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Updated: Jan 20, 2026
Types of Risk: Systematic Risk
Performance anxiety in professional musicians: a systematic review on prevalence, risk factors and clinical treatment
I Fernholz1,2,3, J L M Mumm1,2, J Plag1,2
1Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany.
Abstract:
Music performance anxiety (MPA) is one of the most common disorders among professional musicians, nevertheless, little is known about the disease. With this systematic review, prevalence, risk factors and treatment procedures for MPA were assessed, and for the first time, quality assessments were carried out for all studies using standardized assessment tools. A systematic literature search was conducted via search algorithms in the databases MEDLINE, EMBASE, CINAHL, PsycArticles, PsycInfo and ERIC. Included were case reports, case-control, cohort, cross-sectional and intervention studies examining professional musicians with MPA. For quality assessment, adapted tools of the National Heart, Lung, and Blood Institute were used. A total of 43 studies were included (10 case reports, 21 intervention, 11 cross-sectional, one cohort study). Quality ratings ranged from -11 to 6 out of a maximum of 15/16 points for cross-sectional/cohort studies and -4 to 11 out of 18 points for intervention studies. The prevalence of MPA was between 16.5% and 60%. More women than men were affected and musicians older than 45-50 years reported less MPA than younger musicians. Regarding treatment cognitive behavioural therapy (CBT) and β-blockers were most often researched with beneficial results for CBT. However, studies with adequate control groups for CBT interventions are needed to clarify its efficacy. Studies showed methodological weaknesses, especially in the selection of participants, recording of influencing factors, blinding of interventions, randomization of participants and analysis of comorbidity. Recommendations for further research are made.
Insights
Music performance anxiety (MPA) affects many musicians, with prevalence ranging from 16.5% to 60%. Cognitive behavioral therapy (CBT) shows promise, but more research is needed to confirm its effectiveness and address study limitations.
Area of Science:
- Psychology
- Music Performance
- Mental Health
Background:
- Music performance anxiety (MPA) is a prevalent issue among professional musicians, yet its understanding remains limited.
- Existing research on MPA lacks comprehensive quality assessments, hindering evidence-based practice.
Purpose of the Study:
- To systematically review the prevalence, risk factors, and treatment of MPA in professional musicians.
- To conduct quality assessments of included studies using standardized tools for the first time.
Main Methods:
- A systematic literature search was performed across multiple databases (MEDLINE, EMBASE, CINAHL, PsycArticles, PsycInfo, ERIC).
- Included studies encompassed case reports, case-control, cohort, cross-sectional, and intervention designs focusing on professional musicians with MPA.
- Quality assessment utilized adapted tools from the National Heart, Lung, and Blood Institute.
Main Results:
- Forty-three studies were included, with quality ratings varying significantly.
- MPA prevalence ranged from 16.5% to 60%, with higher rates in women and younger musicians.
- Cognitive behavioral therapy (CBT) and beta-blockers were common treatments, with CBT showing beneficial results, though further research with control groups is recommended.
Conclusions:
- MPA is a widespread condition in professional musicians, with identifiable demographic risk factors.
- Current research on MPA treatments, particularly CBT, shows potential but requires more rigorous study designs.
- Methodological weaknesses in existing studies necessitate recommendations for future research to improve understanding and treatment of MPA.
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