Osborne CBTforMPAinHSstudents 2005

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Impact of a Cognitive-Behavioural Treatment Program on

Music Performance Anxiety in Secondary School Music
Students: A Pilot Study
Article in Musicae Scientiae · July 2007

DOI: 10.1177/10298649070110S204
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Musicæ Scientiæ/Spec.Iss. 07/RR 30/07/07 15:51 Page 53
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Special issue 2007, 53-84 for the Cognitive Sciences of Music
Impact
of a cognitive-behavioural treatment program
on music performance anxiety
in secondary school music students:
A pilot study
MARGARET S. OSBORNE, DIANNA T. KENNY*

AND JOHN COOKSEY**
* Australian Centre for Applied Research in Music Performance
Sydney Conservatorium of Music
The University of Sydney
** Performance Edge Consulting
• ABSTRACT
This study assessed the effectiveness of a combined individual and group cognitive-
behavioural treatment (CBT) program to reduce music performance anxiety (MPA)
in adolescent musicians. Twenty-three adolescents with high MPA from a selective
high school were randomly assigned to either a seven-session intervention program
or a behaviour-exposure-only control group. The intervention consisted of
psychoeducation, goal setting, cognitive restructuring, relaxation training and
behavioural exposure in the form of two solo performances with audience.
Outcome measures included self-reports of MPA, trait and state anxiety, diagnostic
interview for social phobia, heart rate, frontalis EMG, and performance quality.
Significant improvements in self-reported MPA were observed at posttest for
adherent students only (i.e., students who were actively engaged in the program
and who adopted program techniques). Adherent students also had higher MPA at
commencement. Non-adherent and behaviour-exposure-only students both
showed reductions in MPA over the study period but not to the same degree as
adherent students. There appeared to be no effect of CBT on performance quality.
INTRODUCTION
Child and adolescent musicians suffer from music performance anxiety (MPA) that
is similar in quality and intensity to that experienced by adult musicians (Kenny &
Osborne, 2006; Osborne & Kenny, 2005, and in press; Osborne, Kenny, &
Holsomback, 2005; Ryan, 2005; Smith & Rickard, 2004). MPA has negative
53
educational consequences for university students, with expert evaluations of

performance quality being significantly lower when perceptions of anxiety are higher
(Kubzansky & Stewart, 1999). Up to a third of adolescent music students report
being adversely affected by MPA. Solo performances generally elicit the highest levels
of MPA, particularly in the presence of high status audiences such as teachers and
professors (Fehm & Schmidt, 2005). MPA may also compromise educational
achievement. Maroon (2003) found that 7th and 8th grade students with high state
anxiety who performed solo at a district contest did not perform as well as students
with lower levels of anxiety. There is also some evidence that highly musically trained
students in selective schools report significantly higher MPA than non-selective
school students with less musical training (Osborne et al., 2005).
MPA is characterised by a tripartite response system comprising behaviours (e.g.,
practice skills, performance preparation and/or avoidance), cognitions (thoughts and
beliefs) and physiological arousal (e.g., increased heart rate, muscle tension and
cortisol) (Craske & Craig, 1984; Lang, 1971; Osborne & Franklin, 2002; Osborne
& Kenny, 2005). An investigation of anxiety according to the three systems model
requires an assessment of all three components (Keller, Hicks, & Miller, 2000).
Negative cognitions play a prominent role in child, adolescent and adult MPA
(Craske & Craig, 1984; Kirchner, 2003; Osborne & Franklin, 2002; Ryan, 2005;
Steptoe & Fidler, 1987; see Osborne & Kenny, in press, for a review). Cognitions
can negatively impact musical performance by (i) disrupting attention by focusing
on anxiety rather than task relevant stimuli (ii) producing off-task, incompetent or
competing behaviours, and/or (iii) behavioural selection effects such as reducing
one’s effort, or choosing less competent behaviours such as inadequate practice
techniques and performance preparation (Haid, 1999; Hallam, 1997; Kaspersen
& Goetestam, 2002; Kenny, 2004).
Psychophysiological measures provide an alternate and unique view to self-report
of an individual’s functioning (Keller et al., 2000). The autonomic nervous system
initiates and maintains the arousal of multiple body systems in extreme stage fright.
Concomitant decreases in heart rate and self-reported MPA and improved
performance quality have been reported following intervention with psychotherapy
(Appel, 1976; Sweeney & Horan, 1982) and beta-blockers (Neftel, Adler, Kappeli,
Rossi, Dolder, Kaser, Bruggesser, & Vorkauf, 1982). Treatment incorporating EMG
biofeedback and skin temperature training reportedly decreased state anxiety prior to
a jury performance, although no EMG data were provided (Niemann, Pratt, &
Maughan, 1993). Musicians diagnosed with social phobia showed increased self-
report anxiety and heart rate during a musical performance (Clark & Agras, 1991).
CBT resulted in significant reductions in subjective anxiety but not heart rate or
improved performance quality. However, the quality of early studies on treatment
outcomes for MPA are generally poor and reported outcomes need to be interpreted
cautiously (Kenny, 2005). There are also difficulties in inferring psychological
significance from physiological signals which cast some doubt on the reliability of
54
Impact of a cognitive-behavioural treatment program on music performance anxiety

MARGARET S. OSBORNE, DIANNA T. KENNY AND JOHN COOKSEY
physiological measures in normal and clinical subjects (Cacioppo & Tassinary,

1990). Examples include desynchrony across the physiological arousal systems
(Gatchel, 1978) particularly among non-anxious individuals (Craske & Craig,
1984), individual variability in responding to the same stressful stimulus across time
(Arena, Blanchard, Andrasik, Cotch, & Myers, 1983), and “cross-talk” from other
physiological activity affecting recorded signals (Shirley, Matt, & Burish, 1992).
ROLE OF PARENTS
Parents of anxious youth are more likely to report pessimistic expectations regarding
their children’s social, academic and health related functioning (Cobham, Dadds, &
Spence, 1998; Kortlander, Kendall, & Panichelli-Mindel, 1997) and to selectively
focus on negative outcomes, and/or catastrophise future negative outcomes for their
children (Barrett, Rapee, Dadds, & Ryan, 1996; Chorpita & Barlow, 1998).
Children may internalise the negative response styles of their parents and adopt
pessimistic self-beliefs about their lack of resources to cope with anxiety-provoking
situations. Although it is unclear whether pessimistic parental expectancies precede
or accompany childhood anxiety (Eisen, Spasaro, Brien, Kearney, & Albano, 2004),
high parental anxiety is a risk factor for poorer treatment outcomes in anxious
children (Cobham et al., 1998; Dadds & Barrett, 1996).
Parental support and encouragement can have a profound influence on the
development of musical ability in their children (Howe & Davidson, 2003). Davidson,
Howe, Moore and Sloboda (1996) found that the most successful children had
parents who were highly involved in lessons and practice in the earliest stage of
learning. Further, successful music learners often had parents who were involved
with music themselves. Davidson et al. (1996) reasoned that this could be attributed
to parental beliefs about the level of talent in their children being a strong
determinant of their behaviour (Dweck, 1986). Alternatively, children whose parents
were involved in music may actually have more musical ability. Parents can both
facilitate musical development and impair their children’s ability to perform and
enjoy music by their imposition of high demands and low support for meeting those
demands (Kenny & Osborne, 2006).
AVAILABLE TREATMENTS
Various treatments have been investigated for reducing performance-impairing
MPA. Psychological treatments include behavioural, cognitive, cognitive-behavioural,
combined treatments, and other therapies (e.g. hypnotherapy, meditation). In a
systematic review of MPA treatments, Kenny (2005) concluded that although the
evidence for improvements in MPA following CBT is consistent and positive
compared to other approaches, MPA treatment research as a whole is compromised
by inconsistent methodologies, unclear definitions of MPA, and the use of
psychometrically weak and inappropriate outcome measures. All MPA treatment
studies to date have used adult or tertiary student musicians. Only Ely (1991)
55
suggested strategies to decrease MPA specifically aimed at adolescent musicians, but

did not provide empirical validation of the treatment method. Thus, the broader
child and adolescent anxiety treatment literature was consulted to develop an
empirically valid treatment program and research hypotheses.
Behavioural exposure to feared situations is an essential feature of almost all
psychological anxiety treatments and one of its most effective components (Albano,
Causey, & Carter, 2001; Barrios & O’Dell, 1998; Martin & Pear, 2002). Behaviour
therapy produces significant decreases in self-reported MPA and improved
performance quality (Kendrick, Craig, Lawson, & Davidson, 1982; Sweeney &
Horan, 1982). However, in light of the significant impact that negative cognitions
have on the experience of high MPA in adolescents (Osborne & Kenny, in press;
Rae & McCambridge, 2004), one would expect that the addition of a cognitive
restructuring component would lead to additional benefits over behaviour exposure
alone.
CBT is the most effective treatment for anxious children and adolescents
(Kazdin & Weisz, 1998; Velting, Setzer, & Albano, 2004). Typically, CBT programs
incorporate psychoeducation, where corrective information about the nature of
anxiety and feared stimuli are provided; somatic management, targeting autonomic
arousal and related physiological symptoms through breathing retraining and
relaxation training; cognitive restructuring, where maladaptive thoughts, beliefs and
images are identified and more realistic, coping-focused thinking is taught; problem
solving using active methods of coping with specific problem situations and in vivo
testing of potential solutions; graduated, systematic and controlled behavioural
exposure to feared situations, and relapse prevention, with the focus on consolidating
anxiety management skills and generalising treatment gains over time (Velting et al.,
2004).
Reductions in anxiety using brief CBT interventions for preadolescent children
with anxiety (Barrett, Dadds, & Rapee, 1996; Barrett, Duffy, Dadds, & Rapee,
2001; Kendall, 1994; Kendall, Flannery-Schroeder, Panichelli-Mindel, Southam-
Gerow, Henin, & Warman, 1997) and social phobia (Gallagher, Rabian, &
McCloskey, 2004) have been demonstrated using individually administered CBT.
Group based CBT for adolescents with social phobia (GCBT-A) also shows promise
(Albano, Marten, Holt, Heimberg, & Barlow, 1995; Hayward, Varady, Albano,
Thienemann, Henderson, & Schatzberg, 2000). Early intervention school-based
group CBT programs successfully reduced anxiety and subsequent likelihood of
future anxiety problems in children (Dadds, Holland, Laurens, Mullins, Barrett, &
Spence, 1999; Dadds, Spence, Holland, Barrett, & Laurens, 1997) and adolescents
(Masia-Warner, Klein, Dent, Fisher, Alvir, Albano et al., 2005). The reported success
of school-based treatment programs on school children selected at risk for anxiety
disorders raises the possibility of including such interventions as a regular part of
school health promotion programs.
56

ADHERENCE
Treatment adherence or compliance (i.e., the extent to which the adolescent
complies with prescribed treatment) has a significant impact on therapeutic outcome
(Chu & Kendall, 2004; Shaw, 2001). This includes the adolescent’s willingness to
participate in therapy activities, to self-disclose, ask questions, and mentally engage
with the therapeutic material (e.g., Braswell, Kendall, Braith, Carey, & Vye, 1985).
Treatment adherence is influenced by the development of a therapeutic alliance
between therapist and client (Creed & Kendall, 2005; Kendall & Chu, 2000;
Shirk & Karver, 2003; Shirk & Saiz, 1992). Alliance building is essential for valid
assessment and effective therapy, given that children and adolescents rarely refer
themselves for treatment, often do not recognize or acknowledge the existence of
problems, and frequently are at odds with their parents about the goals of therapy
(DiGiuseppe, Linscott, & Jilton, 1996; Shirk & Saiz, 1992).
Previous research has shown that the more challenging performance context of
students with extensive music training in selective specialised schools may be a
contributing factor to significantly higher reports of MPA than students with less
musical training in non-selective schools (Osborne et al., 2005). It is plausible that
students in a selective school environment perform under conditions of high
expectations of excellence, thereby increasing the fear and likelihood of negative
evaluation of their performance, and any potential negative consequences that may
result (Osborne & Franklin, 2002). Currently there is no published empirical data
assessing cognitive-behavioural intervention for MPA within a school setting. The
aim of this study is to provide an indication of the feasibility and effectiveness of such
an intervention for secondary school music students, taking into account program
adherence and parental expectancies.
It was hypothesised that adolescent musicians who participated in a combined
individual/GCBT program (CBT) would obtain significant reductions in MPA
measured through self-report, physiological assessments of heart rate and frontalis
muscle tension, and behaviourally through enhanced performance quality of a piece
played to an audience. It was hypothesised that reductions in MPA would be greater
for the CBT group than the behaviour exposure (music performance) only group,
and that adherent students would achieve better outcomes from the intervention
than less adherent students. It was further hypothesised that parental expectancies of
students who achieved the most reduction in MPA scores would be more positive
than students who reported minimal change in anxiety scores as a result of the
intervention.
57
METHOD
PARTICIPANTS
One hundred and eleven (111) students from Grades 7, 8, 9 and 11 were screened
for MPA at the Conservatorium High School, Sydney, Australia. Entrance is decided
by competitive auditions, providing a population of highly competent students.
Thirty-two students who scored within the top 25% of scores on the Music
Performance Anxiety Inventory for Adolescents (MPAI-A) (Osborne & Kenny, 2005)
were invited to participate in the treatment study, of whom nine boys and 14 girls
chose to participate following parental consent. Their mean age was 13.87 years
(SD = 1.22 years). They played string (33%), piano (22%), wind (18.5%), brass
(18.5%), and percussion (7.4%) and had learned for a mean of 6.46 years
(SD = 2.71 years). Mean time spent practising per day was 1 hour 25 minutes
(SD = 36 minutes).
PROCEDURE
Ethical approval for the study was obtained from the Human Research Ethics
Committee of The University of Sydney. The study was introduced to students in
music class and information sheets and consent forms were distributed for delivery
to parents. Following screening and selection of eligible consenting students, half
were randomly allocated to the cognitive-behavioural intervention group (MPEP),
and half to the behaviour-exposure-only control group (BEO). The control group
was invited to participate in a MPEP intervention at the conclusion of the first
program.
Parents were invited to attend an information session outlining the program and
time commitments for after-school sessions and performances. The Parental
Expectations Scale (PES) (Eisen et al., 2004) was subsequently mailed out to parents
with a cover letter instructing parents to return in the reply paid envelope provided.
A preintervention assessment of all participating students was conducted. Upon
presentation for assessment, the students were interviewed using the Anxiety
Disorders Interview Schedule for DSM-IV (Child version, ADIS-IV:C) (Silverman
& Albano, 1996). Students completed the self-report State-Trait Anxiety Inventory
(STAI) trait anxiety subscale (Spielberger, 1983) in session and were assessed for their
baseline heart rate and frontalis muscle tension. Within a week of their preintervertion
assessment, students gave a solo unaccompanied performance in front of an audience
of parents and peers of a 2-3 minute piece of music that demonstrated their highest
level of musical proficiency. Their performance was audio recorded for later review
by professional musicians. Prior to the performance, students completed the STAI-
state anxiety subscale. Heart rate and frontalis muscle measurements commenced
five minutes before the performance, continued throughout the performance, and
finished five minutes after the performance ended. Assessments were conducted by
a Registered Psychologist (first author).
58

Students allocated to the treatment condition undertook the Music Performance

Enhancement Program (MPEP) outlined in Table 1. Another Registered Psychologist
(third author) acted as the program therapist.
Table 1
Music Performance Enhancement Program (MPEP)
The MPEP included the main components of CBT for child and adolescent
anxiety disorders. Sessions were scheduled weekly, apart from a free “practice week”
scheduled between the third and fourth sessions due to the unavailability of the
therapist, and the mid-semester break of two weeks, which took place between
sessions five and six. Group sessions of one hour duration were scheduled from 4-
5pm in a large classroom with the high school. Individual sessions of 45 minutes
duration were conducted in an office within the Conservatorium.
Within two weeks of program completion all students undertook a postintervention
assessment using the same methodology as the preintervention assessments. Students
played the same piece of music as their first performance. The procedural protocol
showing tests and times of assessment is presented in Table 2.
59
Table 2
Assessments at each time period for experimental and control groups
MEASURES
Self-report measures
1) Demographics. Data collected included age, gender, principal instrument, length
of time studied, time practised each day, desire to be a professional musician,
importance of music in the family, pattern and frequency of performing.
2) Music Performance Anxiety Inventory - Adolescents (MPAI-A) (Osborne & Kenny,
2005) was designed for adolescent musicians aged 12-19 years to assess the somatic,
cognitive and behavioural components of MPA. Fifteen items measured the somatic
(e.g., “Before I perform, I get butterflies in my stomach”), cognitive (e.g., “I often
worry about my ability to perform”) and behavioural (e.g., “I would rather play on
my own than in front of other people”) characteristics of anxiety, which were
answered on a seven-point Likert scale ranging from “0-Not at all” to “6-All of the
time”. Descriptive statistics from a sample of 298 specialised music students used to
construct and validate the measure were: mean = 42.92; standard deviation = 19.44;
minimum = 0; maximum = 87. This measure has high internal consistency
(Cronbach’s alpha = .91). Construct validity was demonstrated by significant positive
relationships with self-reported social phobia, convergent validity by moderate to
strong positive correlation with an adult measure of MPA, and discriminant validity
by a weaker positive relationship with depression, and no relationship with
externalizing behaviour problems.
3) Anxiety Disorders Interview Schedule for DSM-IV: Child Interview Schedule
(ADIS-IV:C) (Silverman & Albano, 1996). The ADIS-IV:C is a semi-structured
interview schedule for the diagnosis of childhood and adolescent anxiety disorders
using DSM-IV criteria (APA, 1995). The following diagnoses were assessed:
60

Separation Anxiety Disorder, Social Phobia, Panic Disorder, Agrophobia,

Generalised Anxiety Disorder, Obsessive-Compulsive Disorder, Dysthymia and
Major Depressive Disorder. A number of children met criteria for more than one
diagnosis. The social phobia diagnosis, overall social phobia interference rating scale
(0-8), specific music performance fear (0-8) and avoidance/distress (yes/no) ratings
were used to assess impact of symptoms. Inter-rater reliability (IRR) using the ADIS-
C (kappa range .59 to .82) indicated moderate to high IRR (Rapee, Barrett, Dadds,
& Evans, 1994). The diagnosis of social phobia using the ADIS-C has been shown
to have good test-retest reliability (Kappa = .84) (Silverman, 1991).
4) State Trait Anxiety Inventory (STAI) (Spielberger, 1983). The STAI-Trait subscale
measures relatively stable individual differences in the tendency to perceive stressful
situations as dangerous or threatening (trait anxiety). This measure has excellent
stability with high school students (30 day test-retest interval males = .71,
females = .75) and internal consistency (males and females = .90). High school norm
descriptive statistics for males are M = 40.17 and SD = 10.53; females M = 40.97 and
SD = 10.63 (Spielberger, 1983). The STAI-State subscale is a 20-item self-report
measure of the emotional state experienced by an individual in a particular situation
or time period. Persons with high trait anxiety exhibit state anxiety elevations more
frequently. This measure has excellent internal consistency (overall .92; males .86,
females .94). Total scores range from 20 (low) to 80 (high). High school norm
descriptive statistics for the STAI-state subscale for males are M = 39.45 and
SD = 9.74; females M = 40.54 and SD = 12.86 (Spielberger, 1983).
5) Parental Expectancy Scale (PES) (Eisen et al., 2004) is a 20-item self-report
measure that assesses five dimensions of parental expectancies for their children in
academic, extra-curricular, household, social and general success. Expectancies are
more pessimistic among parents of children with anxiety disorders, reflected by
significantly lower PES scores than parents of children without anxiety disorders.
The PES has high internal consistency (Cronbach’s alpha = .86 for mothers; .87 for
fathers) and test-retest reliability (mothers: Pearson’s r = .92, p < .001, kappa = .65;
fathers: Pearson’s r = .91, p < .001, kappa = .87). Academic, general success and
overall PES scores discriminate between clinically anxious (mean age 11.8 years) and
normative groups (mean age 10.3 years). For clinically anxious children, M = 56.6
(SD = 11.6) and for the normative group, M = 69.4 (SD = 12.3) (Eisen et al., 2004).
Physiological measures
Heart rate (beats per minute, BPM) and frontalis muscle movements (microvolts,
µV) were collected continuously, commencing five minutes prior to the start of
playing, continuing throughout the piece, and ending five minutes after the student
had finished playing. Sample speed was 1,000 samples per second. Normative figures
(means, standard deviations) for resting heart rate and frontalis EMG are as follows:
adolescent heart rate for boys = 65.0 BPM (9.7) and girls = 69.4 BPM (10.3) (Gutin,
Howe, Johnson, Humphries, Snieder, & Barbeau, 2005); frontalis EMG for frontalis
61
right side = 1.82 µV (1.39), left side = 2.04 µV (1.43) (Matheson, Toben, & de la
Cruz, 1988).
Behavioural measure
One musical phrase of approximately 20 seconds in length was sampled from each
performance for each student. Pre- and postintervention samples were randomised
within subjects and played to ten judges for evaluation of performance quality.
Judges had obtained at least a masters degree in music. Prior to presentation of
stimuli judges were asked to rate the performance samples for overall performance
quality by providing a rating of “1 — Better” or “2 — Worse”. Criteria-specific
evaluation was considered too complex for the purpose of this study. An additional
sample from one student was used as a practice example. Five student samples were
repeated as a measure of intra-rater reliability.
APPARATUS AND EXPERIMENTAL SETTING

Physiological assessments
A PowerLab 8SP (8 channel input) and ML132 Dual Bio Amp (ADInstruments Pty
Ltd) was used to transmit heart rate and frontalis muscle movements to an Apple
PowerBook G4 laptop computer two metres away from the performer. Readings
were recorded using PowerLab Chart software v5.3. Heart rate was measured using
three Kendall Meditrace ECG foam latex-free conductive adhesive disposable ECG
electrodes (30 mm diameter) with shielded lead snap-connect wires placed on the
ankle (earth), middle of the subject’s chest (positive), and back (negative) directly in
line with the chest electrode. These placements provided least interference with the
subject’s movements whilst playing their instruments. Skin resistance was minimised
by lightly abrading the skin using an abrasive pad before attaching electrodes.
Frontalis muscle measurements were taken by attaching two EMG flat electrodes
(9 mm diameter) on skin that had been prepared with an alcohol swab. A small
amount of conductive electrode paste was put in the concave side of each electrode.
The electrodes were held firmly in place using surgical adhesive tape.
Perceptual test
Performances were conducted and recorded in a performance hall at the Sydney
Conservatorium of Music. All subjects used their own instruments except for piano
students who performed on a Steinway & Sons Concert Grand Model D (8’11’’).
Performances were recorded using a DPA4006 Versatile Omnidirectional
Microphone. This was placed one metre from the sound source of each instrument
(e.g., from the bridge of a violin, or middle C on the piano). Music was recorded
onto a Tascam DA-P1 portable Digital Audio Tape (DAT) recorder at 44.1kHz,
16-bit format. A simultaneous digital copy was recorded in Sony Philips Digital
Interchange File Format (SPDIFF), using a Marantz compact disc recorder CDR640.
Calibrations were performed immediately before and after each student
62

performance using 1 kHz pure tone and pink noise played on a Sony CDP-921 CD
player through a BOSE Lifestyle Powered Speaker System (left speaker only) at one
meter from each instrument’s sound source. Sound levels were measured using a
Rion NL-06 integrating sound level meter. The recorded pink noise for each
recording was used to equalise the peak levels of each sample to ensure that the
relative sound pressure level for each performance was the same. The files were then
edited in Digital Performer (Version 4.12, Mac OSX) and final samples saved to CD.
Performance evaluations were conducted in an acoustically treated room. Judges
1, 2 and 3 were seated in front of two DynAudio BM15 speakers in a two metre
equilateral (60 degree angle) listening triangle. This provided an optimal listening
position. Judges 4 to 10 listened to the samples in a quiet environment via circum-
aural closed-back stereo monitoring headphones (Sennheiser HD 650). This enabled
the study to be conducted in the first author’s office. Samples were played on CD
from a Sony CDP-921 CD player with a constant output level for all judges.
DESIGN
The study employed a 2 × 2 mixed design with a between subjects (intervention
versus control group) comparison and a within subjects Time 1 (preintervention)
versus Time 2 (postintervention) comparison. Behavioural exposure was used both
as an intervention and outcome measure in order to have a direct method of
comparing the two groups.
RESULTS
Between group comparisons were undertaken using intention to treat analyses. The
difference between the MPAI-A at pre- and postintervention was calculated. The
difference score for one participant who had an outlying value of – 55 points was
recoded to – 40 points to be 2.1 standard deviations from the mean. This placed the
value closer to the remainder of the data to avoid undue influence on mean values.
Parametric tests (independent t-tests) were used for comparisons for measures that
were normally distributed. Mann-Whitney U and Kruskal-Wallis tests were used for
measures that violated normality. Scatterplots and Pearson’s correlation coefficient
were used to examine relationships between continuous variables.
DEMOGRAPHICS
Participants were aged between 12 and 16 years of age (M = 13.87, SD = 1.22).
There were 14 students in the MPEP group and nine in the BEO group. Unequal
group numbers were due to student withdrawal after commencement of the
program. The baseline characteristics of each group shown in Table 3 indicate that
the two groups were comparable. The difference in total number of other diagnoses
reported (Dysthymia, Generalised Anxiety Disorder, Major Depressive Disorder and
63
Obsessive-Compulsive Disorder) was proportional to the number of students in each

group. There were no significant differences in MPAI-A t (21) = 0.75, p = .46, STAI-
Trait t (19) = – 0.25, p = .81, PES (mother) t (14) = 1.3, p = .22, and PES (father)
t (11) = 0.80, p = .44 total scores across the MPEP and BEO groups.
Table 3
Baseline characteristics by group
The MPAI-A correlated significantly with STAI-trait anxiety scores, r = .51,

p = .02, indicating that students with higher MPA also had higher trait anxiety, as
found previously in another sample of high school students specialising in music
performance (Osborne & Kenny, 2005a).
SELF-REPORT MEASURES
Table 4 shows the outcome measures for the two groups. The MPEP group scored
lower at postintervention than the BEO group for MPA and performance fear as
indicated by larger negative mean differences, however the confidence intervals were
wide. There was no difference in MPAI-A scores between the MPEP and BEO
groups, F (1,21) = 0.69, p = .42. Similarly there was no difference in STAI-State
64

anxiety scores either pre- (t (21) = – 0.54, p = .60) or postintervention

(t (21) = – 0.51, p = .62).
Table 4
Mean values, standard deviations and tests of significance for self-report measures
Correlations between total PES score for mothers and fathers with MPAI-A
difference scores were not significant: mothers, r = – .01, p = .88; fathers, r = .37,
p = .21.
Students in both the MPEP and BEO groups met various ADIS-IV:C diagnostic
criteria. Equal numbers of students in each group met ADIS-IV:C criteria for Social
Phobia (performance subtype; generalised), Obsessive-Compulsive Disorder,
Dysthymia and Major Depressive Disorder. These diagnoses did not change from
pre- to posttest for either group.
The number of students who met criteria for Social Phobia (SocP) (generalised
including music performance) and Generalised Anxiety Disorder (GAD) pre- and
postintervention by group is presented in Figure 1. The most significant changes
between pre- and postintervention were for SocP (generalised including music
performance) and GAD diagnoses. The numbers with GAD decreased by 50% for
both MPEP and BEO groups. Diagnoses of SocP decreased by 84% for the MPEP
group, and 50% for the BEO group. No valid comparison could be made with BEO
because there were only two students pretest with a diagnosis of SocP.
Figure 2 shows the pre- to postintervention reduction in performance avoidance
ratings for the MPEP and BEO groups. This difference was significantly greater for
the MPEP group than the BEO group, Fisher’s Exact Test = .04.
Participant adherence
A total adherence variable was calculated using a combination of therapist judgment
and objective measures. The therapist coded the students as 0 or 1 for adherence
65
Figure 1.
ADIS-IV:C diagnostic changes in SocP (generalised including music performance) and GAD pre-
and postintervention in the MPEP and BEO groups.
Figure 2.
Pre- and postintervention ADIS-IV:C performance avoidance ratings for MPEP and BEO groups.
66

based on his subjective rating of their motivation and degree to which they
demonstrated integration and implementation of new learning from their treatment
sessions. Objective measures of adherence included the number of sessions attended
and homework tasks completed. If all criteria were achieved, the student was coded
as adherent. If one or more criteria were not met, the student was coded as non-
adherent.
(i) MPAI-A and STAI
Students in the adherent group reported significantly higher preintervention MPA
than the non-adherent and BEO groups, t (20) = 2.6, p = .02. There was a significant
group x time interaction favouring the MPEP group F (2,20) = 11.52, p = .000.
Figure 3 shows the differences in MPAI-A by adherent, non-adherent and BEO
groups. Adherent students reported (non-significantly) higher STAI trait anxiety:
Adherent mean = 46.8 (12.8); non-adherent mean = 41.5 (14.8) (p = .52). There was
also a greater (non-significant) decrease in STAI state anxiety for the adherent group
[mean = – 5.6 (5.0)] than the non-adherent group [mean = – 3.1 (10.1), p = .60].
Figure 3.
Pre- and postintervention MPAI-A scores by group.
(ii) ADIS-IV:C diagnostic changes

The adherent group reported a 100% reduction in pre- to postintervention
diagnoses of SocP (generalised including music performance) and 67% reduction in
GAD. The non-adherent group reported a 75% reduction in SocP (generalised
67
including music performance) diagnoses and 33% reduction for GAD (Figure 4).
There was a greater (non-significant) decrease in ADIS-IV:C performance fear
ratings for the adherent group (M = – 3.7, SD = 2.9) than the non-adherent group
(M = – 2.6, SD = 1.9; p = .44).
Figure 4.
Number of participants showing diagnostic changes for SocP (generalised including music
performance) and GAD pre- and postintervention in the adherent and non-adherent groups.
(iii) ADIS IV:C avoidance ratings

Figure 5 shows a 50% reduction in avoidance ratings pre- to postintervention for the
adherent group, compared to a 63% reduction for the non-adherent group. This
difference was not significant, Fisher’s Exact Test = .53.
(iv) PES
PES scores for mothers and fathers were analysed to determine whether students in
the adherent group had parents who reported significantly more positive
expectancies than parents of students in the non-adherent group. Analyses were not
significant for either mothers, U = 8.5, p = .40 (adherent M = 63.0, SD = 11.1; non-
adherent M = 69.6, SD = 17.4) or fathers, U = 6.5, p = .39 (adherent M = 61.2;
SD = 9.9; non-adherent M = 70.5, SD = 22.2).
PHYSIOLOGICAL MEASURES
Descriptive statistics and Kruskal-Wallis tests of significance for heart rate (BPM)
and frontalis EMG measurements (µV) by adherence are given in Table 5. There
68

Figure 5.
Pre- and postintervention ADIS-IV:C performance avoidance ratings for MPEP adherent and
non-adherent groups.
were no significant differences between the three groups on any of the physiological
measures. Students’ resting heart rates for all three groups were between 10 and 13.8
BPM higher than norms for their age.
Figure 6 shows the heart rate data. Heart rate five minutes before and five
minutes after the performance was, on average, between 14 and 25 BPM greater
than the normative heart rate for the age group. This difference increased to between
92 and 111 BPM immediately before and after the performance which was an
increase of between 27 and 46 BPM. All three groups showed the same heart rate
pattern — a higher than baseline heart rate five minutes before the performance, a
further increase at the start and end of the performance, and a reduction heart rate
five minutes after the performance that remained higher than baseline heart rate.
Such a pattern was not evident in frontalis EMG, which retained a flat line across
the performance measurements.
BEHAVIOURAL MEASURE
The percentage of correct identifications of pre- and postintervention samples for
each judge is given in Table 6. The number and percentage of correct judgements of
randomised repeats from five students is also presented. For percent correctly
identified, the overall percent in agreement was 62.1%. For repeat percent agreement
with original rating, the overall percent in agreement for all raters was 53.1% and
kappa was 0.06.
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Table 5
Mean values, standard deviations and tests of significance for physiological measures
Analysis of number of correctly identified pre- and postintervention

performances across all judges for adherent (M = 6.00, SD = 3.16), non-adherent
(M = 5.13, SD = 2.90) and BEO (M = 7.33, SD = 1.41) groups showed differences
by group were not significant, F (2,20) = 1.69, p = .21.
DISCUSSION
This paper presents data on a novel investigation of the effectiveness of a combined

individual/group cognitive-behavioural intervention to reduce MPA within a school
setting. Results showed that participation in the program significantly improved self-
report of MPA for adherent students. Students in the MPEP group also self-reported
significantly less performance avoidance than the BEO group, although there was
little difference between adherent and non-adherent groups on this variable.
Although not significant, possibly due to a lack of power in the study to detect
70

Figure 6.
Pre- and postintervention heart rate for adherent, non-adherent and BEO groups.
significant differences that may have been detectable with a larger sample, there was
a greater reduction in performance fear ratings for the adherent MPEP group but not
for the non-adherent MPEP or BEO groups. The MPEP group achieved a greater
reduction in SocP (generalised including music performance) than the BEO group.
There was little difference in diagnoses at posttest between the adherent and non-
adherent groups. Both the MPEP group and adherent sub-group reported a greater
reduction in heart rate at the start and end of their performances than BEO and non-
adherent groups, but these reductions were not significant. There was also no
discernible improvement in overall performance quality as a result of participation
in MPEP as indicated by the inability of the judges to correctly identify
postintervention performances.
The significant reduction in self-reported MPA for the adherent group is
consistent with previous research demonstrating reductions in self-reported state
anxiety following cognitive-behavioural intervention for MPA in tertiary students
(Harris, 1987; Roland, 1994) although Roland (1994) also reported moderate to
strong effect sizes for improvement in performance quality. Similar disjunctions
between self-report anxiety, heart rate and performance quality have been
demonstrated in previous studies following behavioural treatments for MPA with
tertiary music students. For example, pre- to posttreatment improvements have been
found for self-report measures of performance anxiety (Deen, 2000; Grishman,
1989; Mansberger, 1988) and heart rate (Grishman, 1989; Wardle, 1975), but not
performance quality (Deen, 2000; Mansberger, 1988; Wardle, 1975).
71
Table 6
Percentage of samples correctly identified and repeat sample percent agreement
ADHERENCE
As hypothesised, there were significant differences between adherent and non-
adherent students in the MPEP, a finding consistent with previous research (Hudson,
2005; Ollendick & Schroeder, 2003; Pulliam, Gatchel, & Robinson, 2003). The
significantly higher levels of preprogram MPA in the adherent students may have
motivated adherence (McPherson & McCormick, 2006) and/or created higher
treatment expectancies (i.e., perceptions of treatment credibility and expectations for
improvement) (Chambless, Tran & Glass, 1997). Motivational processes can influence
a child’s acquisition, transfer, and use of knowledge and skills (Dweck, 1986).
Motivation has been found to mediate the effectiveness of a brief CBT intervention
for test anxiety in secondary school students, with more motivated students
achieving higher scores in end of school exams than less motivated students (Keogh,
Bond, & Flaxman, 2006).
PSYCHOPHYSIOLOGY
There are inherent problems in inferring psychological processes from psycho-
physiological measures (Cacioppo, Tassinary, & Berntson, 2000). Heart rate was a
more reliable measure than frontalis EMG. Heart rate has been used as an outcome
72

measure following psychotherapeutic intervention for MPA in numerous studies

(Kenny, 2005). The arc-shaped pattern of heart rate before, during and after
performance in this study (Figure 6) is identical to that found by Roland (1994).
EMG did not show the same time to event changes as heart rate, possibly because
signals can be affected by involuntary movements (Cacioppo & Tassinary, 1990). In
the current study it was not possible to control “random” movements, given that
playing an instrument is physically demanding, and music performance typically
involves integrated body movement both to play the instrument and to assist in
musical expression (Juslin, Friberg, Schoonderwaldt, & Karlsson, 2004). This may
have contributed to the desynchrony between the heart rate and frontalis EMG
measurements observed in this study.
PERFORMANCE EVALUATION
The perceptual study indicated that there did not appear to be any benefits on
performance quality for MPEP participants as assessed by the judges. Indeed, the
judges were more accurate in correctly identifying post-program performances for
the BEO group than for either the adherent or non-adherent treatment groups. The
perceptual assessment format assumed that students would play better at their
second performance. This may not have been the case for some students. If students
in the treatment group did play worse in their second performance, the conclusion
that the MPEP program did not have a positive impact on their performance quality
would still be valid.
PARENTAL EXPECTANCIES
Parental expectancies have predicted barriers to treatment participation, treatment
attendance, and premature termination from therapy in previous studies
(Nock & Kazdin, 2001). There was no relationship between expectancies of mothers
or fathers as measured by the PES and reduction in MPA after the intervention.
Further analyses did not show any significant differences between the adherent and
non-adherent groups, although adherent group means were lower than the non-
adherent group for both mothers and fathers. This finding is consistent with the
adherent group reporting more preprogram MPA, given that parental expectancies
have been reported to be more negative among parents of children with anxiety
disorders and higher for parents of children without anxiety disorders (Cobham et
al., 1998; Eisen et al., 2004; Kortlander et al., 1997). However, the adherent group
did have a better treatment outcome than the non-adherent group, which suggests
that for these students, high MPA may have been a more dominant motivating factor
than parental expectancy.
FEASIBILITY
There are many challenges to providing treatment in schools (Masia-Warner et al.,
2005). It was not possible to conduct the study at other school sites because all of
73
the technical equipment needed for the study was located in the research laboratory
on site, and the need to conduct performances in the same venue. There are logistical
difficulties in conducting a relatively intensive intervention with students whose days
are already heavily committed to a range of other activities. The therapeutic
relationship is often nominated as the most important factor in decisions to
prematurely end treatment, followed closely by logistical difficulties such as family
problems (e.g., sick family member, transportation problems), appointment
problems, time and effort concerns (too much travel time involved, competing
demands with other academic subjects and sports), and perception that treatment is
not needed or not helpful (Garcia & Weisz, 2002; Kazdin, Holland, & Crowley,
1997; Morris & Thomas, 1995). All of these difficulties were encountered in this
study, and were given as reasons for not wanting to participate in the program,
attend sessions or complete homework tasks. Time and cost of implementing
psychotherapeutic interventions in schools is considerable (Kratochwill & Van
Someren, 1995) and programs such as MPEP are labour intensive, requiring much
effort to gain support from teaching staff, student administration, parents, and
prospective participants.
LIMITATIONS
First, the most obvious limitation of this study is the small number of participants.
This was due to the small population of students at the performance high school
from which we recruited participants. Second, this study investigated postintervention
outcomes without long term follow-up. Stronger effects have sometimes been found
following CBT intervention at long term follow-up than immediately postintervention.
For example, some music students following CBT intervention showed greater
reductions in heart rate at one year follow-up than at posttest (Roland, 1994).
Children who qualify for an anxiety diagnosis show a greater reduction in diagnoses
at 24 months follow-up than post intervention (Dadds et al., 1999) as well as lower
self-report anxiety at 6- and 12-months follow-up (Cobham et al., 1998). Third,
assessments were conducted by a psychologist who knew which group the students
were in, opening up the possibility of experimenter bias. Standardised measures were
used to counteract such bias (McBurney, 1994). Fourth, although holistic marking
is viewed as an ecologically valid measure of performance quality (Thompson
& Williamon, 2003), some judges found it difficult to provide an overall rating of
performance quality as they did not know which criteria should take precedence in
a particular piece (e.g., technique, rhythmic accuracy, intonation etc.).
IMPLICATIONS
Participation in a CBT program may reduce the subjective experience of MPA in
secondary school students who are adherent to the program requirements. The most
anxious students were more adherent to the cognitive-behavioural intervention and
achieved greater reductions in self-reported anxiety postintervention. Given that this
74

study utilised students within a highly specialised and competitive educational

environment, this provides some evidence that an intensive CBT program may be
beneficial only for a small subset of extremely anxious students.
The absence of reductions in heart rate and non-discernible improvement in
performance quality for the MPEP group suggests that performance focused
interventions may be needed to achieve improvements in performance quality.
Considering the large number of non-adherent students, in addition to the more
accurate perceptual ratings for the BEO group, the current findings suggest that if
students are encouraged to perform pieces more frequently in front of audiences
(with the necessary prerequisites that pieces are appropriate to their skill level in
terms of task complexity and have been practised to mastery), behavioural exposure
alone may enhance performance quality for some music students, that is, those with
mild to moderate MPA.
FUTURE DIRECTIONS
This intervention study raises many interesting questions and replication is
necessary. Students did not enjoy the performance component of the program but
recognised its value in performance anxiety management. As performing is an
essential component of music education (Bergee, 2003) a future study that examines
a more frequent program of behavioural exposure with larger numbers of students
would be advantageous. Although this study provides qualified support for
psychological intervention in reducing high MPA in adolescent music students,
careful selection of students is necessary to achieve cost-effective outcomes.
Address for correspondence:

Margaret S. Osborne
e-mail: margaret@pepsych.com.au
Associate Professor Dianna T. Kenny, Director
Australian Centre for Applied Research in Music Performance (ACARMP)
Sydney Conservatorium of Music C41
The University of Sydney, NSW
Australia 2006
Phone: 61-2-9351 9644
Fax: 61-2 9351 9540
e-mail: d.kenny@fhs.usyd.edu.au
75
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81
• El impacto de un programa de tratamiento

del comportamiento cognitivo sobre la ansiedad
en la interpretación musical en los estudiantes
de música de secundaria : un estudio piloto
Este estudio juzga la efectividad de un programa de tratamiento de comportamiento

individual y grupal combinado (CBT) para reducir la ansiedad de la interpretación
musical (MPA) en músicos adolescentes. Veintitrés adolescentes con una alta MPA
de una Escuela de Secundaria fueron distribuidos al azar para participar bien en un
programa de intervención de siete sesiones, bien en un grupo de control del
comportamiento. La intervención consistió en educación psicológica, planteamiento
de un objetivo, reestructuración cognitiva, técnicas de relajación y exposición del
comportamiento a través únicamente de dos interpretaciones públicas. La medida
de los resultados incluía auto-informes de MPA, tratamiento y estado de la
ansiedad, entrevista para diagnosticar la fobia al público, pulsaciones cardiacas,
electromiograma frontal (EMG), y calidad de la interpretación. Los avances más
significativos en los auto-informes de MPA fueron observados en los estudiantes
partidarios del programa (esto es, estudiantes que se comprometieron activamente
con el programa y que adoptaron las técnicas del mismo). Estos estudiantes
partidarios tuvieron también un mayor grado de MPA al comenzar. Los estudiantes
no partidarios y los estudiantes que expusieron solamente su comportamiento
mostraron también reducciones de MPA en el periodo estudiado, pero no en el
mismo grado que los partidarios. CBT no mostró tener efectos en la calidad
interpretativa.
• L’impatto di un programma di trattamento cognitivo-comportamentale

sull’ansia da prestazione musicale negli studenti di musica
delle scuole superiori : uno studio pilota
Il presente studio valutava l’efficacia di un programma di trattamento cognitivo-

comportamentale (cognitive-behavioural treatment, CBT) combinato, individuale e
di gruppo, per ridurre l’ansia da prestazione musicale (music performance anxiety,
MPA) in musicisti adolescenti. Ventitre adolescenti con un alto MPA di una scuola
superiore selettiva sono stati assegnati casualmente ad un programma di intervento
in sette sessioni o ad un gruppo di controllo limitato ad un’osservazione del
comportamento. L’intervento consisteva di psicoeducazione, formulazione di
obiettivi, ristrutturazione cognitiva, training di rilassamento ed esposizione
comportamentale in forma di due esecuzioni solistiche in pubblico. Le misure di
outcome comprendevano autodescrizioni dello MPA, ansia di tratto e di stato,
intervista diagnostica sulla sociofobia, polso cardiaco, EMG frontale e qualità
esecutiva. In sede di posttest si sono osservati significativi miglioramenti nelle
autodescrizioni dello MPA solo negli studenti participanti (ossia studenti attivamente
impegnati nel programma, e che ne avevano adottato le tecniche). Gli studenti
participanti avevano inoltre avuto un maggiore MPA iniziale. Sia gli studenti non-
participanti che quelli sottoposti alla sola osservazione del comportamento hanno
82

mostrato riduzioni dello MPA durante il periodo di studio, ma non nello stesso
grado degli studenti aderenti. Non è apparso alcun effetto del CBT sulla qualità
esecutiva.
• L’impact d’un programme de traitement cognitif et comportemental

sur l’angoisse ressentie par des élèves en musique du secondaire
face à l’interprétation
Dans cette étude, nous évaluons l’efficacité d’un programme de traitement cognitif
et comportemental (CBT : cognitive-behavioural treatment) qui combine un travail
individuel et en groupe pour réduire l’angoisse devant l’interprétation musicale
(MPA : musical performance anxiety) chez les jeunes. Vingt-trois adolescents d’une
école secondaire sélective, ayant une MPA forte, ont été assignés de manière
aléatoire à un programme d’intervention de sept sessions ou à un groupe témoin
uniquement soumis à une observation du comportement. L’intervention a consisté
en psychoéducation, définition d’objectifs, restructuration cognitive, travail de
détente et étude du comportement lors de deux performances solistes devant un
public. Après ce travail, nous avons étudié l’autoévaluation de MPA, les caractéris-
tiques et le niveau d’angoisse, des interviews pour diagnostiquer d’éventuelles
phobies sociales, le rythme cardiaque, l’EMG du muscle frontal et la qualité de
l’interprétation. On a trouvé d’importantes améliorations dans l’autoévaluation de
la MPA au cours d’un test ultérieur mais ceci uniquement chez les étudiants ayant
participé activement au programme et qui en avaient utilisé les techniques. Leur
MPA était aussi plus élevée au début. Les autres étudiants ont montré des
réductions de MPA pendant la période de l’étude, mais inférieures à celle des
participants actifs. Il a semblé que le CBT n’avait pas d’effet sur la qualité de
l’interprétation.
• Der Einfluss eines kognitiv-verhaltenstherapeutischen

Behandlungsprogramms zur Aufführungsangst von Musikschülern :
Eine Pilotstudie
Diese Studie untersuchte die Effektivität einer kognitiv-verhaltenstherapeutischen

Behandlung als kombinierte Individual- und Gruppenbehandlung zur Reduzierung
von Aufführungsangst bei jugendlichen Musikern. Aus einer ausgewählten
weiterführenden Schule wurden 23 Jugendliche mit hohem Lampenfieber
randomisiert entweder einem Interventionsprogramm mit sieben Sitzungen oder einer
Kontrollgruppe (nur Verhaltensexponierung) zugeordnet. Die Intervention umfasste
psychologische Aufklärung, das Setzen von Zielen, kognitive Restrukturierung,
Entspannungstraining sowie Verhaltensexponierung in der Form von zwei
Solo-Aufführungen vor Publikum. Gemessen wurden die selbstberichtete
Aufführungsangst, die persönlichkeitsabhängige und momentane Angst, die
Herzrate, ein Frontalis-EMG und die Darbietungsqualität; außerdem wurde eine
diagnostische Befragung zur Sozialphobie durchgeführt. Signifikante Besserungen
83
in der selbstberichteten Aufführungsangst wurden in Posttests nur für engagierte

Schüler beobachtet, die aktiv an den Programmen teilnahmen und die Techniken
übernahmen. Die engagierten Schüler hatten auch zu Beginn eine stärkere
Aufführungsangst. Weniger engagierte Schüler und die Schüler der Kontrollgruppe
zeigten im Verlauf der Studie eine sinkende Aufführungsangst, jedoch nicht in
gleichem Ausmaß wie die engagierten Schüler. Die kognitiv-verhaltenstherapeutische
Behandlung zeigte keine Effekte hinsichtlich der Aufführungsqualität.
84
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Impact of a Cognitive-Behavioural Treatment Program on

Article in Musicae Scientiae · July 2007

Margaret S. Osborne Dianna Theadora Kenny

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Musicae Scientiae © 2007 by ESCOM European Society

MARGARET S. OSBORNE, DIANNA T. KENNY*

educational consequences for university students, with expert evaluations of

Impact of a cognitive-behavioural treatment program on music performance anxiety

physiological measures in normal and clinical subjects (Cacioppo & Tassinary,

suggested strategies to decrease MPA specifically aimed at adolescent musicians, but

Impact of a cognitive-behavioural treatment program on music performance anxiety

Impact of a cognitive-behavioural treatment program on music performance anxiety

Students allocated to the treatment condition undertook the Music Performance

Impact of a cognitive-behavioural treatment program on music performance anxiety

Separation Anxiety Disorder, Social Phobia, Panic Disorder, Agrophobia,

APPARATUS AND EXPERIMENTAL SETTING

Impact of a cognitive-behavioural treatment program on music performance anxiety

Obsessive-Compulsive Disorder) was proportional to the number of students in each

The MPAI-A correlated significantly with STAI-trait anxiety scores, r = .51,

Impact of a cognitive-behavioural treatment program on music performance anxiety

anxiety scores either pre- (t (21) = – 0.54, p = .60) or postintervention

Impact of a cognitive-behavioural treatment program on music performance anxiety

(ii) ADIS-IV:C diagnostic changes

(iii) ADIS IV:C avoidance ratings

Impact of a cognitive-behavioural treatment program on music performance anxiety

Analysis of number of correctly identified pre- and postintervention

This paper presents data on a novel investigation of the effectiveness of a combined

Impact of a cognitive-behavioural treatment program on music performance anxiety

Impact of a cognitive-behavioural treatment program on music performance anxiety

measure following psychotherapeutic intervention for MPA in numerous studies

Impact of a cognitive-behavioural treatment program on music performance anxiety

study utilised students within a highly specialised and competitive educational

Address for correspondence:

Impact of a cognitive-behavioural treatment program on music performance anxiety

Impact of a cognitive-behavioural treatment program on music performance anxiety

Impact of a cognitive-behavioural treatment program on music performance anxiety

• El impacto de un programa de tratamiento

Este estudio juzga la efectividad de un programa de tratamiento de comportamiento

• L’impatto di un programma di trattamento cognitivo-comportamentale

Il presente studio valutava l’efficacia di un programma di trattamento cognitivo-

Impact of a cognitive-behavioural treatment program on music performance anxiety

• L’impact d’un programme de traitement cognitif et comportemental

• Der Einfluss eines kognitiv-verhaltenstherapeutischen

Diese Studie untersuchte die Effektivität einer kognitiv-verhaltenstherapeutischen

in der selbstberichteten Aufführungsangst wurden in Posttests nur für engagierte

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