy. Results: Demographic details: Mean age 34.8 ± 11.8 years, 10 males (83.3%) and 2 females (16.7%). Clinical history: History of trauma in dystonic segment, 6 patients (50%); family history of neurological diseases in first-degree relatives, 6 patients (50%); occupational history according to music category, 8 patients (66.6%) were classical musicians and 4 patients (33.3%) were popular musicians. Phenomenology: The dystonia syndrome was characterised by having a mean age of onset of 28.2 ± 11.3 years (range 18-57 years). The segment affected was the hand (91.7%) in 11patients. Of all the musicians seen in the clinic, 9 of them (75%) received therapy. The majority of patients appeared to have triggering factors specific to musical execution and linked to the requirement of fine motor control. It should be mentioned that 50% of the musicians treated maintained their professional activity or position in the orchestra to which they belonged. Conclusions: The majority of our phenomenological findings are consistent with those reported in the current literature. However, it is worth mentioning the presence of triggering factors attributed to the specific requirements of performing music, linked to the participation of fine motor control

Characteristics of test anxiety among medical students and congruence of strategies to address it.

INTRODUCTION: Medical students may experience test anxiety associated with 'high stakes' exams, such as Step 1 of the United States Medical Licensing Examination. METHODS: We collected qualitative responses about test anxiety at three points in time from 93 second-year medical students engaged in studying for and taking Step 1. RESULTS: Causes of test anxiety as reported by students were related to negative self-talk during preparation for the exam. Effects of anxiety had to do with emotional well-being, cognitive functioning, and physical well-being. Strategies included socializing with others and a variety of cognitive and physical approaches. Comparison of individuals' strategies with causes and effects showed some congruence, but substantial incongruence between the types of strategies chosen and the reported causes and effects of test anxiety. DISCUSSION: Students' adoption of a 'menu' of strategies rather than one or two carefully selected strategies suggest inefficiencies that might be addressed by interventions, such as advisor-directed conversations with students and incorporating student self-assessment and strategies for managing anxiety within courses on test-taking. Such interventions are in need of further study. An annotated list of evidence-based strategies would be helpful to students and educators. Most important, test anxiety should be viewed by medical educators as a 'real' experience, and students would benefit from educator support.

Physical activity helps to control music performance anxiety.

We evaluated if regular physical activity could influence musical performance anxiety (MPA) in college music students. Levels of MPA, as measured with the Kenny MPA Inventory, and a survey about the physical activity habits were obtained from 87 students of music. The results showed that physically active musicians had lower MPA scores (p<0.05) than non-active ones, independent of gender. We conclude that there is an association between physical activity and minor MPA, and studies with a longitudinal design should be done to explore this important issue.

Estrés y ansiedad maternos y su relación con el éxito de la lactancia materna / Maternal stress and anxiety and their association with successful breastfeeding

Introducción: la lactancia materna es la única forma natural de alimentar al bebé, e inigualable para su crecimiento y desarrollo. Múltiples son los factores que se han relacionado con el establecimiento o no de una lactancia materna exitosa. Objetivo: identificar en las madres, los niveles de vulnerabilidad al estrés y de ansiedad como estado, y su relación con el éxito de la lactancia materna. Métodos: se realizó un estudio prospectivo y descriptivo. Se estudiaron 101 madres y sus hijos de 13 consultorios del Policlínico Luis Augusto Turcios Lima, de San José de las Lajas, Mayabeque, entre el 1ro. de febrero de 2012 y el 30 de enero de 2013. Resultados: el 76,2 por ciento de madres estaba en el rango de 20 a 35 años, 89,8 por ciento tenían pareja estable, el 50,5por ciento nivel preuniversitario y el 41,4 por ciento de ellas padecían de asma bronquial. La vulnerabilidad al estrés y la ansiedad como estado se encontraban al final del tercer trimestre en el 46,5 y 56,4 por ciento respectivamente. El 49,5 por ciento de las madres ofreció lactancia materna exclusiva por 4 o 5 meses, y el 27,7 por ciento hasta los 6 meses. Lograron mejores índices de lactancia materna exclusiva a los 4, 5 y 6 meses aquellas con menores niveles de vulnerabilidad al estrés y de estado de ansiedad. Conclusiones: se evidenció que existe una estrecha relación entre los niveles de estrés y ansiedad y el éxito de la lactancia materna(AU)

Introduction: breastfeeding is the only natural way of feeding the baby and unique for his/her growth and development. There are a lot of factors that have been associated to the application of successful breastfeeding or not. Objective: to identify the degree of vulnerability to stress and state of anxiety in mothers, and their relationship with successful maternal breastfeeding. Methods: a prospective and descriptive study was conducted to study 101 mothers and their children from 13 medical offices of Luis Augusto Turcios Lima polyclinics located in San José de las Lajas, Mayabeque province. The study was performed from February 1st, 2012 through January 30th 2013. Results: in this group, 76.2 percent of mothers were 20 to 35 years of age, 89.8 percent had stable couple, 50.5 percent showed high-school education and 41.4 percent had asthma. Vulnerability to stress and anxiety as a condition were found to be present in 46.5 percent and 56.4 percent of patients, respectively. Almost half of the group (49.5 percent) exclusively breastfed their babies for 4 or 5 months whereas 27.7 percent did it up to 6 months after birth. Those mothers with lower levels of vulnerability to stress and anxiety state showed better breastfeeding rates on the 4th, 5th and 6th months. Conclusions: it was confirmed that levels of stress and anxiety and successful breastfeeding are closely related(AU)

Estrés y ansiedad maternos y su relación con el éxito de la lactancia materna / Maternal stress and anxiety and their association with successful breastfeeding

INTRODUCCIÓN: la lactancia materna es la única forma natural de alimentar al bebé, e inigualable para su crecimiento y desarrollo. Múltiples son los factores que se han relacionado con el establecimiento o no de una lactancia materna exitosa. OBJETIVO: identificar en las madres, los niveles de vulnerabilidad al estrés y de ansiedad como estado, y su relación con el éxito de la lactancia materna. MÉTODOS: se realizó un estudio prospectivo y descriptivo. Se estudiaron 101 madres y sus hijos de 13 consultorios del Policlínico "Luis Augusto Turcios Lima", de San José de las Lajas, Mayabeque, entre el 1ro. de febrero de 2012 y el 30 de enero de 2013. RESULTADOS: el 76,2 % de madres estaba en el rango de 20 a 35 años, 89,8 % tenían pareja estable, el 50,5 % nivel preuniversitario y el 41,4 % de ellas padecían de asma bronquial. La vulnerabilidad al estrés y la ansiedad como estado se encontraban al final del tercer trimestre en el 46,5 y 56,4 % respectivamente. El 49,5 % de las madres ofreció lactancia materna exclusiva por 4 o 5 meses, y el 27,7 % hasta los 6 meses. Lograron mejores índices de lactancia materna exclusiva a los 4, 5 y 6 meses aquellas con menores niveles de vulnerabilidad al estrés y de estado de ansiedad. CONCLUSIONES: se evidenció que existe una estrecha relación entre los niveles de estrés y ansiedad y el éxito de la lactancia materna.

INTRODUCTION: breastfeeding is the only natural way of feeding the baby and unique for his/her growth and development. There are a lot of factors that have been associated to the application of successful breastfeeding or not. OBJECTIVE: to identify the degree of vulnerability to stress and state of anxiety in mothers, and their relationship with successful maternal breastfeeding. METHODS: a prospective and descriptive study was conducted to study 101 mothers and their children from 13 medical offices of "Luis Augusto Turcios Lima" polyclinics located in San José de las Lajas, Mayabeque province. The study was performed from February 1st, 2012 through January 30th 2013. RESULTS: in this group, 76.2 % of mothers were 20 to 35 years of age, 89.8 % had stable couple, 50.5 % showed high-school education and 41.4 % had asthma. Vulnerability to stress and anxiety as a condition were found to be present in 46.5 % and 56.4 % of patients, respectively. Almost half of the group (49.5 %) exclusively breastfed their babies for 4 or 5 months whereas 27.7 % did it up to 6 months after birth. Those mothers with lower levels of vulnerability to stress and anxiety state showed better breastfeeding rates on the 4th, 5th and 6th months. CONCLUSIONS: it was confirmed that levels of stress and anxiety and successful breastfeeding are closely related.

A yoga intervention for music performance anxiety in conservatory students.

Music performance anxiety can adversely affect musicians. There is a need for additional treatment strategies, especially those that might be more acceptable to musicians than existing therapies. This pilot study examined the effectiveness of a 9-week yoga practice on reducing music performance anxiety in undergraduate and graduate music conservatory students, including both vocalists and instrumentalists. The intervention consisted of fourteen 60-minute yoga classes approximately twice a week and a brief daily home practice. Of the 24 students enrolled in the study, 17 attended the post-intervention assessment. Participants who completed the measures at both pre- and post-intervention assessments showed large decreases in music performance anxiety as well as in trait anxiety. Improvements were sustained at 7- to 14-month follow-up. Participants generally provided positive comments about the program and its benefits. This study suggests that yoga is a promising intervention for music performance anxiety in conservatory students and therefore warrants further research.

Monitoring stage fright outside the laboratory: an example in a professional musician using wearable sensors.

We implemented and tested a wearable sensor system to measure patterns of stress responses in a professional musician under public performance conditions. Using this sensor system, we monitored the cellist's heart activity, the motion of multiple body parts, and their gradual changes during three repeated performances of a skill-demanding piece in front of a professional audience. From the cellist and her teachers, we collected stage fright self-reports and performance ratings that were related to our sensor data analysis results. Concomitant to changes in body motion and heart rate, the cellist perceived a reduction in stage fright. Performance quality was objectively improved, as technical playing errors decreased throughout repeated renditions. In particular, from performance 1 to 3, the wearable sensors measured a significant increase in the cellist's bowing motion dynamics of approximately 6% and a decrease in heart rate. Bowing motion showed a marginal correlation to the observed heart rate patterns during playing. The wearable system did not interfere with the cellist's performance, thereby allowing investigation of stress responses during natural public performances.

Incorporating flow into practice and performance.

In the music profession, individuals often work under stress filled conditions. This is especially true for individuals making their living as performing musicians. Musical performance anxiety has been well documented in both students and professionals. For some, the experience may lead to a termination of what might otherwise remain a successful performing career. Humans are susceptible to anxiety and so the phenomenon of musical performance anxiety is not likely to disappear. Learning how to effectively deal with musical performance anxiety is paramount for those in the performing arts. Entering a state of flow, in which there is total absorption in an activity, allows for the possiblity of any ensuing anxiety to become facilitative, rather than debilitative. This article will discuss several characteristics of flow, as defined by Mihalyi Csikszentmihalyi, and provide practical applications for musical practice and performance in an attempt to counterbalance musical performance anxiety. Musicians will benefit from a closer examination of the elements of flow and means of incorporating these elements into practice and performance.