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Journal o f Music Therapy

temperature indicated that this approach was effective in

managing MPA to some extent. When the difference scores

for the two approaches w ere compared there was no

statistically significant difference between the two approach-

es for any of the seven measures. Therefore no one •

treatment condition appeared more effective than the

other

Although statistically significant differences were not found

between the two groups a

visual analysis

o f

mean

difference

scores revealed that the music-assisted PMR and imagery

condition resulted in greater mean differences from pretest

to posttest than the improvisation-assisted desensitization

condition across all seven

measures

This result may be due

to the fact that all participants in the music-assisted

PfV R

and imagery condition followed the procedure easily while

two o f the 15 participants in the improvisation-assisted

desensitization group had difficuity improvising.

Music perform ance anxiety MPA) is a prevalent problem for

musicians, and its causes are complex. Thus, th ere is a great n eed

to develop therapeutic interventions to manage stress and

alleviate the effects of music performance anxiety in response to

these com plex issues Brodsky, 1996). A music therapy interven-

tion, as one alternative treatment modality, can be used to treat

the symptoms of music performance anxiety. Dileo-Maranto

1992) suggested that th e m ost viable approach in trea ting

performance anxiety in musicians was the use of music because

musicians possibly have different responses to music physiologi-

cally and psychologically than nonm usicians as a result of train ing

Brennis, 1970; Sopchak, 1955; Trolio, 1975). Such responses to

music can heighten the effectiveness of music as a therapeutic

modality. Dileo-Maranto also concluded that a long-term and

intense relationship with music allowed musicians to feel more

readily comfortable with music and to relate and commit

themselves to a therapeutic environment supplemented with

music. Another reason that music can be used as a treatment

modality in MPA studies is that music and/or music therapy has

shown .some positive effects in stress and anxiety treatment in

general Hanser, 1985). Although results of previous research are

not specific to a performance anxiety situation, the fact that music



Vol. XLV No. 2 Summer 2008 67

possibihty for music enhanced therapy in MPA treatment

(Brodsky Sloboda, 1997).

There are several reasons for using music as a treatment of

anxiety and stress. First of all, music can promote relaxation

response and thus reduce anxiety (Scartelli, 1989); music may

enhance relaxation by providing cues for physiological aspects of

relaxation and by focusing the subject's attention, thus red ucing

distractions and anxiety-provoking thinking. Moreover, music is a

powerful emotional stimulus which can evoke responses physio-

logically, psychologically, and cognitively (Brodsky

c

Sloboda,

1997). Thus, music-assisted therapy can change physiological,

psychological, and cognitive symptoms of anxiety. Furthermore,

music has the potential for physiological and psychological

entrainment, and may evoke imagery and associations which

enh anc e the relaxation expe rience (Brodsky Sloboda, 1997).

Music therapy is a viable treatment for musicians with MPA

because music therapists are musically trained; therefore, they are

familiar with problems of musicians with MPA and are likely to

offer a unique form of treatment (Rider, 1987). Ostwald (1987)

also insisted that music therapists are appropriate professionals to

treat musicians. He argued that music therapists with their

musical backgrounds have the skills to facilitate emotional rapport

with performer patients, to select appropriate topics for discussion

and further analysis, and to steer the psycho therapeu tic dialogue

in and out of troubled waters.

Music therapy has recently received attention as one alternative

mode for MPA treatment, as music therapy researchers have

attempted to develop various interventions using music to treat

MPA. Among these interventions, a desensitization techn ique

com bined with music (Avants, Margolin, Salovey, 1990-1991 ;

Davis

c

Th aut, 1989; Reitman, 1997) and music paired with

progressive muscle relaxation (PMR) technique (Craske

c

Rach-

man, 1987; Grishman, 1989; Nagel, Himle, Papsdorf 1989)

have been used to enhance the relaxation experience. Since both

desensitization and PMR have been found to be viable treatment

modes for MPA (Appel, 1976; Bryson, 1980; Lu nd , 1972; McCune,

1983; Wardle, 1975), researchers have argued that adding music

to these techniques could intensify the treatment effect (Avants et



8

oumal of Music Therapy

these results, these studies emphasized listening as the m ain m ode

of mtisic activity by employing pre-recorded music.

Compared to the use of prerecorded music, improvisation has

rarely been used to treat the symptoms of MPA. It is often a

puzzling and intimidating idea for adults without disabilities

(Ansdell, 1995). Especially, some classically trained musicians do

not feel comfortable with improvising and even are afraid of it.

This reluctance to improvise may be due to the fact that

improvisation is relatively unusual in Western musical culture.

Moreover, these musicians often think that a good performer

should get it right, as it is written by a famous com poser.

Therefore, improvising music on the spot is a new idea to these

musicians.

On ce musicians become aware that the re is no right or wrong in

improvisation, and overcome their anxiety to improvise with a

therapist's support and guidance, musicians with MPA can use

improvisation to enhance relaxation. Since musicians can fully

decide what kind of music they play moment by moment,

improvised music can be tailored to an individual's needs and

music preference. Moreover, music improvisation is live music by

na ture, which is app ropria te for relaxation purposes. According to

Rider (as cited in Hanser, 1988), the use of live music in clinical

settings is important because live music can help each individual

maintain minute-by-minute control in his or her personal musical

environment.

Previous music therapy research, however, primarily employed

music listening instead of improvised music to facilitate relaxa-

tion. Only a few studies utilized music improvisation as a

treatment method for MPA research (Montello, 1989; Rider,

1987). However, these studies lacked enough empirical evidence

and a control group with similar treatment without music

(Brodsky & Sloboda, 1997).

While some previous studies utilized the control group with no

contact (Montello, 1989; Niem ann, P ratt, & M aughan, 1993), or

with similar intervention without music (Brodsky

Sloboda , 1997;

Reitman, 1997), no single study compared two active music

therapy treatments in MPA research. Thus, the present study

compared the effectiveness of two music-assisted relaxation



Vol. XLV No. 2 Summ er 2008 69

One music therapy intervention used in this study was

improvisation-assisted desensitization training. Tbis training was

based on the Music Therapy Improvisation and Desensitization

Protocol (MTIDP) wbicb bas been used in Kim's (2005) study.

This pilot study examined the effect of a MTIDP on ameliorating

MPA of 6 female coiiege pianists. Kim found that tbere were

significant differences in the Likert Anxiety Scale and Spielber-

ger's State Anxiety Inventory from pre to posttest. Tbe MTIDP was

originally modified from Reitman's (1999) protocol of music-

assisted systematic coping desensitization. In his protocol, Reit-

man implemented a music therapy intervention whicb included

(a) a deep muscle relaxation training, (b) a bierarchy of anxiety-

provoking scenes, and (c) visualization of these scenes while in a

relaxed state. Based on his protocol, MTIDP utilized improvisa-

tion instead of prerecorded music to assist the desensitization

process. Thus, the MTIDP was designed to combine live

improvised music with desensitization training to facilitate

relaxation, to ameliorate performance anxiety, to provide more

musical options for subjects based on tbeir music preference, and

to provide more opportunity for subjects to be involved in

creating a musical product tbat could refiect tbeir individual

experience.

The other intervention used in this study was music-assisted

PMR and imagery train ing. Over tbe years, music pa ired with PMR

has been fotind effective in stress and anxiety management

(Kibler Rider, 1983). Moreover, by com bining imagery, PMR,

and music, relaxation effects could be intensified (Rider et al.,

1985;

Wagner as cited in Scartelli, 1989). Although no single study

has directly investigated the effect of music-assisted PMR and

imagery in

MP

research, tbis approacb has been one of tbe more

popular relaxation interventions in music tberapy. In tbe PMR

approacb, prerecorded music was selected based on a partici-

pant's music preference.

Tbe purpose of this study was to investigate the effects of two

music therapy approaches, improvisation-assisted desensitization,

and music-assisted progressive muscle relaxation and imagery on

ameliorating the symptoms of music performance anxiety among

stud ent pianists. Hypotheses for this study were: (a) the re will be a



Vol. XLV No. 2 Summ er 2008 7

Williams, 2002; Vinsnes

Hunskaar,

1991;

Zeidin, Keller, Shiflett,

Schleifer, & Bartlett, 2000). The present study utilized four types

of visual analogue scales: MPA, stress, tension, and comfort. In

addition to MPA, stress, tension, and comfort levels were selected

because they are main characteristics of anxiety (Salmon, 1990;

Spielberger, Gorsuch, Lushene, Vagg, &:Jacobs, 1983). Additional

defmitions for the four subscales were not provided except

tension, which was defined as physical reaction to music

performance situations.

Each participant was asked to mark a vertical line anywhere on

the continuums to indicate the levels of

MPA,

stress, tension, and

comfort that she felt before or during a performance. Tbe MPA

scale consists of a 15 cen timeter con tinuu m line with a range from

low anxiety to high anxiety, while the stress scale consists of a

continu um line of the same length with a range from not very

stressed to very stressed. Th e tension scale consists of a

15 centim eter continuum line with a range from low tension to

high tension, while the comfort scale concerns a range from

very com fortable to highly uncom fortab le. Scores of each

visual analogue scale ranged from 0 (minimum score) to 15

(maximum score). Higher scores indicated more anxiety, stress,

tension, or discomfort.

The State Portion of the State-Trait Anxiety Inventory STAJ). T h e

STAI was used as one of the measures because it has been the

most extensively used assessment in MPA research (Abel

Larkin,

1990; Brotons, 1994; Clark 8c Agras, 1991; Cox & K enardy, 1993;

Craske & Craige, 1984; Ham ann : Sobaje, 1983; Kendrick. Craig,

Lawson,

Davidson, 1982; Lehrer et al., 1990; Nagel et al., 1989;

Niem ann et al., 1993; Steptoe, 1989; Steptoe

8c

Fidler, 1987). The

State-Trait Anxiety Inventory (STAI) was developed by Spielber-

ger, Gorsuch, and Lushene (1970) to assess anxiety traits and

measure current level of anxiety. Since many researchers have

confirmed that MPA is situational and correlated with state

anxiety (Brodsky & Sloboda, 1994; Fogle, 1982; I^ h re r et al.,

1990),

the current study used the State Anxiety scale to evaluate

how musicians felt in a music performance situation. Scores ofthe

State Anxiety scale ranged from 20 (minimum score) to 80

(maximum score). Higher scores indicated more anxiety.



7


(1990) to measure particular sources of MPA. The scale degrees

comprise five categories, which include very much, mu ch,

som e, little, and not at all. This questionnaire measures five

separate dimensions of MPA: (1) planning to cope with anxiety

symptoms, (2) high standards and a judgm enta l attitude abo ut

performance, (3) worry about anxiety and its effects on

performance, (4) concern with the reactions of important others,

and (5) concern about distraction in one.self and in the audience.

Am ong the 32 ques tions, 18 items representative of the five factors

from the MPAQ and measuring state-related

MP

were selected to

assess the MPA levels of participants in this study. Scores of the

modified M PAQ ranged from 18 (minim um score) to 90

(maximum score). Higher scores indicated more anxiety.

ing r temperature

Index finger temperature of each participant

was used as a physiological measure. The thermometer used was

manufactured for this purpose and is sold by standard biofeed-

back equipment providers. Adams, Victor, and Ropper (1997)

argued that finger temperature might be a reUable physiological

measure for MPA because the capillaries in the hands contain

only sympathetic postganglionic fibers. When musicians become

anxious about an upcoming performance, the temperature of the

hands typically drops because anxiety induces their sympathetic

system to becom e excited. This excitem ent leads to a constriction

of the capillaries in the hands. The recovery (dilation) of the

capillaries is exclusively dependent on sympathetic withdrawal,

because the inhibitory effects of the parasympathetic system are

no t prese nt. Thus, the removal of music performance anxiety, as a

result of termination of a performance or coping with anxiety,

allows the temperature of musicians' hands to be recovered. Tbat

is, lower temperature indicates more anxiety.

O ne possible problem with using hand tem pera ture as a

physiological marker of stress is that hand temperature is affected

by ambient temperature. In this study, the temperature was

controlled at 72 degrees Fahrenheit across all lab performance

conditions. Thus, the ambient room temperature did not distort

the results.

Design



Vol. XLV No. 2. Summ er 2008 73

intervention, another lab performance, and a posttest. Regarding

the 6 weeks of music therapy intervention, subjects received either

improvisation-assisted desensitization training or music-assisted

PMR and imagery training, according to their assigned group.

ab Performances and Procedure

The 30 participants each provided two lab performances. The

first performance compiled baseline data and was completed

before music therapy sessions began. The second performance

was held 1 week after therapy sessions ended. The posttest was

completed immediately following the second performance.

The following procedures applied to both performances.

Performances took place in a large music studio. Three

professional musicians were present as the audience of each

recital. Each subject was asked to come to the studio individually

to perform at a previotisly appointed time. If a participant

appeared earlier than the scheduled time, she was asked to take a

walk or wait in the hallway until her scheduled time. Prior to each

lab performance, eacb performer

was

asked to measure her finger

temperature by taping a small thermometer to the dorsal surface

of her left forefinger. After 2 minutes, the subject was instructed

to read the temperature and record it. Next, the subject

was

asked

to perform her prepared musical piece. Immediately after

performing, the subject was asked to complete the cognitive

measures including the self-report measures, the state portion of

the STAI, and the MPAQ.

For their perform ance, student participants were asked to play a

piece of their choice from the standard classical repertoire that

represented their highest level of technical achievement. Subjects

were asked to play a piece at least 10 minutes in length. In their

second performance, participants were asked to perform a

different piece with similar difficulties and length. During the

performances, the participants were asked to stop once their piece

exceeded 10 minutes, even though they were not told to do so in

advance. Thus, their expectation and level of preparation could be

kep t at a similar level as they performed a complete piece of music.

The time length of the pieces is a significant factor for this

study, when compared to previous studies which allowed only 2-



7


1997;

McKinney, 1984; Sweeney Hora n, 1982). Playing 2 -

5 m inu te excerpts is significantly different from perform ing a

com plete piece of music in terms of performers' expectations and

l v l

of preparation ; therefore, such a design fails to replicate tbe

ull complexities of performing (Torberg, 2002).

Music Therafyy Sessions

All music therapy sessions were held in a private m usic studio in

the northeast Asia metropolis. The same board-certified music

therapist conducted eacb session one-on-one witb eacb partici-

pant. Ail music tberapy sessions were conducted once a week and

were approximately 30 minutes in du ration. Eacb participan t

received the music therapy intervention on tbe same day of tbe

week for 6 weeks. When a partic ipan t missed the appointed time,

make-up sessions were provided later in the week.

Improvisation-A.ssisted Desensitization Condition

Subjects in the improvisation-assisted desensitization condition

received

weeks of music therapy sessions that inc luded the music

therapy improvisation and desensitization protocol (MTIDP). Tb e

MTIDP was designed for individual treatment. Tbe procedure for

the MTIDP is as follows:

Session

Introduction (10 min ): Tbis section included (a) brief descrip-

tions of how performance anxiety could affect one's performance

and life, and (b) inter\'iews about eacb subject's personal and

musical background, including performance-related stress or

anxiety experiences.

Rhytbmic breathing exercise (5 min): The therapist established

a tempo of 80 beats per minute using a metronome, and tben

asked tbe subject to breatbe in keeping witb this tempo. Each

subject inhaled on beat 1 and exhaled on beats 2 and 3, which

doubled the length of the exhalation (Montello, 1989).

Free piano improvisation with the therapist and conversation

(10 m in): Improvisation might be a new experience for some

musicians, whicb might make them uncomfortable and afraid to

try. To minimize this problem, tbe therapist improvised togetber



Vol. XLV No. 2 Summe r 2008 75

were no guidelines or rules for improvisation; (b) tbe therapist

played chords in the lower register while the subject played tbe

melody in the higher register; (c) tbe therapist played tbe melody

in tbe bigber register while tbe subject played cbords in the lower

register; and (d) after improvising on tJie piano, eacb subject

sbared her experiences verbally with the therapist.

Homework assignment and closing conversation (5 min): The

therapist reviewed tbe session and assigned homework to eacb

subject. Homework included a 5-minute free piano improvisation

and a 3-minute rbytbmic breathing exercise to be used during

regular daily practice time.

Session

Open ing conversation (3 m in): The therapist reviewed the

homework and discussed any difficulties that might have arisen

during tbe bomework.

Improvisation and conversation (10 min): During the second

session, the subject was asked to improvise alone. This portion of

tbe session consisted of tbe following tasks: (a) eacb subject

improvised a relaxing piece of music of her choice two or three

times; and (b) the subject analyzed what kind of musical elements

(i.e.,

melody, harmony, dynamics, phrases, rhythms, and keys)

made her relaxed.

Guided m editation and conversation (15 m in): The therapist

imp lemented a guided meditation techn ique (Montello, 1989),

which facilitated a jou rne y from the m usician s earliest m em ory /

experience of music through her musical development, early

performance experiences, family experiences with music, college

experiences and professional experiences up to tbe present. After

tbe meditation, each subject sbared her experiences verbally and

identified underlying causes of her performance anxiety.

Homework assignment and closing conversation (3 min): Tbe

therapist reviewed tbe session and assigned the same bomework as

in Session 1.

Session 3

Open ing conversation (3 m in): This portion was the same as

tbat for Session 2, Step 1.



7


Desensitization training (15 min ): This portion consisted of th e

following tasks: (a) each subject developed a relaxing image or

scene, which m ade h er calm. The subject

was

encouraged to focus

on the relaxing scene while her body was relaxed. The subject

imagined this scene in as much vivid detail as possible for brief

periods of time (e.g., 10-15 seconds) in order to verify clarity and

relaxing potential; (b) each subject shared the relaxing scene with

the music therapist; and (c) each subject improvised a relaxing

piece of music of her choice to match

h r

relaxing imagery.


therapist reviewed the session. Homework included a rhythmic

bre ath ing exercise (2 m in ), a daily free improvisation warm-up

(2-3 min), and desensitization training as demonstrated in step 3

(3 min) during the musician's daily practice time.

ssion

Opening conversation (3 min): This portion was the same as

that for Session 2, Step 1.

Rhythmic breathin g exercise (3 min)

This section was the same

as that for Session 1, Step 2.

Development of hierarchy (6 min): Each participant rated the

Basic Anxiety Scale, a list of 15 music perform ance-related events,

to determine the level of anxiety she felt at each event.

Desensitization training (17 m in): Th e training consisted of the

following tasks: (a) each subject imagined the relaxing image

which was created during Session 3; (b) the therapist instructed

the subject to allow your mind 's eye to turn off your relaxing

image and turn on the image o fth e first scene in your hierarchy,

repeating this step at least twice to allow for the shift in imagery to

take place (Reitman, 1999); (c) the subject imagined each event

that she had idenüfied via the performance-related hierarchy

while the therapist verbally described each event. This procedure

began with the event of lowest distress and progressed gradually

upward on the hierarchy; (d) after the subject imagined each

hierarchy scene, she returned to her personally relaxing image.

The therapist instructed each subject at least twice to shift her

imagery in order for a complete change of scenes to take place.

While imaging a relaxing scene, the subject was encouraged to



Vol. XLV. No. 2 Summ er 2008 •

t ?

comfortable; and (e) once the subject felt comfortable and

relaxed, she improvised to match and reflect her relaxing image.

Homework and closing conversation (3 m in): The therapist

reviewed the session and distributed to each participant a copy of

her Basic Anxiety Scale. Homework included a rhythmic

breath ing exercise (2 m in), a daily free improvisation warm-up

(2-3 min), and desensidzation training as demonstrated in step 4

(5 to 10 min) three times a week during regular practice time.

ssions 5 and 6

Opening conversation (3 min): This portion was same as that

for Session 2, Step 1.

Rhythmic breathing (3 min): This section was the same as that

for Session 1, Step 2.

Co ntinued desensitization training (20 m in): Each subject

proceeded through her hierarchy until she finished the most

anxiety provoking scene. At this point, the therapist mentioned

that in the near future, improvised music should be gradually

faded from the subject s hom e training. Thus, the subject could

eventually control her music performance anxiety by imagining a

relaxing image without matching improvised music.



breath ing exercise (2 m in), a daily free improvisation warm-up

(2-3 min), and desensitization training as demonstrated in step 3

(5 to 10 min) three times a week during regular practice time.

, Music-Assisted PMR and Imagery Condition

Subjects in the music-assisted PMR and imagery condition

received six weeks of music therapy sessions tbat included the

Music-Assisted PMR and Imageiy protocol (MPMRI). The MPMRI

was designed for individual treatment. The procedure for the

MPMRI is as follows:

Session

Introduction (10 m in) : This portion was same as that for

MTIDP Session 1, Step 1.



T o u m a l o f Mus ic Therapy

Music-assisted PMR training and conversation 10 m in) : Each

subject was taught to tense and relax specific muscle groups in a

sequenced m ann er. D uring this PMR training, the subject listened

to the piece of music that she brought to the session.

Homework assignment and closing conversation 5 m in): Th e

therapist reviewed the session and assigned homework to each

subject. The therapist distributed a PMR instruction manual for

the subject to refer to, if necessary, during her home training.

Hom ework included a 5-mÍnute daily music-assisted PMR exercise

and a 3-minute daily rhythmic breathing exercise.

Session 2

Opening conversation 3 m in): This portio n was same as that

for MTIDP Session 2, Step 1.

Music-assisted PMR training 10 m in): This po rtion of the

session was the same as that for MPMRI Session 1, Step 2.

Guided m editation and conversation 15 m in): This portio n

was same as that for MTIDP Session 2, Step 3.

Hom ework assignment and closing conversation 3 m in): Th e

therapist reviewed the session and assigned the same homework as

in MPMRI Session 1.

ssions

3 4 5, and 6

Open ing conversation 3 m in): This portion was the same as

that for MPMRI Session 2, Step 1.

Rhythmic breath ing exercise 3 min)

This section was the same

as that for MPMRI Session 1, Step 2.

Music-assisted PMR and imagery 20 m in) : This portion

consisted of the following tasks: a) each subject was instructed

to tense and relax each major muscle group in the body in a

sequenced manner until the entire body was in a deeply relaxed

state wbile listening to her preferred music; b) each subject was

asked to imagine freely du ring listening; and c) each subject

shared her experience after the termination of imagery.

Homework assignment and closing conversation 3 m in): Th e


breath ing exercise 2 m in) , and a daily music-assisted PMR and



Vol XLV

No. 2

Summer 2008

79

TABLE 1

Means

and

Standard

Deviations

for

the

Improvisation Assisted Desensitization

Group

Measures

Self-repon measures

MPA

Stress

Tension

Comfort

State Anxiety STAI)

MPAQ

Température

JV

15

15

15

15

15

15

15

Pr e

8.23

8.88

9.11

7.47

56.00

59.07

84.80

M

Posl

7.07

7.07

6.73*

7.43

50.73

57.33

89.47*

Prc-

2.74

2.55

3.63

3.39

9.51

7.97

5.65

r>

PtlM

3.35

2.93

2.67

3.35

9.90

7.13

5.80

Results

Effects of the Improvisation-Assisted Desensitization Condition

Repeated measures

of

ANOVA were used

to

analyze

the

difference between pre and posttest on the self-report measures,

the state anxiety

of

the

STAI,

the

MPAQ,

and

finger tempera ture

for each of the two conditions: tbe improvisation-assisted

desensitization, and the music-assisted progressive muscle relax-

ation and imagery. For the improvisation-assisted desensitization

group, results indicated significant differences from pre- to

posttest in the level of tension, F = 7.55, p = .016, df = 1, 14;

in state anxiety of the STAI,

F =

5.57,

p =

.033,

df

=

1

14; and

in the finger tempera ture measure,

F =

7.87,

p

= .014,

df =

1,

14. Results showed no significant differences in MPA, F = 2.38, p

- .145

df

=

1,

14;

in

stress,

F =

3.65,

p =

.077,

df =

1,

14;

in

the level of comfort measure,

F =

.08,

p =

.789,

df

= 1, 14; or in

tbe MPAQ.

F =

.68,

p =

.423,

df

= 1, 14. Altbough results

indicated no significant differences in MPA, stress, comfort, and

MPAQ measures, visual inspection

of

mean scores revealed that

tbe posttest scores were lower than tbe pretest scores on four

measures see Table 1). For vistial analysis, tbe mean score graph

from pre- to posttest is presented see Figures and 2).

Effects of the Music-Assisted PMR and Imagery Condition

For the music-assisted progressive muscle relaxa tion and



8

oumal

o

Mus c Therapy

T n É m -

The mean score graph of the self-report measures from pre to posttesi

improvisation-assisted desensitization condition).

MPAQ

FIGURE 2.



8

oumal

o

Music Therapy

FIGURE 3.

The mean score graph of the self-report measures from pre to posttest music-

assisted PMR and imi^ery condition).

S T

MPAQ Tomptmtma

FIGURE 4.



Vol. XLV No. 2 Summ er 2008

183

TABLE 3

Sc«n-e

Differences from Pre to

Posttest between

Group 1

(Improvisation-Assisted

Desen sitization

Condition) and Group 2 Music-Assisted PM R and Imagery Condition)

Self-report measures

MPA

Stress

Tension

Comfort

State Anxiety STAI)

MPAQ

Temperature

Mean dißerenccs

Group 1

H 7

1 81

2 38

0 04

5.27

^

1.73

- 4 . 6 7

Pre to positesl)

Imiip

1

2 65

7 06

5 82

2 23

9 67

7 07

- 8 . 4 0

t i nmp t

2.93

3.67

3.36

3.33

8.64

8.13

6.44

0

Group 2

2.55

25.61

2.52

3.57

10.80

7.01

7.50

condition resulted in a greater mean difference from pre- to

posttest in all seven measures than the improvisation-assisted

desensitization con dition see Table 3). For visual analysis, the

mean difference score graph from pre- to posttest is presented

see Figures 5 and 6).

• Omapl

StIMI

FIGURE 5.

The mean difference graph

of the

self-report measures from

pre to

posttest



8


sta

MPAQ

Temperature

F iGt I RK 6 .

he mean difference graph of the STAI, the MPAQ, and finger temperature from

pre

to posttest between Group improvisation-assisted desensitization condition)

and Group 2 music-assisted PMR and imagery cond ition) .

Discussion

Effects of

the Music Assisted

PMR and

Imagery

ondition

When results of the music-assisted PMR and imagery condition

were compared from pretest to posttest, statistically significant

differences occurred in six out of the seven measures—MPA,

tension, comfort, STAI, MPAQ, and finger temperature. With six

statistically significant measures out of seven, the music-assisted

PMR and imagery treatment seemed very successful in reducing

MPA. These significant results might be due to the fact that the

technique was simple to implement and required no prerequisite

skills. All subjects easily followed the PMR and imagery procedure

from its first presentation. As a result, their physical tension and

anxiety levels were readily reduced.

Implementation of the music-assisted PMR and imagery

technique does not require any prerequisite skills; therefore,

any musician with or without composition and/or mtisic theory



Vol.

XLV No. 2 Summer 2008 W^

a variety of .settings. For example, musicians could employ this

technique while waiting for their upcoming performances, which

could help them to reduce anticipatory music performance

anxiety and to release any physical tension. Furthermore, the

music-assisted PMR and imagery training has the flexibility for

application with both instrumentalists and vocalists.

Effects of the Improvisation Assisted Desensitization Condition

Results of the improvisation-assisted desensitization condition

indicated statistically significant differences in only three out of

seven measures. The statistically significant decreases in tension,

and STAI, witb increases in finger tem pera ture indicated that tbis

approacb was effective in managing MPA to some extent. Several

participants in tbis group mentioned that they enjoyed their

music and were self-confident about tbeir improvised perfor-

mances. They indicated that they did not worry about following

tbe music score in improvisation, and several participants

commented that improvisation actually helped them play the

piano without stress. Combined with improvisation, tbe desensi-

tization tecbnique seemed effective in managing participants

levels of

MPA.

Several participants mentioned tbat the desensiti-

zation tecbnique belped them identify their own anxiety-

provoking scenes and imagine a shift from these images to more

relaxing ones. Consequently, tbe approacb provided opportuni-

ties to cope witb tbeir MPA.

Despite its merits, the improvisation-oriented technique had

some drawbacks for others. Results depended on prerequisite

skills to make music without a score. Two participants, in

particular, bad difficulties due to insufficient composition and/

or music theory skills. Tbe measurement scores from pretest to

posttest for these two participants remained similar across all tbe

seven measures, indicating that the level of tbeir MPA was not

reduced. In fact, these p articipants skill deficits may have created

additional anxiety and discomfort. Consequendy, the approach

was not viable for them, and their scores may have strongly

affected the statistical outcome for the 15 participants who

experienced this technique. The approacb may have yielded very

different results in a larger sample of participants who bad



Vol. XLV No. 2. Summer 2008 87

control the lab performances to make them similar to real

performance situations. The number of audience members

should be greater tban 10 in order to simulate a small recital or

a master class setting.

The second variable was the unequal level of repertoire

preparation across participants in each lab performance. Inter-

views with participants reveaied that tlie level of preparedness was

one of the key factors affecting their MPA. Since tbe level of

reperto ire p repara tion for this study

w s

not controlled, tbis factor

may have influenced results. In addition, uneven repertoire

preparation between the two lab performances was anotber

variable. Some participants may have been more prepared for

one lab performance tban the other depending on their time

availability. If some participants had a higher level of prepared-

ness for tbeir first lab performance before treatment and a lesser

level of prepa ration for the ir second perform ance after treatm ent,

tbeir measurement results might be affected. Their scores

depended on their preparation level—a factor for which the

treatment could not compensate. Tberefore, future researcbers

should include tbe level of repertoire preparation in the subject

criteria and select only appropriate subjects.

Another confounding variable was tbe level of willingness to

complete homework which was necessary to develop adequate

anxiety-ioping skills. Sporadic and inconsistent homework could

be a factor influencing the results of the study. Tbus, future

studies must account for the level of homework completed.

Subjects could log tbe amount and quality of the practice whicb

could be treated as a co-variate. Also, a criterion for prac tice levels

could be set as a requirement for inclusion in the study.

Conclusion

The purpose of this study was to examine the effects of two

music therapy approaches, improvisation-assisted desensitization,

and music-assisted progressive muscle relaxation and imagery on

am eliorating the symptoms of music perform ance anxiety MPA)

among student pianists. Overall, tbe participants in both groups

seemed to appreciate treatments that helped them discover tbe

sources of their MPA and acquire appropriate coping skills. Tbe




ed without stress and did not require any prereqtiisite skills.

Although the improvisation-assisted desensitization treatment

required specific improvisation skills to be useful in ameliorating

MPA, musicians with these skills were able to enjoy and be

self

confident about their music by improvising. In addition, it is

suggested that those without sufficient improvisation skills on

their main instruments can use simple OrfT instruments to help

them desensitize from MPA.

These findings stiggest possible music therapy interventions as

alternatives to pharmacological interventions. However, this

generalization is made cautiously because of small sample size

and the confounding variables. Furthermore, this study may point

to new directions for the use of improvised music with

desensitization and the use of

P R

with m usic as an enh anc em ent

to performance and overall performance Wellness.

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