BIOFEEDBACK TRAINING, SELECTED COPING STRATEGIES, AND MUSIC RELAXATION INTERVENTIONS TO REDUCE DEBILITATIVE MUSICAL PERFORMANCE

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BIOFEEDBACK TRAINING, SELECTED COPING STRATEGIES, AND MUSIC RELAXATION INTERVENTIONS TO REDUCE DEBILITATIVE MUSICAL PERFORMANCE ANXIETY

Performance anxiety or stage fright is a widespread problem among musicians. An integrative approach involving biofeedback training, selected coping strategies, and music relaxation interventions may significantly reduce music students' debilitative performance anxiety before performance situations. Subjects in an Experimental Group and a Waiting-list Control Group experienced (a) six sessions of individual biofeedback training consisting of electromyograph (EMG) and skin temperature training and (b) instruction in selected coping strategies during six group meetings and coinciding practice of the strategy with sedative music during individual biofeedback training. A significant difference was found between the Experimental Group and the Waiting-list Control Group on the State Anxiety Scale (p=.001) completed before students' music lessons (1st and 6th week). Following treatment for both the Experimental and Waiting-list Control Groups, a significant reduction of debilitative anxiety was found on the Facilitating Anxiety Scale (p=.001), the Debilitating Anxiety Scale (p=.004), the State Anxiety Scale (p=.002), and the Trait Anxiety Scale (p=.001) completed before students' fall 1991 and winter 1992 jury performances.

Introduction

Performance anxiety or stage fright is a widespread problem among musicians as well as other performing artists. Of the 2,212 classical musicians surveyed in the International Conference of Symphony and Opera Musicians (ICSOM), 24% reported performance anxiety to be a problem, and 16% reported performance anxiety to be a severe problem (Fishbein & Middlestadt, 1988). Of the 302 students and faculty surveyed at the University of Iowa School of Music, 21% reported marked distress while performing, 16.5% reported impairment due to anxiety, and 16.1% stated that performance anxiety had adversely affected their careers (Wesner, Noyes, & Davis, 1990). Steptoe and Fidler (1987) surveyed three categories of musicians -- 65 professional orchestra players from the Royal Philharmonic and London Philharmonic Orchestras; 41 undergraduate music students of orchestral instruments at the Guildhall School of Music and Drama, London; and 40 members of the Sidcup Symphony Orchestra, an amateur orchestra. Of the three categories, music school students reported the highest rating of performance anxiety on the State Scale of the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970) followed by the amateur orchestra players and the professional orchestra,players. Pratt, Jessop, and Niemann (1992) conducted a survey of 246 music students at Brigham Young University. The survey was created for university music students and included questions on physical pain related to performance and how this physical pain may interfere with performing. Eight-seven percent of the respondents reported some degree of performance-related physical pain. Ninety percent of these students indicated interest in receiving additional instruction concerning the emotional and physical demands of performing.

Salmon (1990) defines performance anxiety as "the experience of persisting, distressful apprehension about and/or actual impairment of performance skills in a public context, to a degree unwarranted given the individual's musical aptitude, training, and level of preparation" (p. 3). Two constructs, trait anxiety and state anxiety, are frequently used to distinguish between a relatively stable and enduring aspect of a musician's anxiety proneness (trait anxiety) and the relative intensity of a musician's anxiety at the time of a particular event such as musical performance (state anxiety). Though conceptually different, state and trait anxiety are related; general anxiety traits influence specific anxiety states (Spielberger, 1983). Lehrer, Goldman and Strommen (1990) and Wolfe (1990) found that musicians' levels of state and trait anxiety were significantly correlated with musicians' maladaptive anxiety consisting of disruptive cognitive responses (worry) and disruptive physiological responses while performing.

Anxiety can have both positive and negative effects on performance (Alpert & Haber, 1960; Lehrer, Goldman, & Strommen, 1990). Wolfe (1989) found that musical performance anxiety (MPA) consisted of two positive, or adaptive components (arousal/intensity and confidence/competence) and two negative, or maladaptive, components (nervousness/apprehension and selfconscious-ness/distractibility). Musicians' feelings of arousal and intensity were perceived as a facilitative factor of performance, whereas musicians' feelings of apprehension and distractibility were perceived as a debilitative factor of performance. According to Wolfe (1990), "the apparent complexity of MPA has implications for its management; optimal treatment would aim at reducing maladaptive anxiety, while still permitting concentration, arousal, and intensity required for effective performance" (p. 144). In addition, musicians who engaged in anxiety-coping strategies tended to experience anxiety as a facilitative factor of their performance (Lehrer, Goldman, & Strommen, 1990) while musicians who avoided using anxiety-coping strategies reported high levels of nervousness and apprehension related to performing (Wolfe, 1990).

Clearly, debilitative anxiety is problematic to the performer because it can detract from the enjoyment of performance and can seriously interfere with the quality of performance. Skills the performer depends on the most -- coordination, control, and concentration -- are markedly impaired by performance anxiety (Brantigan, 1975; Leglar, 1978). Poor concentration, rapid heart rate, trembling, dry mouth, sweating, and shortness of breath are the most common symptoms reported by musicians to interfere with performing (Wesner, Noyes, & Davis, 1990). Dry mouth is the most disruptive for wind players, and lack of finger control and feelings of panic are the most disruptive for string players (Wolfe, 1989).

In the behavioral model, performance anxiety is viewed as a classically conditioned fear due to a generalized state of hyperarousal of the sympathetic nervous system becoming conditioning stimuli for increased anxiety (Clark, 1989). For this reason, drugs, known as beta blockers that inhibit sympathetic activation of the nervous system, are used by a surprisingly large percentage of professional musicians. According to Fishbein & Middlestadt (1988), 22% of the 2,212 musicians from the ICSOM survey reported taking beta blockers occasionally for performance anxiety. In contrast to pharmacological approaches for treating performance anxiety, Julie Jaffee Nagel (1981), Coordinator of the Performance Anxiety Program at the University of Michigan, advocated a cognitive behavioral approach utilizing dialogue, systematic desensitization, and biofeedback training for musical performance anxiety. The effectiveness of biofeedback training for reducing debilitative performance anxiety has been demonstrated in only relatively few experimental studies. More evidence of the effectiveness of biofeedback training for reducing debilitative performance anxiety is needed to help musicians cope with the demands of performing and make informed decisions about the effectiveness of treatment.

Budzynski, Stoyva, and Peffer (1980) stated, "the essence of biofeedback training is to provide the client with continuous information regarding the activity of a particular physiological parameter" (p. 186). Physiological changes due to stress or the alarm reaction that customarily go unnoticed are detected and amplified by biofeedback instruments. By enhancing discrimination of subtle physiological functioning, biofeedback training may help clients modify negative, maladaptive responses to anxiety (Budzynski & Peffer, 1982). Because muscle tension, peripheral vasoconstriction (constriction of blood flow away from the hands) and other physiological symptoms of performance anxiety dramatically interfere with a musician's free motor control and coordination, biofeedback training that involves helping musicians learn to make subtle discriminations of muscle tension and skin temperature measures may significantly improve their ability to achieve self-mastery of performance situations.

Statement of Purpose

The underlying purpose of this study was to evaluate the specific effects of a multifaceted treatment approach of biofeedback training, selected coping strategies, and music relaxation interventions to reduce debilitative performance anxiety, as well as evaluate students' perceptions of the most helpful components of treatment. Subjects in an Experimental Group and a Waiting-list Control Group experienced (a) six sessions of individual biofeedback training consisting of electromyograph (EMG) and skin temperature training and (b) instruction in selected coping strategies during six group meetings and coinciding practice of the strategy with sedative music during individual biofeedback training. Previous studies show that sedative music and selected coping strategies significantly enhance bio-feedback training (Reynolds, 1984; Scartelli, 1984). The coping strategies were: breathing awareness, muscle relaxation, and performance-coping imagery.

Review of Related Literature

Numerous treatment methods have been used for performance anxiety including drag therapy, nutrition therapy and exercise, the "Alexander Technique," transcendental meditation and yoga exercises, Edmund Jacobson's (1938) progressive relaxation, and Joseph Wolpe's systematic desensitization (1958). (See Hingley, 1985, and Reubart, 1985 for a review of these treatment methods.) Experimental studies aimed at modifying cognitive, behavioral, and/or physiological components of performance anxiety have evaluated the effectiveness of systematic desensitization (Appel, 1974; Lund, 1972; McCune, 1983), cognitive restructuring and behavioral rehearsal (Kendrick, 1979), cue-controlled relaxation and cognitive restructuring (Sweeney, 1981), group music therapy (Montello, 1989), and biofeedback training.

Biofeedback training. Biofeedback training has been used as a morality for treating the following specific performance-related problems of musicians: A professional woodwind musician with a history of tics and tension in the throat and facial muscles (Levee, Cohen, & Rickles, 1976), a professional violinist with severe occupational palsy (LeVine, 1983), clarinetists' muscle tension in the left forearm extensor muscles (Morasky, Reynolds, & Sowell, 1983), violin and viola players' left hand muscle tension (LeVine & Irvine, 1984) and finally, musicians' medical disorders involving their hands, namely tendinitis, median nerve compression in the carpal tunnel, and sympathetic reflex dystrophy (Fischer-Williams, Sovine, & Clifford, 1985).

The authors are aware of only one study, a pilot study, that has followed a systematic procedure to evaluate the effectiveness of a treatment approach involving biofeedback training for reducing debilitative performance anxiety. Nagel, Himle, and Papsdorf (1989) utilized a combined treatment approach of progressive muscle relaxation, cognitive therapy, and skin temperature biofeedback training for 20 music students with debilitative performance anxiety. Treatment consisted of 6 weeks of group sessions and 6 weeks of individual temperature biofeedback training, both once a week. Subjects were trained in Jacobson's (1938) progressive muscle relaxation and Meichenbaum's (1978) cognitive-coping strategies during group sessions. Both methods were used to help subjects to identify and evaluate their responses to progressively stressful musical performance situations after subjects reported a relaxed state. Skin temperature biofeedback training was used to assist in the development of the relaxation techniques. Subjects in an experimental and a waiting-list control group completed state and trait measures before and after treatment under relaxed conditions. A significant reduction of trait anxiety was found following treatment for the experimental group compared to the waiting-list control group, however no significant differences were found in reduction of state anxiety. While the findings of this study suggest that a multifaceted treatment may be an effective approach for reducing debilitative performance anxiety, limitations of this study were that subjects were not measured before actual performance situations when they may have been most reactive to performance anxiety, particularly state anxiety. More evidence is needed to show that music students are able to transfer the increased awareness of physiological functioning from biofeedback training into reducing debilitative anxiety before potentially threatening performance situations.

Research Hypotheses

To determine the effectiveness of a multifaceted treatment approach of biofeedback training, selected coping strategies, and music relaxation interventions for reducing debilitative performance anxiety before performance situations, the following two hypotheses were posed:

There is a difference at the .05 level of significance between an Experimental Group that receives biofeedback training, selected coping strategies, and music relaxation interventions and a Waiting-list Control Group on the State Anxiety Scale completed before students' music lessons (1st and 6th week).
Following the treatment intervention for both the Experimental and Waiting-list Control Group, there is a reduction at the .05 level of significance of anxiety on (a) the State- Trait Anxiety Inventory (STAI) and (b) the Debilitating/Facilitating Anxiety Scales completed before students' fall and winter jury performances.
Method

Seven hundred and seventy-two undergraduate and graduate students with a major declared in music at Brigham Young University (BYU) were mailed Wolfe's (1990) Trait Anxiety Scale (TAS). The TAS is an adaptation of Alpert and Haber's (1960) Achievement Anxiety Test Scale (AATS) with the wording revised to reflect musical performance, rather than academic performance, as the source of discomfort. The reliabilities of these original scales were 0.75 for the Facilitating Anxiety Scale and 0.84 for the Debilitating Anxiety Scale. The TAS consists of two parts: The Facilitating Anxiety Scale, with eight items to measure the extent to which one's anxiety is a facilitative factor of musical performance as in the prototype item "Anxiety helps me to do better during a musical performance" and the Debilitating Anxiety Scale, with 10 items to measure the extent to which one's anxiety is a debilitative factor of musical performance as in the prototype item "Anxiety interferes with my musical performance." The items in the two scales were randomized and presented to respondents as a single inventory, in keeping with the protocol specified by Wolfe (1990). Respondents rated the extent to which each statement applied to them on a Likert Scale of Strongly Agree (SA), Agree (A), Agree with Reservations (AR), Disagree (D), and Strongly Disagree (SD). One hundred and sixty-three students turned in the completed inventory to the music office.

Procedure

Analogous to the prior studies, a method was followed to identify a sample of music students for which treatment would have the most relevance. Scores on the Facilitating/Debilitating Anxiety Scales for the respondents were rank ordered from the highest scores to the lowest scores and those students with the most severe combined scores were identified as candidates for treatment in the order of extremity.

Candidates were contacted by phone and invited to participate in a specialized 6-week program to manage performance stress. Those that indicated interest met individually with the primary researcher for a half hour. During this time a plan was followed to introduce students to procedures and benefits for participation in the study, informed consent, contract to receive credit for Music 494R, and biofeedback training. Students were also asked to complete a basic information sheet.

The study was limited to the number of students who could participate because of the limited number of hours the biofeedback lab could offer students. The first 21 students to indicate agreement to participate were recruited for the study.

The wait-listing group was determined on the basis of students' schedules and availability for the two time blocks. Students indicated on the information sheet one of two preferred time periods -- the first 6 weeks of winter 1992 semester (the Experimental Group) or the second 6 weeks of winter 1992 semester (the Waiting-list Control Group). The Waiting-list Control Group were given the promise of treatment at a future time and served as a control for nonspecific treatment factors. Three students withdrew their commitment prior to treatment because of conflicting time obligations.

The Experimental Group (n=9) and Waiting-list Control Group (n=9) each consisted of seven females and two males. Instruments represented were voice (4), piano (4), flute (2), clarinet (1), harp (1), oboe (1), organ (1), violin (1), viola (2), and saxophone (1). Year in school data were as follows: two freshmen, five sophomores, six juniors, four seniors, and one graduate student. The mean number of years students had been playing their instrument was 10. None of the subjects indicated that they were presently involved in a specific intervention to manage stress and anxiety. In addition, they agreed not to do so during the duration of the study.

Setting

Biofeedback sessions took place in the stress management lab in the Brigham Young University (BYU) Counseling and Development Center under the supervision of Dr. Michael Maughan, a psychologist and director of the stress management lab. Group meetings were held in a classroom in the Harris Fine Arts Center. Biofeedback sessions and group meetings were conducted by the primary researcher. The primary researcher's qualifications are a bachelor's degree in psychology and experience in biofeedback training and stress management.

Apparatus

An Autogen 1100 Feedback Myograph and a Biofeedback Systems DT-100 Thermal Instrument were used to provide analog and digital feedback. An Autogen HT-10 integrator was connected to the feedback myograph to provide a digital readout of EMG averages for successive 10-second intervals. The standard placement of a velcro head band with conductive gel and contact snaps was affixed over the frontalis muscles (approximately 1 inch above the eyebrows) for EMG feedback. Recording electrodes were attached to the contact snaps on the head band. The temperature sensor was affixed to the pointer finger of the right hand.

Treatment

Treatment consisted of six 35-minute biofeedback sessions and six 1-hour group meetings. Each group meeting consisted of learning a coping strategy to manage performance stress, namely, breathing awareness, muscle relaxation, and performance-coping imagery. Coinciding instruction was given during the biofeedback session on a professionally recorded tape with music to practice the strategy during the session. Group meetings and biofeedback sessions followed Meichenbaum's (1985) three-stage model for stress inoculation training, consisting of (a) instruction about the nature of performance stress, (b) training and rehearsal of a particular strategy, and (c) assignment to practice the strategy.

The procedure for biofeedback training entailed three sequential phases following hook-up to the instruments: (a) the initial 10 minutes to become comfortable in the lab with selected music, (b) 10 minutes of recorded instruction and music, and (c) 15 minutes of serf-initiated practice of the strategy with a continuation of the recorded music. A speaker hooked up to the EMG was turned on during the self-initiated practice phase to provide audiofeedback of relaxation and permit students to close their eyes. Readings were recorded during the initial phase and every minute thereafter during the instruction and practice phases.

During the initial phase, students were given the choice of one of three compact discs to listen to: Baroque Guitar by Julian Bream (1990), Peaceful Ocean Surf by Gentle Persuasion (1987), or Cristofori's Dream by David Lanz (1988). The instruction and music used subsequently was recorded by the primary researcher in the sound recording studio at Brigham Young University (BYU) with the help of Scott Sessions, a sound recording engineer, and Stephen Brannen, a pianist with a specialization in keyboard improvisation. The recorded music was done on a Yamaha DX7, a computerized, synthesized keyboard. Soft electronic tones with reverberation and softening effects were selected to encourage relaxation. The recorded music involved a simple, repetitive melodic line to avoid cognitive involvement and critical listening on the part of the music students. Scartelli (1984) found sedative music to enhance relaxation during biofeedback training.

Measures

Both self-report questionnaires and subjective rating scales were used to determine the effectiveness of treatment. State and trait anxiety were measured by the State-Trait Anxiety Inventory (STAI) which consists of 20 statements to evaluate how respondents feel "right now, at this moment" (S-Anxiety) and 20 statements to evaluate how respondents "generally feel" (T-Anxiety) (Spielberger, 1983). The internal consistencies for both scales are quite high (.92 for S-Anxiety and .90 for T-Anxiety) (Spieiberger, 1983). Debilitating and facilitating anxiety were measured by Wolfe's (1990) Facilitating/Debilitating Anxiety Scales. Five subjective questions on a 10-point rating scale were presented to students following treatment to identify students' perceptions of the most helpful components of treatment. Students in the Experimental and Waiting-list Groups completed the State-Trait Anxiety Inventory (Spielberger, 1983) and the Facilitating/Debilitating Anxiety Scales (Wolfe, 1990) prior to their fall 1991 and winter 1992 jury performances and completed the State Anxiety Scale prior to their weekly winter 1992 music lessons.

Research Design and Data Analysis

The difference between scores (posttest minus pretest) on the self-report questionnaires completed before students' fall 1991 and winter 1992 jury performances (before and after treatment) were compared to test the level of significance of treatment for both groups. The difference between scores (posttest minus pretest) on the State Anxiety Scale (S-Anxiety Scale) completed before students' music lessons (1st and 6th week of treatment) were compared to test the level of significance of treatment between the Experimental Group and the Waiting-list Control Group. Two periods (Period A and Period B) were analyzed to compare the S-Anxiety Scale scores for the first 6 weeks consisting of treatment for the Experimental Group and no treatment for the Waiting-list Control Group, Period A, and the second 6 weeks consisting of treatment for Waiting-list Control Group and no treatment for the Experimental Group, Period B. Analysis of Period A tested whether the S-Anxiety Scale, scores significantly differed for the Treatment Group compared to the Waiting-list Control Group. Analysis of Period B tested whether or not groups significantly differed following treatment for the Waiting-list Control Group and 6 weeks after the Experimental Group received treatment.

Analysis of covariance (ANCOVA) of the gain scores of each of the dependent measures was done to control for individual differences on initial scores and-to reduce the estimate of experimental error. Initial scores were used as the covariate and a standard procedure was followed to test for randomization of the covariate and to test for interaction between the covariate and treatment before proceeding with the analysis of covariance. Since students choose participation in either the Experimental Group or the Waiting-list Control Group (referred to as a restricted randomization procedure) a test for randomization of the covariate was important to make sure that groups did not significantly differ on the initial scores. Minitab statistical software (1989) was used for the analysis of the data.

Results

All students received the treatment. Distinction between the Experimental Group (n=9) and the Waitinglist Control Group (n=9) lay in immediate or delayed treatment.

Period A

A preliminary analysis of variance (ANOVA) of Period A revealed no significant differences (p=.603) between groups on initial S-Anxiety scores. Analysis of variance (ANOVA) revealed the interaction between treatment and covariate (T(*)C) to be non-significant p=.425). At this significance level, the decision was made to pool the T(*)C term into error. With both conditions satisfied, the decision was made to perform the Analysis of Covariance (ANCOVA) which revealed the treatment to be significant (p=.001) and the covariate to be non-significant (p=.110) (Table 1). Thus, a significant difference was found between the Experimental Group and the Waiting-list Control Group on the S-Anxiety Scale, while individual differences on scores, the covariate, did not significantly predict a reduction on the S-Anxiety Scale. A mean reduction of 7.36 adjusted for the covariate on the S-Anxiety Scale was found for the Experimental Group and a mean increase of 4.905 adjusted for the covariate on the S-Anxiety Scale was found for the Waiting-list Control Group.

Period B

A preliminary analysis of variance (ANOVA) for Period B revealed no significant differences (p=.716) between groups on the initial S-Anxiety scores. Analysis of variance (ANOVA) revealed the interaction between treatment and covariate (T(*)C) to be non-significant (p=.690). At this significance level, the decision was made to pool the T(*)C term into error. With both conditions satisfied, the decision was made to perform the Analysis of Covariance (ANCOVA) which revealed differences between groups on the S-Anxiety scores to be non-significant (p=.583) and the covariate to be nonsignificant (p=.079) (Table 2).

Thus, no significant difference in S-Anxiety scores was found between the Waiting-list Control Group following treatment and the Experimental Group 6 weeks following treatment. Mean reduction of S-Anxiety scores for Waiting-list Control Group was 3.643 adjusted for the covariate and mean reduction of S-Anxiety scores for the Experimental Group was 1.277 adjusted for the covariate. Figure 1 shows the change in mean S-Anxiety scores over Period A and Period B for groups.

Jury Scores

Students in the Experimental Group and the Waitinglist Control Group completed the State-Trait Anxiety Inventory and the Facilitating/Debilitating Anxiety Scales before fall 1991 and winter 1992 jury performances. Since a jury performance is a critical evaluation of a student's musical abilities by the music faculty, an important aspect of this study is to determine if there is a significant reduction of debilitative anxiety before jury performances (before and after treatment) for both groups. The data were analyzed to see if there was a significant reduction of S-Anxiety, T-Anxiety, Debilitating Anxiety and a significant increase of Facilitating Anxiety between fall 1991 and winter 1992 jury performances for both the Experimental and Waiting-list Control Groups. The model for this analysis is: Y(i)= u + X(i)+e, where X is the centered covariate and the significance of the gain score adjusted for the covariate is tested by a t-ratio.

Analysis of covariance revealed that the Experimental and Waiting-list Control Groups did not significantly differ in the level of stress reduction on any of the jury self-report measures and therefore, the decision was made to pool the scores for the Experimental Group and Waiting-list Control Group and test for the significance of the combined level of stress reduction on each of the measures with the above model. A mean gain score adjusted for the covariate of 3.89 was found for the Facilitating Anxiety Scale and was significant (t=3.94, p=.001). A mean gain score adjusted for the covariate for the Debilitating Anxiety Scale was found of -4.78 and was significant (t=-3.34, p=.004). A mean gain score adjusted for the covariate for the S-Anxiety Scale of- 10.16 was found and was significant (t=-3.70, p=.002). Finally, a mean gain score for the T-Anxiety Scale of-5.17 was found and was significant (t=-4.32, p=.001). Mean gain scores, t-ratios, and level of significance for each of the self-report jury measures are shown in Table 3.

Subjective Rating Scales

To identify students' perceptions of the most helpful components of treatment, students rated five questions on the following 10-point rating scale: 1 2 3 4 5 6 7 8 9 10 Not

Very Helpful

Helpful

A mean of 8.06 was found on the following question: The biofeedback training was helpful to me.

A mean of 8.44 was found on the following question: The group meetings were helpful to me.

A mean of 8.22 was found on the following question: I believe the strategies learned during biofeedback training and the group workshops will help me in my preparation for my jury or recital.

A mean of 8.83 was found on the following question: I would be confident in recommending the biofeedback training and group workshops to a friend who is anxious in situations involving performance.

A mean of 9.22 was found on the following question: I believe the biofeedback training and group workshops to be helpful in situations other than musical performance.

Of the coping strategies students reported helpful for performance situations, 83% reported breathing awareness, 100% reported muscle relaxation, 88% reported performance-coping imagery.

Discussion

Both research hypotheses are supported by the analyses (see Tables 1 and 3). A significant difference for Period A was found between the Experimental Group that received biofeedback training, selected coping strategies, and music relaxation interventions and the Waiting-list Control Group on the State Anxiety Scale (p=.001) completed before students' music lessons (1st and 6th week). Following the treatment intervention for both the Experimental and Waiting-list Control Groups, a significant reduction of anxiety was found on the Facilitating Anxiety Scale (p=.001), the Debilitating Anxiety Scale (p=-.004), the State Anxiety Scale (p=-.002), and the Trait Anxiety Scale (p=.001) completed before students' fall 1991 and winter 1992 jury performances.

The groups did not significantly differ on the State Anxiety Scale for Period B and both groups experienced a mean decrease on the State Anxiety Scale for this period. These findings may be important in evaluating the long-term effectiveness of the treatment intervention and are reported in this study as an expansion of the two main hypotheses. A more thorough follow-up is needed to determine the long term impact of the treatment approach.

Students reported the biofeedback and group meetings to be comparable in their overall helpfulness. These findings are supported by the Nagel, Himle, and Papsdorf (1989) study, which found an integrative approach to be effective for reducing debilitative performance stress.

A limitation of this study was that treatment was carried out in major part by the researcher. A method of pre-recording the relaxation tapes was used in order to standardize the treatment during biofeedback training. Also, group meetings followed a structured format and outline. While very little is known about the therapist's effects in relaxation training (Borkovec, Johnson, & Block, 1984), the external validity of this study is limited in the researcher's ability to generalize the findings of this study to other therapists differing in personality characteristics, style, level of experience, and other factors.

Conclusions

Based on the results of this study, the following conclusions are made:

A multifaceted treatment approach of biofeedback training, selected coping strategies, and music relaxation interventions may significantly reduce student's music lesson and jury performance anxiety.
This approach may significantly reduce state anxiety or anxiety that is reactive to performance situations in addition to trait anxiety and debilitative anxiety.
Recommendations

It is notable that students rated the relative effectiveness of biofeedback training and group meetings to be comparable with a mean of 8.06 for the biofeedback training and 8.44 for the group meetings. Two students reported neutral ratings (5) for biofeedback training, while the remainder of students reported that the biofeedback training was very helpful. The rationale for including both biofeedback training and group meetings as components for treatment was to help students integrate biofeedback training with an overall performance anxiety management program outside of the biofeedback lab. Future researchers may want to evaluate the effectiveness of other integrative modalities with biofeedback training.

This study sought to determine the effectiveness of treatment to reduce debilitating performance anxiety. An important research question would be to determine the impact of treatment on general areas of a music student's life outside of performance. Stated another way, how much influence does a student's general lifestyle and habits have on performance anxiety and quality? And, do biofeedback training, selected coping strategies, and music relaxation interventions modify general lifestyle habits and functioning that interfere with performance? Students gave the highest rating (mean of 9.22) to the question: I believe the biofeedback training and group workshops to be helpful in situations other than musical performance. A recommended procedure for future research would be to have students answer the State- Trait Anxiety Inventory at randomized non-musical interval periods and compare these scores with the scores of the same questionnaires before musical performance intervals.

Six weeks was the length of treatment. Future studies with biofeedback interventions might profitably study the effectiveness of longer 8- or 12-week treatment periods. While most students seemed to experience treatment gains after 6 weeks, longer treatment periods are recommended for students with specialized needs.

Music students in this study represented all levels of year in college (freshmen through graduate students) and represented a wide variety of instrumental and vocal majors. Because jury performances and recitals are important for college advancement, future treatment interventions might profitably include analogous college levels and categories of instrumental and vocal majors.

Participants in this study represented students who reported high debilitative anxiety in the department of music at Brigham Young University (BYU). Because of the subtle nature of performance-related problems, music students in general would benefit from training to teach active and preventative skills to cope with the demands of performing, an approach taken by an increasing number of conservatories and music departments.

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Article copyright MMB Music, Inc.

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By Brand Keola Niemann; Rosalie R. Pratt and Michael L. Maughan

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