Ego-Strengthening and Visualization: Self-hypnosis for Music Performance Anxiety

B. Irons 1 “Ego-strengthening and Visualization: Self-hypnosis for Music Performance Anxiety” Benjamin Irons, CHt, CMI

I. Introduction Henry Ford reminds us that “one of the greatest discoveries a man makes, one of his greatest surprises, is to find he can do what he was afraid he couldn’t do.” There are several studies indicating a notable presence of Music Performance Anxiety (MPA) in the music community. The International Conference of Symphony and Opera Musicians National US survey (1988), distributed to 48 orchestras (2212 respondents) reported that 25% of musicians suffered stage fright, 13% acute anxiety and 17% depression.1 A large number of musicians (professional and amateur) experience MPA in the high-pressure performance situations similarly experienced by athletes, yet this issue rarely discussed in a constructive manner in the music community. When the subject does arise the two most common solutions are to either practice more, or take beta-blockers to manage the symptoms. Beta-blockers—a medication used to reduce blood pressure--are a stop-gap, at best. While they can manage the physiological symptoms of anxiety (heart palpitations, feeling of edginess, breathlessness, “butterflies” and nausea, dry mouth, blurred or “tunnel” vision, sweaty palms and forehead, as well as, “pins and needles” in the muscles2), the drugs do nothing to tackle the root cognitive causes of the anxiety.

Through ego-strengthening (planting positive suggestions directly into the subconscious during a trance state), hypnotherapy works in totality to treat the physical, emotional, and mental components of anxiety, preventing debilitating MPA from arising.

Kenny, Dianna T., Pamela Davis, and Jenni Oates. “Music Performance Anxiety and Occupational Stress Amongst Opera Chorus Artists and Their Relationship with State and Trait Anxiety and Perfectionalism.”

Journal of Anxiety Disorders 18 (2001): 759.

2 Wilson, Glenn. “Performance Anxiety.” The Social Psychology of Music (1997): 229.

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B. Irons 2 Previous research covers the effects of MPA on performers, yet very little research has been done regarding the use of hypnotherapy as a possible treatment, and none explain how to use self-hypnosis as a tool. The literature discusses what MPA is, and who is seemingly susceptible, but that’s where the trail ends. There are several research components that indicate hypnotherapy is a successful treatment option: a) anxiety exists in music, sports, academic testing, and public speaking; b) hypnotherapy is known to ameliorate the root causes of anxiety; and, c) hypnotherapy has been used to treat anxiety in athletes. It would be an incalculable service to the music community to connect the final dot, not only showing hypnotherapy as a viable and effective treatment modality for MPA (as it has been shown successful for athletes) but going one step further to outline how musicians can use self-hypnosis for their benefit. Until musicians are better educated on techniques like self-hypnosis, betablockers will persist as an ineffective crutch to alleviate MPA. Hypnotherapy treats the totality (the mind, body, and emotions) of root causes for anxiety through performance visualization and ego-strengthening in a trance state, reprogramming the performer’s subconscious for success.

The practice is more effective than medication designed to only manage the physiological symptoms of “stage fright.”

II. Thesis Paragraph While there is little research on MPA, there is evidence to support self-hypnosis has been successful in the areas of sports psychology, public speaking, and academic testing3. I have found several strong articles in support of my hypothesis, ranging from the sports realm into music. These resources will serve as a foundation for addressing anxiety in a music performance setting; specifically, the use of self-hypnosis as a tool for an ego-strengthening regimen leading 3

Liggett, Donald. Sport Hypnosis. Champaign, IL: Human Kinetics, 2000.

B. Irons 3 up to a performance or audition. I will not only show why hypnotherapy is a better solution than simply ingesting beta-blockers, but will give instructions and samples scripts for creating a customized self-hypnosis program for musicians.

I will begin my thesis with a brief summary of MPA and its presence in the music community. I will briefly define and summarize hypnosis and the common components of a hypnotherapy session. I will outline the advantages and disadvantages to both hypnotherapy and beta-blockers. Through previous research literature, I will connect the dots from sports psychology to music psychology, advocating for hypnotherapy as a viable treatment modality.

My ultimate goal is to provide the skills for musicians to create a customized self-hypnosis script that they may record and use while preparing for an audition or performance. For this to be effective, my audience needs to feel confident in the process. This is achieved by debunking common misconceptions around hypnosis, and educating in regards to its numerous strengths.

Finally, after showing the efficacy of hypnotherapy, I will create directions for creating a customized self-hypnosis script and recording. I believe not only showing why, but how to use hypnotherapy is a critical step currently missing in this field.

III. Literature Review There are several sources pertaining to the various components of my topic, yet few that have connected all the dots—and none that actually show the path to healing. There is research on anxiety; hypnotherapy; anxiety’s presence in high-performance scenarios; hypnotherapy’s efficacy toward anxiety; and, therefore, hypnotherapy as a viable treatment modality for athletes, academic testing, and public speaking. All that remains is to connect those final dots tying hypnotherapy to musicians, and to show how one can use hypnotherapy as a treatment modality.

B. Irons 4 Research has categorized MPA as a social phobia stimulated by “performing or behaving in front of other people and by anticipating the negative evaluation that may result.”4 Glenn Wilson’s 1997 article Performance Anxiety outlines the common characteristics, symptoms, and occurrences of MPA. Noting the similarity to the “fight-or-flight response”, Dr. Wilson points to symptoms consisting of: “(1) the heart pumps harder to supply oxygen to the muscles, (2) the liver releases stored energy (feeling of ‘edginess’), (3) the lungs work harder and airways widen, (4) the stomach and gut shut down so that energy is diverted to the muscles (‘butterflies’), (5) body fluids such as saliva are redirected into the bloodstream (dry mouth), (6) there is a sharpening of the vision, (7) the skin sweats to cool the working muscles, and (8) calcium is discharged from tense muscles.”5 Dr. Andrew Steptoe noticed that all the physical systems performers need to be successful are put into jeopardy by excessive tension and the physiological symptoms of MPA. Managing these symptoms is crucial to giving a peak performance, but the physiological problems are only one component of MPA. Beta-blockers are not designed to manage the cognitive avenue of anxiety. This can only be addressed through positive self-talk, or “ego-strengthening” as British hypnotherapist Dr. John Hartland termed it.

There are overlapping ideas in previous literature geared towards treating MPA. Wilson cites four techniques for managing MPA symptoms: drugs, behavior therapy, Alexander technique, and hypnotherapy. Steptoe (University College London) also cites drugs and hypnotherapy. Dr. H.E. Stanton (University of Tasmania) is a firm supporter of hypnotherapy.

Dr. McGinnis (Ph.D. Pennsylvania State) has written about biofeedback, hypnosis, cognitive therapy, music therapy, and medication as possible solutions for MPA. Each avenue has their

Anne M. McGinnis and Leonard S. Milling, “Psychological Treatment of Musical Performance Anxiety: Current Status and Future Directions.” Psychotherapy: Theory, Research, Practice, Training 42 (3)(2005): 357.

5 Wilson, “Performance Anxiety,” 229-230 4

B. Irons 5 own benefits and drawbacks, but hypnotherapy shows the most promise for customizable treatment of all the mental, emotional, and physical symptoms of MPA. Wilson notes that drugs “may get musicians through the performance but they have sideeffects that are detrimental in the long run.”6 In addition to alcohol, tranquilizers, and recreational drugs, about a quarter of performers use beta-blockers, with or without prescription, in an effort to manage the symptoms of their anxiety. This practice has its own risks including “loss of sexual potency, sleep disturbance, baldness, nausea, tiredness, and blunting of affect”7 [emotional numbness]. Steptoe’s research coincides with Wilson’s negative drawbacks to betablockers, noting individuals show discomfort with the numbness (blunting of affect), and despite physical calm, their cognitive symptoms persisted, and the negative chatter was a continued distraction.

According to the research, behavior therapy, biofeedback, and Alexander technique are viable treatment options. The aim of behavior therapy is to replace “self-handicapping” with positive self-talk. Steptoe, and many others, have found “the performer’s internal dialogue or inner speech plays an important part in exacerbating anxiety.”8 Musicians with negative self-talk are prone to “catastrophizing.” It is one objective of a practicing hypnotherapist to craft positive self-talk, empowering the performer through “ego-strengthening.” In hypnotherapy, this is accomplished in a trance state, allowing the positive suggestions to be programmed directly into the subconscious. Dr. Hartland notes a marked improvement of his patients through this technique, citing a boost in both confidence and self-reliance. “[They] find it easier to adjust to

Wilson, “Performance Anxiety,” 238 Ibid., 238 8 Andrew Steptoe, “Performance Anxiety: Recent Developments in its Analysis and Treatment,” The Musical Times 123 (1674)(August 1982): 539.

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B. Irons 6 [their] environment, and are consequently much less likely to relapse.”9 Wilson admits Alexander technique (AT) is more of “a craze in Britain” while remaining relatively unknown in the United States. AT is based on “kinesthetic re-education” replacing bad habits—postural or cognitive (as in this case)—with good habits. Dr. Wilson’s conclusion finds that “the most successful treatment approaches are those that combine relaxation training with anxiety inoculation (developing realistic expectations relating to autonomic symptoms) and cognitive restructuring (modifying self-talk in a positive direction).10 Hypnotherapy fits this description the best, with a session consisting of a progressive relaxation, a “deepener” (inducing the trance state), ego-strengthening and the planting of positive suggestions, and concluding with an “awakening” sequence.

Another off-shoot of MPA research pertains to the timing of anxiety, and what Jon Gorrie describes as the “zone of optimal functioning.” This zone indicates the appropriate level of “arousal” (your “state of mind before and/or during a performance”).11 Some level of arousal is necessary to each performance. Positive arousal is “excitement,” while negative arousal is “anxiety.” Both Steptoe and Kenny (University of Sydney) note that the best performances occur when the musician is at an intermediate level of arousal. Wilson draws conclusions between amateurs and professionals with anxiety: “Experienced performers learn to let their arousal peak just before the performance, whereas less experienced performers suffer anticipatory anxiety which builds over a long period of time and reaches its peak during performance itself.”12 This information is useful to a hypnotherapist when creating positive imagery for the session.

John Hartland, “The Value of ‘Ego-Strengthening’ Procedures Prior to Direct Symptom-Removal Under Hypnosis,” The American Journal of Clinical Hypnosis 8 (2)(Oct 1965): 90.

10 Wilson, “Performance Anxiety,” 243 11 Jon Gorrie, Performing in the Zone (CreateSpace Independent Publishing Platform, 2009), 25.

12 Wilson, “Performance Anxiety,” 236 9

B. Irons 7 Knowing when anxiety is likely to occur gives the practitioner the advantage to turn the situation around before any chance of “catastrophizing” can occur.

Most literature relevant to MPA and hypnosis refers to a study performed by Australian hypnotherapist, Dr. H.E. Stanton. In 1994 Stanton conducted MPA research on 40 conservatory students, “identified by their teachers as being prone to anxiety.”13 Similar to the components Wilson champions, Stanton’s hypnotherapy sessions (two 50-minute sessions) combined progressive relaxation, positive performance imagery, and ego-strengthening. Stanton felt “people need to think differently about whatever it is that is creating their anxiety and this may often be accomplished through a blend of relaxation, verbal suggestion, and mental imagery.”14 The results reported that the “hypnosis group reduced self-reported anxiety more than the control group” and “there was another significant reduction in self-reported anxiety at a 6-month followup.”15 Not only is the hypnotherapy effective after the initial session, but maintains its efficacy over time. The Stanton article is important because it supports my hypothesis and Stanton claims that after his positive results “further investigation of the use of hypnotherapeutic methods in the alleviation of performance anxiety would therefore appear to be warranted.”16 His publication also outlines the positive imagery he used in his sessions, and why they were affective on anxiety. I can his research as a foundation for creating my sample scripts.

There is one large drawback to hypnotherapy, presented by McGinnis: “there are large individual differences in responsiveness to hypnosis, and not all musicians will be appropriate

McGinnis, “Psychological Treatment,” 362 H.E. Stanton, “Reduction of Performance Anxiety in Music Students,” Australian Psychologist 29 (2)(1994): 127.

15 McGinnis, “Psychological Treatment,” 363 16 Stanton, “Reduction,” 127 13 14

B. Irons 8 candidates for it.”17 She is absolutely correct, and the hypnotic suggestibility of a candidate should (and typically is) tested before continuing on to the therapeutic stage. However, this individual responsiveness is also a massive strength for hypnotherapy. Indeed, everyone responds to hypnosis differently, but they also respond to stress differently. It’s important to find a treatment that is as customizable to the performer as their individual response to stress. Drugs, like beta-blockers, are not able to be individually tailored the way hypnosis is.

V. Relevance and Conclusion Research has shown a high percentage of both amateur and professional performers experience anxiety18. MPA takes root at an early age and can continue to affect even professional musicians, some to a debilitating level. While there is some research pointing the way to cognitive behavior modification techniques, like hypnotherapy, none are published with the goal of showing musicians how they can achieve amelioration through self-hypnosis. A regimen of self-hypnosis leading up to a performance or audition, utilizing customized ego-strengthening suggestions and visualizations, is significantly more effective at treating MPA than relying on drugs like beta-blockers. The benefits of beta-blockers do not outweigh the negative side-effects; whereas, hypnotherapy treats mental, physical, and emotional causes of anxiety without any side-effects. Only by openly discussing MPA in early stages of music education, can we begin to identify and help those students who show signs of MPA at a young age. With positive reinforcement in a trance state, players not only develop better resilience to high-stress situations but also experience higher emotional intelligence and greater confidence toward challenges— McGinnis, “Psychological Treatment,” 370 Sarbescu, Paul and Madalina Dorgo. “Frightened by the Stage or by the Public? Exploring the Multidimensionality of Music Performance Anxiety.” Psychology of Music, 42 (4)(July 2014): 568.

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B. Irons 9 both essential to high-quality musical performances. In the future, we must also begin to investigate other contemplative and behavior modification practices, such as meditation and Neuro-Linguistic Programming, and how they can be used to advance the realm of music psychology.

VII. Outline A. Abstract B. Lit. review a. Wilson “Performance Anxiety” b. McGinnis “Psychological Treatment…” c. Stanton “Reduction…” d. Hartland “Value of Ego-Strengthening…” e. Steptoe “Performance Anxiety…” f. Kenny, et. al. “MPA amongst Choral...”

C. Defining MPA a. What is it? b. Who is susceptible? c. Why do we care?

D. Defining Hypnosis a. What is hypnosis? i. Clinical definition ii. Practical definition

B. Irons 10 b. Misconceptions of Hypnosis19 i. “It’s only for the weak-minded.” ii. “What if I don’t wake up?” iii. “Hypnosis will cause me to lose control and reveal my secrets.” iv. “Hypnosis has harmful effects.” v. “Hypnosis is a state of sleep.” vi. “Hypnosis is a form of brain washing.” c. How does hypnosis help anxiety? i. Progressive relaxation ii. Body-scan iii. Ego-strengthening (Positive self-talk) iv. Visualization v. Post-hypnotic suggestion d. How does that apply to MPA? What circumstances is hypnosis appropriate for music anxiety? e. Advantages and disadvantages of the practice i. Advantages 1. Customizable 2. Treatment totality 3. Lasting effects 4. No side-effects ii. Disadvantages

Allen Chips, Clinical Hypnotherapy: A Transpersonal Approach (2nd edition, NC: Transpersonal Publishing, 2010), 74.

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B. Irons 11 1. Trusting the practice 2. Not for everyone (suggestibility) a. Better for right-brained creatives than left-brained logics b. Can be tailored to the individual 3. Requires patience, open mind, and discipline; not just a pill E. Hypnosis versus Beta-blockers a. Drugs are bad i. Steptoe, “MPA Developments…”, 539 ii. Wilson, “Performance Anxiety”, 238-239 iii. Sanders, “Wise Alternative” F. Creating a self-hypnosis script/recording a. The text b. The voice c. Time d. Environment G. Appendix a. Glossary of hypnotherapy terms H. Comprehensive Bibliography

B. Irons 12 Annotated Bibliography Azodi-Deylami, Cherie. “Self-hypnosis as a Treatment Intervention for Anxiety among Artists.” Psy.D. diss., The Chicago School of Professional Psychology, 2015.

This dissertation is a case study on the self-hypnosis as a tool for alleviating stress and anxiety in artists (plastic arts). As with most case studies, there is a fair amount of statistical data to weed through. Azodi-Deylami does summarize the impact of stress on artists’ lives. The article also showed a marked improvement on stress with the use of selfhypnosis. There is an interesting section about the innate characteristics of “artists” and the way they express themselves (and their stress). She advocates that healthcare professionals take these personality “quirks” into consideration when developing a treatment plan for stress. Due to the internal and creative processes utilized in hypnotherapy, that treatment modality is especially effective on artistic individuals.

Carich, Mark. ”Hypnotic Techniques and Adlerian Constructs,” Individual Psychology: The Journal of Adlerian Theory, Research & Practice 46 (2)(June 1990): 166-177.

This article (intended for therapists with little knowledge of hypnosis) goes into detail on several approaches to breaking down the chunks of a hypnotherapy session. Each session follows a specific flow: progressive relaxation, deepener, therapy, post-hypnotic suggestion, and awakening. Carich’s article breaks down each of those sections further and gives suggestions and tactics for carrying out the behavior modification. The bulk of the article focuses on the therapy section, which is useful in the scripts I’ll be devising. Adlerian psychology is a somewhat antiquated pillar—though still a pillar--that is making a resurgence due to its aversion with pharmaceuticals, aligning itself with modern homeopathic ideologies.

Mark S. Carich, PhD, is coordinator of the Sexually Dangerous Persons Program with Illinois Corrections at Big Muddy River Correctional Center. He is currently Adjunct Professor in the Counseling Department at Lindenwood University, and was affiliated with the Adler School of Professional Psychology.

Carich, Peter. “Ego Strengthening: Encouragement via Hypnosis,” Individual Psychology: The Journal of Adlerian Theory, Research & Practice 46 (4)(Dec. 1990): 498-502.

This article provides a sample script from the Adlerian techniques of hypnosis, which focus primarily on ego-strengthening as their treatment modality. This technique uses repetition of positive self-talk to help a person change their perception of self, focusing

B. Irons 13 on the release of tension, frustration, anxiety, apprehension, and nervousness. The script is simple, easy to understand, but a little too specific. The script calls for counting down from 100, which is unnecessary; and, the scenery in the suggestion leave little room for the patient to create their own version. Carich briefly theorizes that low self-esteem is a result of an accumulation of a lifetime’s worth of negative social interactions. These feelings result in a dubious acceptance of love and positivity, leading to the conditions where anxiety might occur. There is a nice definition of “ego-strengthening,” which might be useful later.

The script is designed for practicing hypnotherapists and psychotherapists, though it’s easily understood and accessible by anyone looking to dive deeper into the world of hypnotherapy.

Clark, Duncan and W. Stewart Agras. “The Assessment and Treatment of Performance Anxiety in Musicians.” American Journal of Psychiatry 148 (5)(May 1991): 598-605.

This article is an academic study of professionals musicians with performance anxiety assigned to one of four treatment conditions: cognitive-behavior therapy with a placebo, cognitive-behavior therapy with buspirone, buspirone alone, and placebo alone to see how these professionals responded to treatment. This study is interesting because three of the full-time professionals quit performing as a result of their anxiety, indicating the condition can potentially cause occupational disability. The overall results also corresponded with cases of social phobia, re-categorizing performance anxiety as such. The individuals who underwent a treatment of cognitive-behavior therapy responded significantly better than the other groups, and also, above the statistics tied to betablockers.

Dr. Clark is a psychiatrist and psychologist at the Center for Psychiatric and Chemical Dependency Services at the University of Pittsburgh Medical Center. This research, intended for practicing physicians (and those with a working knowledge of hypnotherapy), won Dr. Clark the American Psychiatric Association Resident Research Award in 1990.

Gorrie, Jon. Performing in the Zone. CreateSpace Independent Publishing Platform, 2009.

This is a self-help coaching guide to cultivating a space for effortless performance.

The book is broken into four parts: the theory, the technique, the programme (12 weeks), and “digging deeper”. The book is intended for all performing artists: actors, dancers, musicians, models, etc. It’s very easy to understand and yields effective results—the

B. Irons 14 techniques evolved from Neuro-linguistic programming. This book is an excellent resource for various techniques and strategies leading to a successful performance or audition.

Jon Gorrie is a professional trumpet player and performance coach. Originally from New Zealand, Gorrie studied and has performed professionally in Sweden, Austria, and Norway. He also does private coachings through his website.

Green, Barry, and Timothy Gallwey. ”Confidence: From Bravura to Integrity.” In The Mastery of Music: Ten Pathways to True Artistry, 188-215. New York: Broadway Books, 2003.

The book, overall, is a great resource of “musicianship,” and by highlighting the ultimate goals in a practice or performance, would work well as a template for crafting scripts. There are endless suggestions that can be drafted and drawn from this resource.

The text is intended for musicians to help them embrace qualities that bolster higher musicianship. This particular chapter encompasses “confidence,” and expands on ways to cultivate it, reinforced by professional artist testimonials. The chapter is broken into sections: pathways to confidence, sustaining confidence, mind-body confidence, and types of confidence.

Barry Green was the principal bassist for the Cincinnati Orchestra, but is now based out of California. He was also a co-author of The Inner Game of Music. Both that text and this one were written with Tim Gallwey, author and life coach.

Hammer, Max. “The Directed Daydream Technique,” Psychotherapy: Theory, Research, and Practice 4 (4)(Nov. 1967): 173-181.

This article is intended for practicing therapists, and dissects a “European practice” that, as of 1967, had not been used much in the States. The Directed Daydream Technique is a shallow form of hypnosis—in that, the client is speaking to the practitioner throughout the entire session, describing the scene and the “conflict”. The benefits of this practice is how customizable the suggestions can be due to the real-time interaction with the trance state. The downside being the patient keeps the conscious mind connected, in order to verbalize the daydream. There is a section on symbols, which is always helpful. The article is well-written, describing the principles of the technique: symbol confrontation, principle of feeding, principle of reconciliation, principle of magic fluids, and the principle of exhausting and killing. There are also a self-guided section, and case studies.

B. Irons 15 Dr. Max Hammer was a professor of clinical psychology at the University of Maine, beginning in the 1960’s. He is known for his Humanistic and Transpersonal approaches in his work.

Hartland, John. “The Value of ‘Ego-Strengthening’ Procedures Prior to Direct SymptomRemoval Under Hypnosis,” The American Journal of Clinical Hypnosis 8 (2)(Oct 1965): 8993.

Dr. Hartland’s article discusses the use of ego-strengthening as a valued component of each hypnotherapy session. As an older article, he’s making claims that are now well understood, advocating against any dangers (anxiety or substitute symptoms) that result from ego-strengthening in symptom-removal hypnosis. Intended for practicing physicians (along with those with a working knowledge of hypnosis), the article contains background on ego-strengthening, a sample script, and a case study supporting his claim.

Dr. Hartland was a psychiatrist, member of the British Society for Medical and Dental Hypnosis—BSMDH, and editor of the Journal of Medical Hypnosis. He played a historical role in developing ego-strengthening in the field of hypnosis. This article will be important to my research as a pillar for ego-strengthening in the field of hypnotherapy, and how I can tie that into my own writings.

Heise, Jack. How You Can Play Better Golf Using Self-Hypnosis. Hollywood, CA: Wilshire Book Company, 1961.

“Self-hypnosis plays a valuable role in a process which makes it easier for an individual to discover and understand the workings of his own body and mind, learn the factors which basically cause his own distress, and learn how to control them.” Dr. Milton Erikson (pg 37) Written for golfers (and men) specifically. No bibliography. Seems well-researched.

Small publishing company.

Liggett, Donald. Sport Hypnosis. Champaign, IL: Human Kinetics, 2000.

There are countless similarities between the psychology of sports and music. Sport Hypnosis focuses on techniques used to develop mental training: progressive relaxation, positive visualizations, dealing with distractions, reducing fear, and gaining inner strength.

All these principals can be linked directly to what is beneficial to musicians. Another aspect

B. Irons 16 of hypnotherapy in musicians that I had not considered until flipping through the book was how effective hypnotherapy is not only with anxiety, but also pain management.

Dr. Liggett is a Stanford educated psychologist, certified through the American Society for Clinical Hypnosis. While teaching the psychology of hypnosis at Stanford, Dr. Liggett was the first person to use hypnotherapy to improve the results of Stanford’s athletic teams, focusing on gymnastics and football. The intended audience for this book is the athlete, coach, or sports psychologist—basically anyone looking to give themselves a mental edge through hypnosis.

McGinnis, Anne M., and Leonard S. Milling. “Psychological Treatment of Musical Performance Anxiety: Current Status and Future Directions.” Psychotherapy: Theory, Research, Practice, Training 42 (3)(2005): 357-373.

This paper is geared toward clinicians and covers an array of treatment modalities: drugs, cognitive-behavior therapy, hypnosis, and biofeedback. McGinnis cites a source by H.E. Stanton for her data on hypnosis. Stanton’s research “points to the promise of hypnosis as a treatment for MPA.” She also mentions the pioneer study of the psychological treatment of MPA comes from a dissertation by Sylvia Appel in the early 70’s. McGinnis also brings up a drawback to hypnotherapy: individuals respond differently, and not every musician will be a candidate for hypnosis. While this is true, it also solidifies hypnosis’ strength in customizability. It’s also important for the candidate to undergo a brief suggestibility test before beginning the treatment.

Dr. McGinnis is a licensed psychologist in New York, a certified school psychologist in New York and Connecticut, and a certified music teacher in Connecticut. Prior to joining Harris Beach, Dr. McGinnis was employed at a Long Island law firm that represented public school districts and boards of education. From 2009 to 2014, Dr. McGinnis worked as a school psychologist in a Nassau County public school district where she conducted psychoeducational evaluations, delivered individual and group counseling to students, consulted with staff and parents, supervised psychology interns and chaired hundreds of Committee on Special Education meetings.

Dr. McGinnis received her JD in 2014 from St. John’s University School of Law, where she was on the Dean’s List; her Ph.D. in 2009 from The Pennsylvania State University; her M.Ed. in 2007 from The Pennsylvania State University; her B.Mus., summa cum laude, in 2004 from the University of Hartford; and her BA, summa cum laude, in 2004 from the University of Hartford.

B. Irons 17 Norris, Richard. The Musician’s Survival Manual: A Guide to Preventing and Treating Injuries in Instrumentalists. Saint Louis, MO: MMB Music, Inc., 1993.

This book has a very brief section on stage fright that addresses beta-blockers, its use (historically) for anxiety, and outlines the pros and cons of the drug. The section is only 3 pages but has succinct information regarding the drug. The chapter is in a reference book with quick-tips and background information covering a gamut of injuries incurred by musicians. It’s extremely brief but has the necessary background information I need for my research.

Osborne, Margaret, and Dianna T. Kenny. “Development and Validation of a Music Performance Anxiety Inventory for Gifted Adolescent Musicians.” Journal of Anxiety Disorders 19 (2005): 725-751.

This is an academic paper, with heavy statistical data, focusing on adolescents.

Osborne makes the argument that little research has been done on MPA, let alone on the effects of MPA specifically on teenagers. Like previous research, she found a correlation between MPA and social phobia. Her data also supports girls are more likely to experience anxiety than boys are. As far as the scope of MPA, Osborne claims “59% of professional musicians experience performance anxiety severe enough to affect their professional and/or personal lives” and “70% reported that their playing is adversely affected by it.”

Dr. Margaret Osborne is a Postdoctoral Research Fellow at the Melbourne Conservatorium of Music, Honorary Fellow at the Melbourne School of Psychological Sciences at The University of Melbourne, a Registered Psychologist, Occupational Rehabilitation and Careers Counselor, and past-President of the Australian Society for Performing Arts Healthcare. She also works as a clinician treating anxiety and other forms of emotional distress, specializing in music and the performing arts, public speaking and sport. As a music performance psychologist, her research investigates how psychological techniques can improve musicians' capacity to cope with performance anxiety and optimize performance, and she is a world leader in this area of research with adolescent musicians.

Robson, Bonnie. “But I’m Not Ready Yet: Overcoming Audition Anxiety in the Young Musician.” Medical Problems of Performing Artists 10 (1)(March 1995): 32.

This article is more in-depth into developing a pre-audition routine that maximizes nutrition, planning, diet, exercise, and mental training as being essential to over-coming anxiety in an audition setting. Nothing about hypnosis specifically, but a really great

B. Irons 18 background for why a practice like hypnotherapy would be great as part of a pre-audition training regimen.

Sanders, Brian. “Hypnosis: An Aid for Stage Fright.” Percussive Notes 50 (3)(2012): 32-33.

Extremely brief article. Sanders uses this article mostly as a narrative for his personal experiences with hypnosis. He does discuss the adverse side effects of betablockers, compared to the benefits of hypnosis. There are no specific techniques or strategies outlined.

Sanders, Brian. “Hypnosis: A Wise Alternative to Beta Blockers for Stage Fright.”

International Musician 109 (11)(Nov. 2011): 14-15.

Coming from a journal geared to the music community as a whole, this article goes further in depth than the Percussion Notes one does. Sanders expands on hypnosis as a treatment modality—while pushing his treatment center in Massachusetts. Like his other article, there are no specific strategies described; however, this article does look to hypnotherapy as a viable solution for stage fright in children.

Sadler, Michael and Christopher Miller. “Performance Anxiety: A Longitudinal Study of the Roles of Personality and Experience in Musicians.” Social Psychology and Personality Science 1 (3)(July 2010): 280-287.

This article is extremely statistical and date-driven. The gist of the article being that there is a correlation between negative disposition and a propensity for music anxiety.

More specifically, there is an indication that unsociable and introverted individuals are more prone to MPA. The authors also found that no matter how many years of formal training the musician has, that training does not contribute/reprieve MPA. They also suggest that performance anxiety be discussed at an early age in the training process so teachers can begin to identify and work with those students who show signs of MPA early on. The article is intended for psychologists and practicing physicians. “Results supported our first hypothesis: Negative emotional temperament constitutes an important predisposition to the occupational hazard of music performance anxiety” (286). This aligns with my argument for ego-strengthening as an important step in alleviating MPA through re-programing of the subconscious for positive self-talk.

Dr. Sadler has a degree in music from the Peabody Conservatory, before he shifted his education to clinical psychology. He is currently teaching psychology courses at Gannon

B. Irons 19 University in Ruskin, FL. His bio (pretty intriguing): http://www.gannon.edu/FacultyProfiles.aspx?profile=sadler002

Sarbescu, Paul and Madalina Dorgo. “Frightened by the Stage or by the Public? Exploring the Multidimensionality of Music Performance Anxiety.” Psychology of Music, 42 (4)(July 2014): 568-579.

Sarbescu’s article includes a phenomenal definition for MPA as “the experience of marked and persistent anxious apprehension related to musical performance that has arisen through specific anxiety conditioning experiences, and which is manifested through combinations of affective, cognitive, somatic and behavioural symptom.” This article is again, highly statistical and data-driven. It is more “readable” than other case studies and has a high-quality and helpful background to MPA, with demographic statistics. The findings of their study suggest that MPA is a multi-dimensional construct (vs. unidimensional) and is the result of a combination of somatic/cognitive features, performance evaluation, and the performance context. This research will be useful in highlighting hypnotherapy’s efficacy as treating a “totality” is more ideal for a multidimensional construct, than beta-blockers.

Dr. Sarbescu has a doctorate in Psychometrics (objective measurement of aptitutes) and is teaching at West University of Timisoara, in Romania.

Stanton, H.E. “Reduction of Performance Anxiety in Music Students.” Australian Psychologist 29 (2)(1994): 124-127.

Most serious research regarding hypnotherapy and MPA alludes to this study. Dr. Stanton outlines three elements for a successful hypnotherapy treatment towards MPA: relaxation, suggestion, and mental imagery. His article is geared towards psychologists but the information is valuable, and supports my hypothesis. His study showed increased confidence in students, and amelioration of MPA through both the test scores and subject anecdotes. Improvement was maintained at a 6-month follow-up. Stanton claims further research of hypnotherapeutic methods for alleviated MPA is warranted.

Dr. Harry Stanton is a fellow of the Australian Society of Hypnosis, American Society of Clinical Hypnosis, and a Member of the Australian Psychological Society. He has over 35 years of experience in the practice of clinical psychology and hypnotherapy, writing extensively on these subjects in journals. He is a consultant on the application of psychology to a wide range of practical activities.

B. Irons 20 Steptoe, Andrew. “Performance Anxiety: Recent Developments in its Analysis and Treatment.” The Musical Times 123 (1674)(August 1982): 537-541.

According to Steptoe “the purpose of this article is to outline advances in our understanding of performance anxiety, bringing them to the attention of professional musicians and teachers.” While this article is heavily statistic, it’s a brief article that is easily understandable by non-scientists. Steptoe discusses the zone of optimum functioning, the role of tension in anxiety, how self-talk affects the performance (differentiating between task-oriented concentration and environmental factors), and how players tend to catastrophize their situation. He outlines several common treatments including betablockers, biofeedback, and cognitive therapy techniques.

Dr. Andrew Steptoe is Director of the Institute of Epidemiology and Health Care in the Faculty of Population Health Sciences, and British Heart Foundation professor of psychology. He graduated from Cambridge in 1972, and completed his doctorate at Oxford University in 1975. He moved to St. George’s Hospital Medical School in 1977, becoming professor and chair of the Department in 1988, where he remained until his appointment in 2000 to University College London (UCL). He became Deputy Head of the Department of Epidemiology and Public Health at UCL in 2005 and subsequently Head of Department before being appointed Director of the Institute in 2011. He was founding editor of the British Journal of Health Psychology, an associate editor of Psychophysiology, the Annals of Behavioral Medicine, the British Journal of Clinical Psychology, the International Journal of Rehabilitation and Health and the Journal of Psychosomatic Research, and is on the editorial boards of seven other journals. He has published more than 400 peer-reviewed articles and is author or editor of 18 books, most recently the Handbook of Behavioral Medicine (2010) and Stress and Cardiovascular Disease (2012).

Wilson, Glenn. “Performance Anxiety.” The Social Psychology of Music (1997): 229-243.

This article provides a brief overview of “anxiety”. Wilson discusses symptoms, “arousal” (energy levels), Alexander technique, hypnosis background, and common drugs. I agree with his summary that Beta-blockers are a stop-gap, at best. Working with Alexander technique and hypnotherapy is a much more effective treatment plan. This article will be helpful as a foundation for what research has been done in the past, not just on MPA, but for hypnotherapy as a viable option for alleviating the disorder.

Glenn D. Wilson is a prominent psychology consultant in Britain. He was the Visiting Professor of Psychology at Gresham College in London from 2009-2014, and has published more than 150 scientific articles and 33 books. Dr. Wilson is also a trained opera singer,

B. Irons 21 from the Guildhall School of Music and Drama in London (still taking professional engagements as an actor, singer, and director).

B. Irons 22 Comprehensive Bibliography Appel, Sylvia S. “Modifying Solo Performance Anxiety in Adult Pianists,” Journal of Music Therapy 13 (1)(Spring 1976): 2-16.

Appel, Sylvia S. “Modifying Solo Performance Anxiety in Adult Pianists.” Ed.D diss, Columbia University, 1974.

Azodi-Deylami, Cherie. “Self-hypnosis as a Treatment Intervention for Anxiety among Artists.” Psy.D. diss., The Chicago School of Professional Psychology, 2015.

Berghs, Geert. “Stage Fright in Singers: Three Reaction Types.” Folio Phoniatr Logop 60 (2008): 294-297.

Bruce, Noah, et. al. “Psychotherapist Mindfulness and the Psychotherapy Process.”

Psychotherapy Theory, Research, Practice, Training 47 (1)(2010): 83-97.

Carich, Mark. ”Hypnotic Techniques and Adlerian Constructs,” Individual Psychology: The Journal of Adlerian Theory, Research & Practice 46 (2)(June 1990): 166-177.

Carich, Peter. “Ego Strengthening: Encouragement via Hypnosis,” Individual Psychology: The Journal of Adlerian Theory, Research & Practice 46 (4)(Dec. 1990): 498-502.

Chips, Allen. Clinical Hypnotherapy: A Transpersonal Approach. 2nd edition. NC: Transpersonal Publishing, 2010.

Clark, Duncan and W. Stewart Agras. “The Assessment and Treatment of Performance Anxiety in Musicians.” American Journal of Psychiatry 148, no. 5 (May 1991): 598-605.

Biasutti, Michele, and Eleonora Concina. “The Role of Coping Strategies and Experience in Predicting Music Performance Anxiety.” Musicae Scientiae 18 (2)(June 2014): 189-202.

Fehm, Lydia, and Katja Schmidt. “Performance Anxiety in Gifted Adolescent Musicians.”

Journal of Anxiety Disorders 20 (2006): 98-109.

Gorrie, Jon. Fate Worse Than Death. Charleston, SC: Thezonebook, 2009.

Gorrie, Jon. Performing in the Zone. CreateSpace Independent Publishing Platform, 2009.

Green, Barry, and Timothy Gallwey. ”Confidence: From Bravura to Integrity.” In The Mastery of Music: Ten Pathways to True Artistry, 188-215. New York: Broadway Books, 2003.

Hadley, Josie, and Carol Staudacher. Hypnosis for Change. 3rd ed. Oakland, CA: New Harbinger Publications, 1996.

B. Irons 23 Hamann, Donald L. “An Assessment of Anxiety in Instrumental and Vocal Performances.”

Journal of Research in Music Education 30 (2)(Summer 1982): 77-90.

Hammer, Max. “The Directed Daydream Technique,” Psychotherapy: Theory, Research, and Practice 4 (4)(Nov. 1967): 173-181.

Hartland, John. “The Value of ‘Ego-Strengthening’ Procedures Prior to Direct SymptomRemoval Under Hypnosis,” The American Journal of Clinical Hypnosis 8 (2)(Oct 1965): 8993.

Heise, Jack. How You Can Play Better Golf Using Self-Hypnosis. Hollywood, CA: Wilshire Book Company, 1961.

Kahn, Jonathan. “Musicians’ Stage Fright: Analysis and Remedy.” The Choral Journal 24 (2)(October 1983): 5-12.

Kendrick, Margaret J., et. al. “Cognitive and Behavioral Therapy for Musical-Performance Anxiety.” Journal of Consulting and Clinical Psychology 50 (3)(1982): 353-362.

Kenny, Dianna T., Pamela Davis, and Jenni Oates. “Music Performance Anxiety and Occupational Stress Amongst Opera Chorus Artists and Their Relationship with State and Trait Anxiety and Perfectionalism.” Journal of Anxiety Disorders 18 (2001): 757-777.

Khalsa, Sat Bir S., et. al. “Yoga Ameliorates Performance Anxiety and Mood Disturbance in Young Professional Musicians.” Appl Psychophysiol Biofeedback 34 (2009): 279-289.

Krane, Vikki. “A Practical Application of the Anxiety-Athletic Performance Relationship: The Zone of Optimal Functioning Hypothesis.” The Sport Psychologist 7 (1993): 113-126.

Lee, Sang-Hie. “Musician’s Performance Anxiety and Coping Strategies.” American Music Teacher 52 (1)(August/September 2002): 36-39, 95.

Liggett, Donald. Sport Hypnosis. Champaign, IL: Human Kinetics, 2000.

McGinnis, Anne M., and Leonard S. Milling. “Psychological Treatment of Musical Performance Anxiety: Current Status and Future Directions.” Psychotherapy: Theory, Research, Practice, Training 42 (3)(2005): 357-373.

Norris, Richard. The Musician’s Survival Manual: A Guide to Preventing and Treating Injuries in Instrumentalists. Saint Louis, MO: MMB Music, Inc., 1993.

Osborne, Margaret, and Dianna T. Kenny. “Development and Validation of a Music Performance Anxiety Inventory for Gifted Adolescent Musicians.” Journal of Anxiety Disorders 19 (2005): 725-751.

B. Irons 24 Papageorgi, Iouli, Susan Hallam, and Graham F. Welch. “A Conceptual Framework for Understanding Music Performance Anxiety.” Research Studies in Music Education 28 (1)(June 2007): 83-107.

Robson, Bonnie. “But I’m Not Ready Yet: Overcoming Audition Anxiety in the Young Musician.” Medical Problems of Performing Artists 10 (1)(March 1995): 32.

Sanders, Brian. “Hypnosis: An Aid for Stage Fright.” Percussive Notes 50 (3)(2012): 32-33.

Sanders, Brian. “Hypnosis: A Wise Alternative to Beta Blockers for Stage Fright.”

International Musician 109 (11)(Nov. 2011): 14-15.

Sadler, Michael and Christopher Miller. “Performance Anxiety: A Longitudinal Study of the Roles of Personality and Experience in Musicians.” Social Psychology and Personality Science 1 (3)(July 2010): 280-287.

Sarbescu, Paul and Madalina Dorgo. “Frightened by the Stage or by the Public? Exploring the Multidimensionality of Music Performance Anxiety.” Psychology of Music, 42 (4)(July 2014): 568-579.

Sprinkle, R. Leo. “Anxiety Management Training Through Self-Hypnosis.” Paper presented at the American Personnel and Guidance Association Convention, Chicago, March 28, 1972.

Stanton, H.E. “Reduction of Performance Anxiety in Music Students.” Australian Psychologist 29 (2)(1994): 124-127.

Steptoe, Andrew. “Performance Anxiety: Recent Developments in its Analysis and Treatment.” The Musical Times 123 (1674)(August 1982): 537-541.

Steptoe, Andrew. “Stage Fright in Orchestral Musicians: A Study in Cognitive and Behavioral Strategies in Performance Anxiety.” British Journal of Psychology 78 (1987): 241-249.

Studer, Regina, et. al. “Hyperventilation Complaints in Music Performance Anxiety Among Classical Music Students.” Journal of Psychosomatic Research 70 (2011): 557-564.

Wilson, Glenn. “Performance Anxiety.” The Social Psychology of Music (1997): 229-243.