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Am J Psychiatry 1991; 148:598-605
Copyright © 1991 by American Psychiatric Association
The assessment and treatment of performance anxiety in musicians
DB Clark and WS Agras
Department of Psychiatry, Stanford University Medical Center, Calif.
OBJECTIVE: Performance anxiety in musicians may be severe enough to require
intervention but has been the subject of relatively little clinical
research. The authors' objectives were to describe the results of a
comprehensive clinical and laboratory assessment and to perform a
double-blind, placebo-controlled study comparing buspirone, cognitive-
behavior therapy, and the combination of these treatments for performance
anxiety. METHOD: Ninety-four subjects were recruited by mass media
announcements and were seen in a university-based outpatient psychiatric
clinic. Assessments were 1) questionnaires for all 94 subjects, 2)
diagnostic interview of 50 subjects, and 3) laboratory performance of 34
subjects. Treatment conditions were 1) 6 weeks of buspirone, 2) 6 weeks of
placebo, 3) a five-session, group cognitive- behavior therapy program with
buspirone, or 4) the cognitive-behavior therapy program with placebo.
Treatment outcome measures included subjective anxiety ratings and heart
rate measures during a laboratory performance, a questionnaire measure of
performance confidence, and a blind rating of musical performance quality.
RESULTS: All subjects fulfilled criteria for DSM-III-R social phobia. Of
the 15 full-time professional musicians, ten had tried propranolol and
three had stopped performing. Most of the subjects had substantial anxiety
and heart rate increases during laboratory speech and musical performances.
Cognitive- behavior therapy resulted in statistically significant
reductions in subjective anxiety, improved quality of musical performance,
and improved performance confidence. Buspirone was not an effective
treatment. CONCLUSIONS: Cognitive-behavior therapy is a viable treatment
approach for performance anxiety in musicians.
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