see: Music and Medicine on Monday (M+M+M) at the University of Iowa - Schedule of Events and Disclaimer

and: Performance Anxiety for Musicians Part 2: Medical Management

Perfectionism and Performance Anxiety (2 min 11 sec):

Full session (39 minutes):

Definitions

Anxiety is considered to be fear, nervousness or worry that is common during stressful situations and may be accompanied by physical symptoms such as palpitations, shortness of breath, dizziness, and muscle tension (Szuhany 2022). As per Kim (2025), anxiety is not necessarily pathologic, is seen across the life span, and can be adaptive. It becomes an anxiety disorder (pathologic) when it is 'disabling, interferes with social interactions or derails normal development'

Performance Anxiety (aka 'stage fright') is defined by Nagel (2010) as 'anxiety aroused about potential mishaps in performance that expose feared inadequacies before an audience and which evoke feelings of embarrassment and humiliation'. Performance anxiety exists on a spectrum and in its lesser extent can be enhancing channeled productively ( Mandrick 2016)

Music Performance Anxiety (MPA) is specifically triggered by the demands of musical performance (differentiating it from General Society Anxiety) with severity fluctuating based on situational factors. It may occur before, during, or after a performance often manifest as a combination of symptoms (Stock 2023):

• Cognitive - negative thoughts and worry
• Physiologic - rapid heart rate, sweating, tremor
• Behavioral - performance impairment or avoidance

Cognitive Behavioral Therapy (CBT) refers to psychological intervention to include psychoeducation, cognitive restructuring, exposure therapy, and relapse prevention to address anxiety "as caused by a pattern of maladaptive cognitive appraisals and avoidance behaviors that perpetuate pathologic fears" (Trent 2024). 

Somatic Complaints (Somatoform, Psychogenic, Hypochondriasis, Imaginary, or Psychosomatic Disease): As per Tavel et al (2015) report that the DSM 5 prefers term 'somatic symptom disorder' in recognizing that 'the mind and body cannot be separated'. Tavel identifies that "the fact that a physical basis is unexplained does not automatically categorize such patients into a purely psychiatric category" but adds "many of the symptoms usually are accompanied by excessive emotional reactions, a psychiatric component is usually apparent, often establishing the need for treatment within this realm".

Agoraphobia is fear or anxiety 'from thoughts that escape may be difficult' (Balaram 2024).  Balaram et al cite the Diagnostic and Statistical Manula of Mental Disorders 5th Edition (DSM 5) in defining agoraphobia as fear or anxiety about at least 2 of the 5 situations. This anxiety 'cannot be attributed to a realistic threat, sociocultural factors, or substance use or withdrawal' and must persist for 6 months to confirm the diagnosis of agoraphobia:

• using public transportation
• being in open spaces
• being in enclosed spaces
• standing in line or being in a crowd
• being outside the home alone

Background

Anxiety disorders reported by Szuhany and Simon (2022) to affect ~ 12.7% of the US population with a lifetime prevalence of 34%. These authors report identify subsets to include a lifetime prevalence of Social Anxiety Disorder (13%), Generalized Anxiety Disorder (6.2%), Panic Disorder (5.2%) and Agoraphobia (2.6%).

Resources for Musician Performance Anxiety

• An entertaining and informative blog by Heather O'Donnell Psychologist, Artistic-Systemic Therapist - "Musicians’ Performance Anxiety: The (nervous) Elephant in the Room": https://www.heatherodonnell.info/musicmind/10-music-mind-the-nervous-elephant-in-the-room

References

Bakhtiari P, Nikanmajd N, Ghasemi Shayan R. Recent developments in coping strategies focusing on music performance anxiety: a systematic review. Front Psychol. 2025 Apr 25;16:1507229. doi: 10.3389/fpsyg.2025.1507229. PMID: 40351598; PMCID: PMC12062091.

Powell DH. Treating individuals with debilitating performance anxiety: An introduction. J Clin Psychol. 2004 Aug;60(8):801-8. doi: 10.1002/jclp.20038. PMID: 15241808.

Nagel JJ. Treatment of music performance anxiety via psychological approaches: a review of selected CBT and psychodynamic literature. Med Probl Perform Art. 2010 Dec;25(4):141-8. PMID: 21170476.

Szuhany KL, Simon NM. Anxiety Disorders: A Review. JAMA. 2022;328(24):2431–2445. doi:10.1001/jama.2022.22744