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Introduction: Most of the anxiety disorders, particularly social anxiety, seem to develop either during childhood or adolescence. Adolescent singers who experience physical, mental and emotional changes along with voice change are particularly prone to the development of MPA. However, adolescence also seems to be an opportune time to instil healthy behaviours in singing students as they are more likely to remember these coping strategies, owing to the release of dopamine and the 'reminiscence bump'. As this period of a singer's life is wrought with inevitable anxiety development, the additional aim of the study was to develop a coaching framework which can be used by singing teachers in their practice. Mindset training for adolescents seems crucial to help them continue singing through puberty so they do not drop out of singing lessons or choir during voice change and identity development. Methods: The study aimed to determine if Acceptance and Commitment coaching could be used with adolescent singers with MPA and to record and analyse rich qualitative data in the form of semi-structured participant interviews and questionnaires. Results: When their perception of MPA symptoms and physiological and psychological arousal before a performance changed, their behaviour and reactions changed accordingly. The change took place over a period of time, which was characterised by discoveries about themselves, confusion in understanding new concepts and letting go of old habits. Interestingly, by the end of the coaching sessions, their preoccupation with pleasing the audience and appearing perfect on stage was replaced by a new-found delight in pursuing values and goals related to their singing. Along with this came the acceptance of themselves and others as individuals with the potential for growth and change and the capacity to learn from mistakes. Discussion: This study marks the first investigation into the effectiveness of using of ACC as an intervention for MPA in adolescent singers undergoing puberty by a singing teacher. The results are promising and suggest that ACC is an effective MPA intervention for adolescent singers to cope with inevitable development-related anxieties and keep them engaged in the activity of singing during their pubertal years.

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Introduction: This study investigated the relationship between personality traits and MPA in the course of a specific performance. Methods: For this purpose, symptoms of MPA, functional coping with MPA and performance-related self-efficacy of a sample of 393 musicians including 23% professional, 49% non-professional orchestra musicians and 28% singers in amateur choirs were categorized and then used to analyze differences in the personality traits. The questionnaires used were the NEO-FFI and the PQM. Results: The results showed that professional orchestra musicians had significantly higher openness and conscientiousness than non-professional orchestra musicians and amateur choir singers. Musicians who had few symptoms of MPA, positive coping with MPA and high self-efficacy across a specific performance (Type 1) have low neuroticism in their personality traits. Regarding MPA, the personality traits were correlated with all MPA scales after the performance but less with MPA scales before and during the performance. Discussion: Results could indicate that personality traits play a particularly important role in the processing of performance experiences after the performance and suggest focusing on the situation after the performance in particular with professional orchestra musicians.

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BACKGROUND: Problematic overstudying is a compulsive and pathological overinvolvement in studying leading to harm and considerable functional impairments. It is conceptualized as "study addiction," a precursor to work addiction. It has been investigated within the addictive behaviours framework in general populations of students for over a decade. A previous study analysed the problem among young musicians as a particularly vulnerable group. It found some important differences in potential personality risk factors among music academy students compared to general populations of students and showed an important role of social anxiety. The current study aimed to validate these findings in a separate larger sample and extend them by investigating the role of music performance anxiety (MPA). PARTICIPANTS AND PROCEDURE: The study was conducted among 213 students of music academies. Valid and reliable measures of study addiction, MPA, Big Five personality and well-being were used. RESULTS: The results showed that MPA played a similar role as social anxiety in terms of being a predictor, mediator, and moderator of the main replicated effects supporting the hypothesised mechanisms regulating study addiction. However, extraversion was not associated with study addiction in multiple hierarchical regression analysis, but conscientiousness and neuroticism were. Study addiction was associated with indicators of decreased well-being, above and beyond MPA, and personality. CONCLUSIONS: These results show that MPA plays an analogous role to social anxiety and that the role of Big Five personality in study addiction among young musicians requires further investigation due to inconsistent findings.

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Several studies have developed and validated specific scales to understand, identify and confirm research hypotheses associated with music performance anxiety (MPA). These scales mostly assess behavioral, cognitive, and physiological factors. There is currently no original MPA assessment tool for higher music education in Continental Portuguese, which suggests a research gap. The aim of this study was to determine if the Portuguese Music Performance Anxiety Scale (PoMPAS), developed for this research, is a valid and reliable measure of MPA for the context of higher education in Portugal. The total sample was N = 414 (166 male, 245 female, and three without gender identification). The development of this scale was based on a three-dimensional model (behavioral, cognitive, and physiological), following the theoretical models of Salmon (1990) and Osborne and Kenny (2005). Confirmatory factor analysis of the PoMPAS suggested a good fit in a three-dimensional model with 27 items. The internal consistency values proved appropriate, showing good Cronbach's alphas (between α = 0.81 and α = 0.90). The McDonald's Omega also demonstrated good consistency (between ω = 0.81 and ω = 0.90). The PoMPAS is a reliable tool to measure the impact of MPA, with good psychometric qualities, specifically for the Portuguese higher music education context.

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Musical performance anxiety (MPA) is considered a subtype of social phobia and affects musicians who must face musical exposure in public, potentially severely affecting their emotional stability and significantly impairing the quality of their performance. This research has utilized previous scientific knowledge on the issue and a qualitative approach to musicians' needs through focus groups in order to design a collective preventive program for MPA that could be implemented within the training curriculum of professional musicians. To evaluate the adequacy of the preventive program 'ConfiDance', a pilot test was conducted with a sample of 17 professional musicians in training, all post-graduate students in classical music performance. For the pilot test, a quasi-experimental model with a repeated measures methodology (pre-post and one-year follow-up after application) was carried out. The results indicate a significant decrease in MPA after the program implementation, with a notable improvement in effect one year post-application, demonstrating an even greater positive impact over time. These data should be interpreted cautiously due to sample limitations but represent an opportunity for the future implementation of a program that can prevent and treat MPA in music education centers.

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This quantitative study aimed to explore the relationships among music performance anxiety (MPA), teacher anxiety (TA), and self-efficacy (SE) through a survey study of Chinese preservice music teachers (N = 237). We also examined gender, grade, primary instrument, secondary instrument, music learning time length, and time spent in four activities: peer teaching, practicum, internship, and private teaching as potential predictors of MPA, TA, and SE. Results indicated that the higher the self-efficacy, the lower music performance anxiety and teaching anxiety; Simultaneously, the increased music performance anxiety was associated with an increased teaching anxiety. Partial correlation results indicated a significant but negative correlation between TA and SE with MPA controlled. Teaching anxiety, followed by primary piano, was the strongest predictor of MPA. MPA, followed by SE and peer teaching, was the strongest predictor of TA. TA, followed by grade level, was the strongest predictor of SE. The results from the multivariate analysis of variance revealed that the SE of male preservice music teachers were significantly higher than their female counterparts. As a study implication, music teacher educators may consider interventions and support mechanisms that address both types of anxiety simultaneously to improve overall teacher preparedness.

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The aim of the research is to determine the applications related to sportspsychology in overcoming performance anxiety among Italian cyclists. Athletes, particularly cyclists, frequently struggle with performance anxiety, which can seriously impair their capacity for peak performance. In this abstract, we investigate the use ofsports psychology strategies designed specially to help Italian cyclists who experience performance anxiety. The research was based on primary data analysis to determine whether it used smart PLS software and generated results that included descriptive statistics, correlation coefficient analysis, and the smart PLS Algorithm Model between them. This research study offers a methodical strategy made up of several psychological treatments meant to reduce performance anxiety and enhance performance. It discusses many techniques, including biofeedback, stress management, goal setting, cognitive restructuring, visualization, pre-performance rituals, simulated pressure scenarios, and creating a supportive team atmosphere. By practicing these tactics, Italian riders can acquire the psychological fortitude required to negotiate stressful competition situations successfully. the overall research It is vital to constantly assess and modify treatments to make sure they are efficient and meet the demands of each athlete.Italian cyclists may overcome performance anxiety and reach their full potential on the bike by incorporating sports psychology concepts into their training program, which will help them succeed in national and international contests. (AU)

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OBJECTIVES: This study aimed to examine the association between the incidence of musculoskeletal disorder episodes (MDEs) and obsessive and harmonious passion as well as performance anxiety throughout a dance season, which lasted 38 weeks. DESIGN: Prospective cohort study. METHODS: A total of 118 professional and preprofessional dancers were recruited and assessed at baseline, while 88 completed the follow-up. Their levels of passion and performance anxiety were assessed at the beginning of a dance season using the Passion Scale and the Kenny Music Performance Anxiety Inventory, respectively. To monitor the incidence of MDEs throughout a dance season, dancers were asked to complete a weekly electronic diary. RESULTS: A higher level of obsessive passion was associated with a higher incidence of MDEs causing an interruption of dance activities (ß = 0.264, p = 0.022). Harmonious passion and performance anxiety were not associated with MDEs throughout the season. CONCLUSIONS: Findings of this study support the role of obsessive passion in the development of MDEs in dancers.

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Background: The neuroendocrine system has important implications for affiliation behavior among humans and can be used to assess the correlation between social relationships, stress, and health. This can be influenced by social closeness; this aspect is the closeness towards another individual or a group of individuals such as a sports team. Sports performance anxiety is considered an unpleasant emotional reaction composed of physiological, cognitive, affective, and behavioral components. This motivates us to learn about the process that can influence the outcome of competition. Hormones and genetics would seem to influence outcome and performance. In this regard, many studies have focused on the exercise response as a function of ovarian hormones and it has been observed that progesterone is a hormone that plays a key role in reducing anxiety, and thus stress, in humans and other animals. On the other hand, high cortisol concentrations are known to contribute to increased anxiety levels. However, the salivary alpha-amylase (sAA) enzyme has been suggested as marker of acute stress than cortisol. Genetics also seem to influence anxiety and stress management as in the case of brain-derived neurotrophic factor (BDNF) and striatal dopamine transporter (DAT). Therefore, the study aims to investigate social closeness, as a measure of sports team cohesion that can influence athletes' performance results, and its ability to influence the secretion of hormones, such as progesterone and cortisol, that affect the management of sports anxiety while also taking into account genetic background during a volleyball match. Methods: Twenty-six female volleyball players who volunteered participated in this study (mean ± SD: age, 12.07 ± 0.7 years), and played in the final of the provincial volleyball championship in Palermo. All girls were during the ovarian cycle, in detail between the follicular and early ovulatory phases. Results: The results showed a significant decrease in salivary cortisol only in the winning group (p < 0.039). In fact, whilst in the latter the pre-match level was 7.7 ng/ml and then decreased to 4.5 ng/ml after the match, in the losers group change was not statistically significant (7.8 ng/ml vs 6.6 ng/ml pre- and post-match). As to the sAA concentration, the winning team showed a statistically significant variation between pre- and post-match than the losers (166.01 ± 250 U/ml vs 291.59 ± 241 U/ml) (p = 0.01). Conclusion: Analyzing the results of the SAS-2 psychological test it is highlighted that, on average, the loser group was more anxious than the winning group, and this contributed to the final result. In conclusion, there is strong evidence supporting the state of the art that many factors can affect performance anxiety and thus the performance itself.

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OBJECTIVE: Developing a measuring tool for physician's performance anxiety during obstetrical procedures, as a self-administered questionnaire. METHODS: We used the Delphi method. First, we did a literature review to identify the items to submit for the first round. A panel of experts was asked to rate the relevance of items from one to six. For the first round of Delphi, items were retained if more than 70% of respondents assigned a five or six rating. Items were excluded if more than 70% of respondents assigned a one or two rating. All the other items, plus those suggested by the panel, were submitted to a second round of Delphi. The same item selection conditions were applied to the second round. RESULTS: The overall response rate to the Delphi was 79% (19 respondents). At the end of the first round, 14 items were consensually relevant, no item was consensually irrelevant. For the second round, the 18 items that did not find consensus and seven new items suggested by the experts in the first round were submitted. At the end of the second round, nine items were retained by consensus as relevant. CONCLUSION: This study defined by consensus 23 items for a self-questionnaire to measure specific performance anxiety in obstetrics divided into five dimensions: perceived stress, assessment of the risk of complications, medico-legal risk, impact of the healthcare team and peers, self-confidence and decision-making confidence. We intend to validate this tool in real population.

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Levels of state and trait anxiety are relevant for performing artists and professional athletes to obtain optimal performance outcomes. However, evidence-based knowledge regarding the effectiveness of psychological interventions on performance anxiety is currently minimal. Thus, the objective of this systematic review with meta-analysis was to characterize, aggregate, and quantify intervention effects on measures of state and trait performance anxiety in performing artists and professional athletes. A systematic search of the literature according to the PRISMA guidelines was conducted on the databases PubMed, Medline, SPORTDiscus, PsycInfo, Embase, and Web of Science from 1 January 1960 to 9 November 2022. The search only included controlled studies employing pre-post measures and excluded performing arts fields that do not depend on fine motor skills. Initially, 1022 articles were identified; after removing duplicates and assessing abstracts and full texts, 20 articles were used to calculate weighted standardized mean differences (SMDs). In terms of state performance anxiety, our results revealed a large overall effect (SMD = 0.88), a medium effect (SMD = 0.62) for studies using scales with total scores (i.e., MPAI-A, STAI), and large effects (cognitive anxiety: SMD = 0.93, somatic anxiety: SMD = 0.92, self-confidence: SMD = 0.97) for studies applying scales with sub-scores (i.e., CSAI-2R)-all in favour of the intervention groups. Regarding trait performance anxiety (e.g., SCAT), we detected a small effect (SMD = 0.32), also favouring the intervention groups. Interventions to reduce performance anxiety in performing artists and professional athletes revealed varying levels of effectiveness ranging from small (trait) to large (state). Therefore, future studies should investigate modalities to increase intervention efficacy, especially for the small-sized changes in trait performance anxiety.

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BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. AIM: The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM. METHODS: A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040. RESULTS: A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%. STRENGTHS & LIMITATIONS: A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published. CONCLUSION: Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

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Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.

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Music performance anxiety (MPA) is a natural, emotional, and physiological response to the stress of public performance. Debilitating forms of MPA are severe and persistent reactions that go beyond the normal adaptive response to music evaluation situations and can negatively impact the quality of musical performance and the musician's life in general. Today, it affects numerous professional performers and can result in an inability to practice their profession, posing a significant threat to their professional activity. Despite its scope, studies exploring this issue and contributing to its resolution are scarce. Thus, this review aims to compile the significant advancements made in the last five years (2018-2023) in the treatment of MPA from a scientific perspective. For this purpose, the PRISMA method was used based on the results obtained from the Web of Science, Scopus, and Google Scholar databases. Reviewed are 10 studies that have made valuable contributions to this matter in this time frame after applying the quality filters using the PRISMA method. It is concluded that, although there are methodological shortcomings and sample limitations in the current research, this field registers advancements that provide valuable information to prevent or solve this problem in professional or aspiring musicians.

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Performance anxiety is fear, anxiety, or avoidance of performative tasks, due to possible evaluation or criticism by others. Performance anxiety is well described in public speakers, musicians, and even surgeons. Its impact on radiologists and especially radiology trainees has not been explored. This article details performance anxiety, framing radiologists as performers, and highlights its potential impact on trainees and practicing radiologists. We offer strategies to manage and enhance the effects of performance anxiety that can be implemented in a training environment.

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Introduction: Research on Music Performance Anxiety (MPA) among amateur musicians is of great interest due to inconsistent results in literature. In addition, amateur music represents an important part of musical culture in Germany. Accordingly, the performance experiences of young wind players represent a relevant issue for research and musical practice. Methods: In the present study, 67 young amateur musicians of a brass choir were examined. Using two different questionnaires, both the dispositional MPA (K-MPAI) and the performance-specific MPA during a joint concert (Performance-specific Questionnaire for Musicians, PQM) were assessed. The PQM measures the symptoms of MPA, functional coping with MPA and self-efficacy before, during and after a specific performance. The PQM was completed by the musicians via an app directly after the concert. Results: Results showed that about 90% of the young amateur musicians had a low dispositional MPA, but about 10% showed high values. For the concrete performance, however, musicians with high dispositional MPA also experienced a very moderate to low MPA in the concert. On average, the musicians were quite nervous before the performance. After the performance, they showed low levels of MPA. Three types of MPA found in previous studies could be confirmed among the amateur musicians, with three quarters being assigned to the positive type, showing low levels of symptoms associated with consistently high levels of self-efficacy and positive functional coping. Discussion: The results provide a differentiated picture of different expressions of MPA in young amateur musicians. They also raise further questions about the correlation between dispositional and performance-specific assessment of MPA in musicians in general.

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Introduction: Music Performance Anxiety (MPA) is a prevalent condition among musicians that can manifest both psychologically and physiologically, leading to impaired musical performance. Physiologically, MPA is characterized by excessive muscular and/or autonomic tone. This study focuses on the cardiovascular blood pressure responses, autonomic tone and baroreceptor sensitivity changes that occur during musical performance due to MPA. Methods: Six professional pianists perform a piece for piano written only for the left hand by Alexander Scriabin. The following parameters have been studied during the performance: ECG, non-invasive beat to beat continuous arterial blood pressure and skin conductance. Sympathetic and parasympathetic autonomic flow was studied with Wigner-Ville analysis (W-V) from R-R ECG variability, and baroreceptor sensitivity with the Continuous Wavelet Transform (CWT). Results: During the concert a significant increase of heart rate, systolic, mean and diastolic arterial pressure were observed. No significant differences were found in skin conductance. The W-V analysis, which studies frequency changes in the time domain, shows a significant increase of sympathetic flow and a decrease of parasympathetic flow during the concert which is associated with a significant decrease in sympathetic and vagal baroreceptor sensitivity. Discussion: The study of cardiac variability using the Wigner-Ville analysis may be a suitable method to assess the autonomic response in the context of MPA, and could be used as biofeedback in personalized multimodal treatments.

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BACKGROUND: Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. METHODS: This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. DISCUSSION: The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).

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I commenced my academic exploration of music performance anxiety in a study with opera chorus artists from Opera Australia in 2004. I subsequently postulated a new theory of the aetiology of music performance anxiety and began the development of the Kenny Music Performance Anxiety Inventory (K-MPAI) to assess the hypothesized theoretical constructs underpinning its diverse clinical presentations. I proposed a new definition of music performance anxiety in 2009 and revised the item content of the K-MPAI from 26 to 40 in 2011. Over the ensuing years, many researchers have used the K-MPAI in studies on a wide variety of musicians, including vocalists and instrumentalists, popular and classical musicians, tertiary music students, and professional, solo, orchestral, ensemble, band, and community musicians. To date, the K-MPAI has been reported in more than 400 studies and has been translated into 22 languages. It has been the subject of more than 39 dissertations. In this paper, I examine the research that has used the K-MPAI to assess the theory and to ascertain how well the assessment tool, and its cross-cultural validation have provided evidence for its factorial structure, robustness, and utility. The evidence indicates that the factorial structure remains consistent across cultures and different populations of musicians. It has good discriminative ability and utility for diagnostic purposes. I conclude with some reflections on how the K-MPAI can guide therapeutic interventions and with some thoughts on future directions.