Guest post by Dr. Elizabeth Brooker
Music Performance Anxiety (MPA) is a widespread problem. It affects musicians of any age, instrument, level of expertise, professional and amateur musicians alike. It can be a crippling experience for anyone who suffers, turning a performance into a nightmare. Promising and talented musicians have given up the idea of professional careers because of MPA. In fact research has shown that over 60% of performing musicians are afflicted with this.
This phenomenon not only affects musicians but also individuals in other fields of performance. It’s a feeling of being ‘in the spotlight’ or ‘on show’ in what is deemed to be a threatening situation. Of course up to a point anxiety can be a good thing, it can focus the mind and enhance the performance; however when cognitive anxiety becomes uncontrollable (catastrophising, imagining the worst possible scenario) it can have devastating effects.
It is said that a small amount of anxiety focuses the mind, but a large amount paralyses it. The mind affects the body, and a whole raft of unwanted physiological and somatic symptoms can occur when performance anxiety sets in, such as palpitations, heart racing, sweating, shaking/trembling, loss of focus and a feeling of being out of control. I know from first-hand experience what performance anxiety is like as in the past I could feel physically sick before a piano performance; and over the years of teaching both piano and singing have noticed how some of my students have also suffered from anxiety in performance.
A large amount of research over the last 40 years has focused on MPA, yet the problem still exists. Therefore you may wonder why MPA is still so prevalent! I believe that the reason for this is that the majority of investigative research has looked at the effectiveness of interventions that focus on the conscious mind. Cognitive Behavioural Therapy (CBT) is the main therapy in vogue at the present time. I would argue that the nature of this therapy, which focuses only on the conscious mind, does not get to the root cause of the problem only dealing with the presenting or surface issues.
I qualified as a Cognitive Hypnotherapist (CH) and Eye Movement Desensitisation and Reprocessing (EMDR) practitioner several years before my PhD research and adopted these therapies in my private practice. I noticed how beneficial these were for the rapid and long-lasting treatment of anxiety. Both therapies have the potential to reduce anxiety quickly and effectively and this is sustainable over time. The protocols and procedures are designed to desensitise and reprocess dysfunctional cognitions, emotions, and memories linked to past and present negative experiences: the underlying unconscious processes that an individual may not actually be aware of that can be maintaining the problem.
CH changes the memory and meaning of distressing events by reducing the perception of threat, and also the somatic symptoms of anxiety associated with the event (threat). Hypnosis dates back over 200 years as an area of scientific research and clinical practice and is used to bring about positive change in a wide variety of psychological conditions. EMDR used initially in the treatment of post-traumatic stress disorder has expanded widely over the last ten years now treating a wide range of pathological conditions, including anxiety disorders and associative problems. It has also been used for enhancement of performance in the arts.
Having noted these positive effects in private practice I wanted to test the therapies from a scientific standpoint. My thesis therefore focused on cognitive anxiety (specifically relating to pianists) and the role of the unconscious mind in maintaining and exacerbating the problem of MPA. It is the first clinical outcome study to compare two psychotherapies, CH and EMDR, for the reduction of MPA. Investigating the efficacy of these therapies therefore became the primary focus of my research.
The procedure and method of my research into MPA is given in brief below.
The therapies were tested initially in a pilot study of six Grade 8 pianists from the University of Leeds and Leeds College of Music. All were suffering from MPA to a lesser or greater extent. Baseline measures of state and trait anxiety were first taken. State anxiety is the anxiety that someone can experience when performing (it has been described by one of my students as ‘feeling like a rabbit when caught in headlights’) and trait anxiety is an individual’s generic level of anxiety. The cognitive, physiological and behavioural aspects of anxiety were also tested before and after application of the therapies. Students played the same Bach Prelude and Fugue in two small concert performances. After the first performance participants were randomly assigned to either a therapy or control group. In the period between the concerts the therapy groups received 2 one-hour sessions of either CH or EMDR.
The results of the pilot study showed a significant decrease in state anxiety at the second performance post-therapy in both the CH and EMDR groups but not in the control group.
Having tested the effects of the therapies in a pilot study I then continued the research with a much larger sample of 46 advanced pianists. (Students were from the Universities of Leeds and Sheffield and Leeds College of Music). The main study basically followed the same procedures as the pilot study but with participants choosing their own repertoire. In this study self-report questionnaires were also completed by the students prior to each performance. These gave personal insights into thoughts and feelings experienced in both performances and showed that cognitive perception of performance relates directly to the physiological symptoms experienced, and to the performance outcome.
The results of the main study demonstrated that after only two therapy sessions there was a substantial decrease in state anxiety in both therapy groups, but not in the control group. This resulted in fewer physiological symptoms and greater enhancement of performance in the therapy groups. Also the general level of anxiety (the trait level) decreased substantially below baseline levels in the EMDR group.
This research highlighted a number of important issues. The findings suggest that CH and EMDR have an important contribution to make to our understanding and treatment of MPA and the role of the unconscious mind. It demonstrated the effectiveness of the therapies in both significantly reducing MPA and enhancing performance outcome after only two therapy sessions. There is also evidence that EMDR decreases an individual’s trait level of anxiety, which can be interpreted as a change in personality. Given the importance of these results it is suggested that clinical studies now be conducted comparing cognitive behavioural therapy (CBT) with CH and EMDR. The effectiveness of each therapy can be assessed as well as the number of sessions required to bring about a beneficial result. Research has shown that CBT often requires 10 or more sessions, with sometimes little positive change as the outcome. Furthermore a comparison of the cost-effectiveness of CH and EMDR with CBT should be undertaken given the beneficial effects of CH and EMDR after only two sessions.
For those interested in looking at my research in greater depth I give a list of my publications below:
Brooker, E. (2015). Music performance anxiety: An investigation into the efficacy of cognitive hypnotherapy and eye movement desensitisation and reprocessing when applied to Grade 8 pianists. Doctoral dissertation eThesis, University of Leeds. Retrieved from http://ethesis,whiterose.ac.uk/12130.
Brooker, E. (2018). Music performance anxiety: A clinical outcome study into the effects of cognitive hypnotherapy and eye movement desensitisation and reprocessing in advanced pianists. Psychology of Music, 46(1, 107-124).
Brooker, E. (2019). Transforming Performance Anxiety Treatment Using Cognitive Hypnotherapy and EMDR. London and New York: Routledge. ISBN: 978-1-138-61493-2 (hbk) ISBN: 978-0-367-60676-3 (pbk, 2020).
Brooker, E. (2019). Cognitive hypnotherapy and EMDR. The longitudinal effects on trait anxiety and music performance in advanced pianists. Advances in Complementary and Alternative Medicine. 2019; 5(4); acam.000616.
Brooker, E. (2020). Cognitive Hypnotherapy. In C. Mordeniz (Ed.), Hypnotherapy and Hypnosis (pp.103-117). IntechOpen: London, UK. http://.doi.org/10.5772/intechopen.83045.