Shaw, Juncos & Winter 2020

Piloting a New Model for Treating Music Performance Anxiety: Training a Singing Teacher to Use Acceptance and Commitment Coaching With a Student

Thus far, treatments for music performance anxiety (MPA) have focused primarily on interventions administered by psychologists and mental health clinicians with training and education in psychotherapy. While these interventions are promising or even efficacious, many musicians prefer not to work with a psychotherapist due to stigma and lack of time/access. Student musicians are particularly vulnerable to developing MPA, and while they may prefer consulting with their teachers about MPA over psychotherapists, many teachers feel unqualified to help. Here, we investigated an alternative intervention model, in which a clinical psychologist with MPA expertise trained a singing teacher with no training or education in psychotherapy to use an evidence-based coaching model, Acceptance and Commitment Coaching (ACC), with a student vocalist with problematic MPA, in a single-subject design format. ACC is a version of Acceptance and Commitment Therapy (ACT) that has been used under various names with non-clinical populations to help enhance psychological flexibility, e.g., with athletes, at the workplace, with undergraduates, and others. The teacher received approximately seven hours of ACC training via Skype. In turn, she provided six one-hour ACC sessions to a university student vocalist. Materials for the training and coaching sessions were taken from an ACC book and an ACT-based self-help book for musicians, and the teacher also adhered to a GROW model of coaching. The student made clinically significant improvements in two ACT-based processes believed to correlate with improved psychological flexibility in previous ACT for MPA psychotherapy research, i.e., acceptance of MPA-related discomfort and defusion from MPA-related thoughts. The student also reported a significant shift had occurred in his thinking: he became more willing to have his MPA, and so he volunteered to sing in classes early in the upcoming semester, and he auditioned for & won a lead role in a musical, both of which he previously avoided doing. ACC appears to be a promising MPA intervention that can be administered by a music teacher without training or education in psychotherapy, and it may help schools who do not employ psychologists and are therefore unable to follow best practice guidelines for treating MPA

Clarke, Osborne & Baranoff 2020

Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists

Music performance anxiety (MPA) is a distressing and persistent anxious apprehension related to musical performance. The experience of MPA forces many musicians to give up performing or develop maladaptive coping mechanisms (e.g., avoidance or substance use), which can impact their career and wellbeing. High levels of MPA in students and vocalists are reported in the literature. Vocalists present a unique challenge for clinicians in that vocal and breathing mechanisms, required for performance, are negatively impacted when anxious. Acceptance and commitment therapy (ACT) has demonstrated efficacy for the treatment of a range of psychological problems including social anxiety disorder (of which MPA may be indicated as a subtype). This study sought to investigate whether group-based ACT may be a feasible and effective intervention for MPA in Australian student vocalists and aimed to design an intervention that could be adopted by music education providers. Potential participants (N = 31) completed an online survey including demographic questions and outcome measures. Six vocal students (four females; two males; aged M = 20.33 years) with elevated MPA scores participated in the ACT for MPA group program and 3-month follow-up. Group sessions were 2 h each week for six consecutive weeks. Participants were followed up 3 months post-intervention via online survey. There was a significant increase in psychological flexibility and significant decreases in MPA and psychological inflexibility. Gains were maintained at 3-month follow-up. The current study offers preliminary evidence for the feasibility and effectiveness of a group-based ACT protocol for musicians with performance anxiety which may be incorporated into tertiary performance training curricula.

Juncos & de Pavia e Pona 2018

Acceptance and commitment therapy as a clinical anxiety treatment and performance enhancement program for musicians

In this article the authors discuss the various options available to musicians wanting to treat their music performance anxiety (MPA), and they recommend that musicians work with a performance psychologist over the other available options. The authors also discuss the potential for Acceptance and Commitment Therapy (ACT) to serve as both a clinical anxiety treatment and performance enhancement program for musicians, while addressing the state of the research for both applications, as well as the research for a similar, mindfulness and acceptance-based performance enhancement program for athletes, i.e., the Mindfulness–Acceptance–Commitment (MAC) approach.

In order for the field of performance psychology to develop into a more credible discipline, the authors believe practitioners working with musicians should follow an evidence-based practice model of care, in which empirically supported treatments for MPA and performance enhancement are promoted, and information about such treatments is disseminated among practitioners, musicians, and music teachers. Such a practice must become the norm in this field, because it will ultimately result in greater protections for those musicians seeking help for performance-related challenges by ensuring a higher level of professional accountability among practitioners. Lastly, the authors discuss some issues that may arise when applying ACT or the MAC approach to musicians.

Juncos et al 2017

Acceptance and Commitment Therapy for the Treatment of Music Performance Anxiety: A Pilot Study with Student Vocalists

This study investigated the use of Acceptance and Commitment Therapy (ACT) as a treatment for music performance anxiety (MPA) in an uncontrolled pilot design. ACT is a newer, “third-wave” therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT “Hexaflex.” A small group of student vocalists (N = 7) from an elite choral college were recruited using objective criteria for evaluating MPA. Participants received 12 ACT sessions, and their baseline functioning served as a pre-treatment control. Treatment consisted of an orientation to ACT, identifying experientially avoidant behaviors, facilitation of Hexaflex processes, group performances in which valued behaviors were practiced in front of one another, meditations, homework, and completion of self-report measures before, during, and after treatment (at a 1- and 3-month follow-up). Improvements were observed in participants' cognitive defusion, acceptance of MPA symptoms, and psychological flexibility at post-treatment and follow-ups. Students also appeared to improve their performance quality and reduce their shame over having MPA. These results add to existing research suggesting ACT is a promising intervention for MPA, while also highlighting how vocal students may be less impaired by physical MPA symptoms.

Juncos & Markman 2015

Acceptance and Commitment Therapy for the treatment of music performance anxiety: A single subject design with a university student

This study marks the first application of Acceptance and Commitment Therapy (ACT) to the treatment of a university student with music performance anxiety (MPA). ACT is a newer, “third-wave” therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT “hexaflex.” For this study, an undergraduate violinist with debilitating MPA received a 10-session ACT treatment using a single-subject design. Treatment consisted of an orientation to ACT, identification of experientially avoidant behaviors, facilitation of hexaflex processes, in-session performances in which valued behaviors were practiced, meditations, homework, and regular completion of ACT-based and symptom-based measures. Clinically significant improvements were observed in her ability to accept and defuse from her anxious thoughts and feelings at post-treatment and at a 1-month follow-up. Her performance quality also improved at post-treatment. Although symptom reduction was not a goal, her MPA and overall distress were significantly reduced, and her perceived control over MPA significantly improved at post-treatment and follow-up. These results suggest ACT may be an effective treatment option for MPA and should be studied further.