for MPA education within a music program, music students from three tertiary ..... Mindfulness is a heightened state of awareness arising from paying attention to the .... Music Therapy can be used as a way of reducing performance anxiety by ...
Music Performance Anxiety In an Education Environment
A discussion on whether
Musicians Performance Anxiety should be included
in the Education Syllabus
Debra T Wattes
BCM360
Research
2018
i
Abstract This research asks whether music students would benefit if Musicians Performance Anxiety (MPA) and coping strategies were included in the education syllabus. To assess the demand for MPA education within a music program, music students from three tertiary institutes were asked about their experience with MPA via an online questionnaire. Furthermore, case studies were done via one on one interviews where participants were encouraged to discuss their experiences with MPA in greater detail. A significant amount of music students suffer from medium to severe MPA and have considered giving up their dream job because their anxiety is so debilitating. It is hoped this research will open a dialogue about MPA within tertiary music institutions and provide possible coping strategies for those students that struggle with the condition.
ii
Acknowledgements I would like to thank Sally Bodkin-Allen for her encouragement to pursue this topic and all the hard work she put in to help me gather the necessary skills to do this research, Jeff Wragg for keeping me on topic, helping to expand my thinking and stay on target, and finally the cooperation of music students from Southern Institute of Technology, Ara and Otago University.
iii Contents Abstract ....................................................................................................................................... i Acknowledgements ....................................................................................................................ii List of Figures ............................................................................................................................ v List of Tables ............................................................................................................................ vi 1
2
3
Introduction ........................................................................................................................ 7 1.1
The researcher’s story ................................................................................................. 7
1.2
Musician Performance Anxiety in Education ............................................................. 8
1.3
Aim .............................................................................................................................. 9
1.4
Methodology ............................................................................................................... 9
1.5
Key Terms ................................................................................................................. 10
Literature Review............................................................................................................. 12 2.1
What is Musicians Performance Anxiety (MPA) ..................................................... 12
2.2
Psychological Symptoms .......................................................................................... 13
2.3
Physical Symptoms ................................................................................................... 13
2.4
Coping Strategies ...................................................................................................... 14
2.5
A fresh perspective on MPA in education ................................................................ 16
Methodology .................................................................................................................... 18 3.1
Introduction ............................................................................................................... 18
3.2
Questionnaire ............................................................................................................ 19
3.2.1 3.3
Interviews .................................................................................................................. 20
3.3.1 4
Data .................................................................................................................... 19 Participants ......................................................................................................... 20
Results .............................................................................................................................. 21 4.1
Questionnaire ............................................................................................................ 21
4.2
Case Studies .............................................................................................................. 25
5
Conclusions ...................................................................................................................... 29
6
Recommendations ............................................................................................................ 31 6.1
MPA Learning Outcomes.......................................................................................... 31
References ................................................................................................................................ 35 7
Appendices ....................................................................................................................... 37 Appendix 1: Information Sheet ............................................................................................ 37 Appendix 2: Sample Questionnaire ..................................................................................... 38 Appendix 3: Interview Consent ........................................................................................... 42 Appendix 4: Sample Interview Questions ........................................................................... 43 Appendix 5: Subjective Units of Distress Scale (SUDS) .................................................... 44 Appendix 6: Beck’s Depression Inventory .......................................................................... 47 Appendix 7: Brief Fear of Negative Evaluation Scale......................................................... 51
iv Appendix 8: Liebowitz Social Anxiety Scale ...................................................................... 52 Appendix 9: Social Interaction Anxiety Scale ..................................................................... 54
v
List of Figures Figure 1: Music students and the discussion on MPA. ............................................................ 21 Figure 2: Other Mental Health conditions suffered by music students. .................................. 22 Figure 3: Severity levels of MPA in music students................................................................ 23 Figure 4: Who did music students speak to about MPA .......................................................... 24
vi
List of Tables Table 1: Changing the Mental Response ................................................................................. 15 Table 2: MPA Module Learning Outcomes............................................................................. 33
7 1
Introduction
1.1
The researcher’s story
I selected the topic of Musicians Performance Anxiety (MPA), also referred to as stage fright, mainly because I suffered so greatly from it. I had symptoms of shaking legs and hands, trembling upper lip, sick to the stomach and it felt like my entire body was going to convulse. The only thing that helped me control the physical symptoms was alcohol, and as I grew up with an alcoholic I knew where that path could take me and therefore made a conscious decision to not use it as a crutch. Even though I was constantly told that I had a beautiful voice, it did not diminish my symptoms. I remember making the decision of not following my dream toward becoming a musician, because of my nervous symptoms when performing. It took me forty years to pluck up the courage to face my performance fears, and eventually the desire to perform became greater than the fear to perform. There were no musicians in my family or immediate community to tell me that what I was feeling was normal. When I first started performing in the music program, I studied keyboard in hope this would give me something to ‘hide behind’. Being a vocalist meant I would be front and centre and I was not ready for that. As I progressed through the degree I also studied vocals, my MPA had improved a little with repeated performance exposure, but I still dreaded performing every week. It was when I started doing the education paper that I asked myself the question ‘why’ my MPA was so elevated. I openly spoke to my classmates about my fears and discovered that they all suffered similar symptoms of varying degrees. These conversations are what prompted me toward learning more about this type of anxiety and not just for myself, but for others. I wanted to understand why the symptoms were so variable and what options were available to manage MPA.
8 I worked in the Ministry of Education in Curriculum Development many years ago, and that knowledge made me question why MPA was not taught to musicians as part of the syllabus. If MPA is so prevalent in the music community, why is it not taught? I felt it was something that would be of huge benefit to not just working musicians but especially music students. 1.2
Musician Performance Anxiety in Education
The facts collated in this research will provide evidence that music students would like more structured content and open discussion on MPA in a classroom environment. This research will discuss how further discussion of MPA could arm music students with the necessary tools to progress through their studies and music careers. An important question to ask here is, due to the lack of information on this topic in education, is there a potential for causal harm? Tests have been done on the relative roles of thought processes, emotions and physical stimulation in predicting MPA in adolescent musicians. It was found that when analysing the characteristics of anxiety, that gender and pre-existing anxiety conditions were the best predictors of MPA, but that negative memories occurring during a ‘worst performance’ experience, added further significant variance to the prediction of MPA.” (Kenny, 2006, p. 54). Music students have the added stressor of performing while being assessed and both activities bear their own stressor. This adds a distinct breadth to the average music students stress levels. It therefore raises the question of how are music students mental health being taken care of and addressed under these specific conditions. This research will determine what percentages of students suffer from MPA and if students are aware of the coping strategies that are available. MPA is medically considered to be when one or more physical symptoms arise, which are initiated by fear, which then creates a panic in the musician. These symptoms can regularly occur when musicians
9 present themselves to an audience in performance situations which is exacerbated by exam or assessment (Sphan, 2011, p. 129). Studying for a Music Degree is a high stress multimodal activity on its own. But when the MPA dual stressors of music performance and performance assessment are combined in the same task, it is reasonable to ask whether music students should be educated about managing the symptoms of MPA as part of the music syllabus. 1.3
Aim
The aim of this research is to better understand what support educational institutes offer to music students for MPA. Music students could flourish into stronger musicians if given the opportunity, from educational institutes offering education on MPA and coping strategies as part of their music degree. A closer examination of the components which make up the diagnosis of MPA will highlight what resources are needed for music students. Exploring student’s responses will show if they are aware of or utilise any on campus psychological support service that deals with MPA, and if the tertiary arena should encourage development in this area. Although considered, this research will not discuss the explicit diagnoses of specific mental health conditions or illnesses. Furthermore, it will not consider if teaching professionals have been given the tools to facilitate their students understanding of MPA, or individually scrutinize tertiary institute music departments as to whether they have trained mental health staff on MPA available for students to access. 1.4
Methodology
The information collected will be in the form of questionnaires and interviews. It discusses music students MPA levels before a performance, their mental health status, how much they know about MPA, are they receiving any support, and if given the opportunity to learn more about MPA within the music syllabus, would this be of use to them. Interviews
10 were chosen to encourage a wider discussion on MPA in the hope that results would provide a deeper level of information regarding student’s personal experience with MPA. 1.5
Key Terms
Musicians Performance Anxiety (MPA) is a collection of symptoms defined under the umbrella of fear based anxiety disorders like social phobia and social anxiety.
Comorbidity refers to a patient suffering from more than one mental health condition.
Multimodal refers to a mix of different symptom triggers which are; o situational; when a students’ MPA is triggered by the performance itself. o cognitive; the thought process in the lead up to or during the performance. o somatic; the physical symptoms; e.g., ones’ ability to not have control of basic physical motor skills.
Situational Initiators, is defined as the situation that initiates the anxiety.
Endocrine system uses the body’s cells to allow hormones to travel to organs.
Neuroendocrine system works with the nervous system which talks to organs throughout the body using hormones from the endocrine system.
Some of the more common therapies available are,
Cognitive Behavioural Therapy (CBT); CBT asks that clients participate by keeping active records of their reactions and behaviours, a commitment to participation, application of therapies and of self evaluation (Farnsworth-Grodd, 2012, p. 18). CBT necessitates working with a mental health professional.
Neurolinguistic Programming (NLP); Neuro refers to the mind and how we organise our mental life; Linguistic is about language and how we use it; Programming is about sequences of repetitive behaviour. Cohesively, NLP is about the connection of our thoughts, speech and actions (Joseph O'Connor, Ian McDermott, 2013, p. 11). NLP is
11 mostly delivered via digital media using subliminal messaging and hypnotherapy directed at adjusting the behaviour specific to the patients affliction.
Emotional Freedom Techniques (EFT) uses a repetitive tapping on explicit Chinese meridian points in a systematic pattern. This is said to release emotional energy which gets stored in our bodies (Ortner, 2013, p. 83).
Beta Blocker drug therapy is only useful for physical symptoms and the most commonly administered are the diazepam type drugs like Propanolol, because of its reduced impact on mental alertness and cognitive function (Kenny, 2006, p. 63).
Hypnotherapy is when a patient is put in a state of being consciously unaware, allowing the hypnotherapist to access the subconscious to aid in reprogramming detrimental beliefs or behaviours.
Growth Mindset is accepting that your awareness and beliefs are in a constant change of growth. (Dweck, n.d, para. 2)
Mindfulness is a heightened state of awareness arising from paying attention to the present moment focussing on acceptance rather than judgement. (Farnsworth-Grodd, 2012, p. 24). The most common mental health disorders mentioned are
Social Anxiety Disorder (SAD)
Social Phobia (SP)
Both are fear based anxiety disorders. SAD was formerly known as Social Phobia.
12 2
Literature Review
2.1
What is Musicians Performance Anxiety (MPA)
MPA is a mix of Social Phobias with the specificity of a musician’s physical and psychological reaction to their performances and public speaking. These reactions have been assessed as being either one or a culmination of two fears; one of social interactions and the other of being examined. For example, being observed in performance is considered part of the stressor initiated by the performance activity (S Safren, C Turk, R Heimberg, 1998, p. 444). de Vente (2014, p. 140) agrees that “SAD is known as a social phobia and is one of the most prevalent and most unsettling mental disorders”. Nevertheless, Buswell (2006, p. 5) discusses the idea that maybe our perceptions and observations should be broadened. He suggests, “It is possible to be mentally unhealthy without being mentally ill, to lack mental strength and resilience without necessarily suffering from a mental illness such as depression, schizophrenia or psychosis.” Several sources concur that the majority of performers experience some level of MPA, and further support to this was provided when test anxiety and academic competence was explored. It showed that thought provoking behaviours were exacerbating and maintaining performance anxiety (Kenny, 2006, p. 54). When an exam creates anxiety and a performance is included, that anxiety multiplies, add a negative experience and it multiplies again; Kenny notes this as multimodal anxiety. When MPA takes hold of a student it can impact their ability to perform or want to perform. This leaves them in a state of low self-esteem and a negative self perspective which may make them apprehensive to attempt another performance (Pizzey, 2018, para 10). In music education when mental health issues are addressed, there is an opportunity to develop strong performers. When a music student experiences a situational stressor like the anxious arousal of performing, it initiates the symptoms of MPA, “Over 85% of individuals with SP reported that their anxiety significantly interfered with their academic
13 functioning” (Meridith Coles, Richard Heimberg, 2000, p. 406). The very act of warming up, exam preparation and performance are regarded as the situation that initiates the anxiety for some students. Scientific studies analysed urine before and after performances and have shown that musician’s heart rate and nervous systems are affected by performance. The stress hormone cortisol and adrenalin levels rose during performance and practice in musicians who have been diagnosed as having Social Phobia (phobic) and those who have not (nonphobic), and in phobic participant’s the levels were higher (M Fredrikson, R Gunnarsson, 1992, pp. 53-54). If an individual perceives their body to be out of control, anxiety is increased which may exacerbate the symptoms that produced the anxiety in the first place: e.g. cold hands, palpitations, dry mouth and tremors. The condition of MPA has several contributing factors with a diverse range of situational initiators. The irony of Social Phobia is they show the symptoms they are afraid of showing, “with anxiety disorders, you get what you oppose” (Carbonell, 2017, para 11-13). 2.2
Psychological Symptoms
MPA and SP are considered to be connected through fear based anxiety. Especially the specificity around the relationship to the fear of being exposed, judged, and worry about behaving in an improper or embarrassing way (W de Vente, M Majdandzic, M Voncken, D Beidel, S Bogels, 2014, p. 140). The symptoms experienced by musicians can vary and depend on their specific set of circumstances. Mental symptoms can be negative self-talk, distraction, a feeling of impending doom, memory blanks and a feeling of panic (Roland, 1997, p. 4). 2.3
Physical Symptoms
Some of the physical symptoms experienced are muscle tension, shaking of various parts of the body, increased heart rate, sweating, hot or cold flushes, nausea, dry mouth, and
14 butterflies in the stomach, desire to go to the toilet frequently and an adrenalin rush. Some musicians are able to harness the adrenalin and use it to their advantage, whereas for others if not managed it can create a disadvantage (Roland, 1997, p. 4). 2.4
Coping Strategies
There are many treatments for MPA; drugs, CBT, NLP, Music Therapy, Hypnosis, EFT and Growth Mindset are among them. MPA is a fear based anxiety disorder which initiates the fight or flight response. Musicians who suffer from MPA perceive performance to be a threat. One path to that cognitive response can come from a place of negative self-talk or imagery. See table one below from Roland (1997, p.17) ‘Changing the mental response’, it shows that by using growth mindset as a tool, it can be one way a musician can manage their inner dialogue.
15 A
B
C
Performance Situation
Self-talk
Consequence
Heart beating quickly before
My heart is going crazy, I’m
Lose control and give a bad
performing
losing control, I’m going to
performance
make a mess of this Heart beating quickly before
My heart is beating faster,
Maintain control and give a
performing
that’s normal, keep focused
good performance
on my breathing and I’ll be fine. Table 1: Changing the Mental Response Lehrer (1987, p. 145) explains that “individuals suffering from severe stage fright must be treated by a combination of methods because of the greater variety of their symptoms”. In a sample of professional, student and amateur musicians, CBT has been found to be superior to drug therapy (Farnsworth-Grodd, 2012, p. 18). Drugs that are popular for coping with MPA are Beta-blockers. A survey of 2122 orchestral musicians discovered 27% of those musicians used propranolol to manage their MPA; 19% of this group used the drug on a daily basis. The reasoning behind beta blockers continued popularity are due to their immediate uptake, for those musicians who primarily report physical responses to MPA in the form of heart palpitations, hyperventilation, tremor, trembling lips and sweating palms. However beta blockers are less effective for those experiencing symptoms related to low self-esteem and social phobias (Kenny, 2006, p. 63). Music Therapy can be used as a way of reducing performance anxiety by helping musicians to become more aware of the underlying factors of performance anxiety, experience unconditional acceptance and support in a safe group environment, bond with their inner musician, transform anxiety through creativity, and bond with others in the spirit of musical community (Kenny, 2006, p. 31).
16 Experimentation with a small pilot study found that positive imagery produced greater results than speaking therapies. They discovered that negative imagery exacerbated anxiety, increased the potential for avoidance and interfered with social performance (Peter M McEvoy, David M Erceg-Hurn, Lisa M Saulsman, Michel A Thibodeau, 2015, p. 43). There are several tools that Psychologists use, one of which is Behavioural Assessment Tests (BATs). A BAT is where a mental health professional may engage the person in a situation that he or she might encounter in everyday life, such as talking to a stranger or participating in a class or meeting. The client's self-reported reactions and observed behaviours during the task may be recorded and evaluated as representative of their reactions to similar situations in everyday life (Meridith Coles, Richard Heimberg, 2000, p. 406). The BAT’s combined with education about the diverse anxious arousal initiators, together with existing coping strategies could offer a significant amount of content which could be taught within a syllabus (Meridith Coles, Richard Heimberg, 2000, p. 406) 2.5
A fresh perspective on MPA in education
Although previous research has examined and studied MPA on music students in both contemporary and classical environments, there appears to be no reference of specifically addressing the issue of whether MPA and/or coping strategies needs to be taught in the education system. This research will show how studying MPA could benefit music students, what components of MPA are necessary to be of benefit and why. Social phobia is a fear based anxiety disorder, and during a performance a music student is vulnerable to judgement from peers, the audience and assessors. Reason tells us that if psychologists agree that MPA is one of the most debilitating social phobia’s, then it makes sense that education is
17 the key to helping musicians manage symptoms in the multimodal exacerbated high stress music education environment. Meridith (2000, p. 406) discussed that students felt their anxiety affected their academic output. Logic states, that if musicians are educated about MPA there would be a positive impact on academic output, and those music students who may have left or failed the music degree due to sustained MPA, may have finished their studies.
18 3
Methodology
3.1
Introduction
Participants were chosen from students and graduates who studied a music performance paper, from a tertiary institute within the geographical area of Southland, Canterbury and Otago in New Zealand. There were no limitations on class, age, religion, gender or ethnicity. The methodology of a questionnaire was initially utilised because it was less intrusive, offered anonymity and allowed music students to answer honestly. Students could be reached via an online link which presented the opportunity for accessing students in other tertiary institutes. In addition this method would control the resulted contents to specific data and therefore furnish the ability to collate statistics. Once data was being produced from the online form this illustrated there was a need for more discussion, therefore interviews were introduced with open ended questions to allow students to speak freely. Students with different experiences came forward which produced significant discussion and supported the researchers argument. Results of the questionnaire will be analysed and statistically reported on as weighted percentages. Interviews will be discussed in the form of a case study. Notes will be taken from the recordings and reported on in relation to the participants experience with MPA while they were studying. An ethnographic methodology was considered however the time required for studying music students before, during and after performances, along with regular questioning and reporting on this qualitative method, current time constraints would have made this difficult. A selfreflective methodology would have been interesting; however the researcher did not keep diaries of her personal journey with MPA which without, would have made this methodology difficult to articulate. The limits of this research are due to the small group of participants. There were 40 questionnaire participants and 4 one on one interviews which was determined by time and geographical constraints.
19 3.2
Questionnaire
A copy of the questionnaire can be found in appendix 2. The link to the questionnaire as an online Google form was distributed via email to music department heads at Ara, in Christchurch Canterbury, Otago University based in Dunedin and Southern Institute of Technology in Invercargill. The purpose of the questionnaire is to investigate how music students deal with and discuss MPA in the tertiary environment. The questionnaire was anonymous for both students and learning institutes to enable freedom of disclosure. The questionnaire will ask if they have any knowledge and/or support with MPA as part of their degree, if any of their degree papers address this issue and if they have experienced or know of any mental health support for MPA on or off campus. It will not identify gender, nor will it investigate to a deep level other mental health anxieties but will highlight their presence in the music community. The limitations of this research are bound to the willingness and honesty of participants, however due to the nature of anonymity this should limit this anomaly. Students are being asked to identify their feelings attached to MPA and how that affects their performance, life and career aspirations as a performer. Ethically this could be confronting for some participants, and has been addressed by encouraging students to seek help from a mental health professional should they become distressed by some of the questions. Due to the nature of time constraints, participants were chosen based on New Zealand lower south island geography and whether the tertiary campus delivered a music degree syllabus. The questionnaire invited music students from the campuses mentioned in 3.2 to participate on the topic of MPA, regarding mental health support on campus, their experience and knowledge with MPA and how their learning institute managed the issue. 3.2.1 Data The data from the questionnaire will be collated to show statistical findings on how prevalent MPA is in the selected tertiary institutes and how students managed it. It
20 will then be compared to the statistics discovered within the researched literature to show evidence that MPA is a pertinent issue for music students, which is currently unaddressed within education. 3.3
Interviews
For the purpose of geographic access to the researcher, Music graduates, current and subsequent music students from Southern Institute of Technology in Invercargill were invited via their facebook student group to participate in interviews. Interviews were structured to create an opportunity for open discussion and offer the student a chance to discuss their personal experience with MPA. This also included whether they had other mental health conditions which may or may not exacerbated their MPA. The interviews were conducted in a closed room to protect the privacy of participants. Each interview was recorded and will be kept digitally on the Southern Institute of Technology secure server. 3.3.1 Participants Music graduates, current and subsequent music students came forward of their own free will to participate in the one to one interviews. The researcher hoped for participants from students who had different experiences with the music degree in regard to MPA. This was successful and gave the opportunity to create case studies. Each participant who came forward brought with them a different set of circumstances and experiences regarding MPA as a music student. Due to the nature of the qualitative results, the researcher decided that delivering in the format of case studies would strengthen the researcher’s argument. And therefore show that a fresh perspective is necessary in dealing with MPA in education.
21 4
Results
4.1
Questionnaire
The results are highly consistent with other studies found in the literature. The geographic area accessed was Southland, Canterbury and Otago in New Zealand. There were 40 respondents over three campuses. Music students were asked if they experienced symptoms of MPA, if they had received any in class discussion and if not would they like the topic to be discussed in class.
100 90 80 70
71.35 64.8
62.3
60 50
Yes 37.7
No
34.2
40
Don't know
30
21.1
N/A
20 10
0
0
0
1.35
0
3.775
0 % of Students who suffer from MPA
% of Students who have had in class discussion
% who would you like in class discussion about MPA
Figure 1: Music students and the discussion on MPA. 62.3% of students advised they suffered from MPA and 64.8% shared there was no in class discussion about MPA. Furthermore, students were asked if they felt MPA should be included in the curriculum, 71.3% said they felt it would be beneficial if MPA was taught as part of the syllabus and only 1% specifically stated they did not think it would add benefit. The variance in percentage ratio shows a high amount of music students not only want but feel the need to be taught more information on MPA. This is a strong indicator that music students feel uninformed about MPA and furthermore, it implies they are intimidated by how overwhelming the topic is. Farnsworth-Grodd (2012, p. 16) discussed
22 that from a survey of 190 music students one third said that stage fright (MPA) was a problem, 4% said it was not an issue for them. This further supports the notion that there is a high level of music students suffering in silence. Other mental health conditions could contribute to MPA; therefore it is important they are given consideration.
Mental Health 100 90 80
75
72.5
70 60
Depression 52.5
Social Anxiety
50 40 30 20 10 0
Social Phobia BiPolar 12.5
Identity Disorder 12.5
Figure 2: Other Mental Health conditions suffered by music students. In the questionnaire students were asked if they suffered any other mental health conditions, 52.5% deal with Social Phobia, 72.5% with Social Anxiety, 12.5% with Bipolar, 75% with depression and 12.5% deal with Identity Disorder. Analysing these statistics it is obvious comorbidity is present where a student experiences more than one condition. When stressors like performing and live assessments are added, this shows there is a need to educate music students on MPA as it could directly affect their success in the degree.
23 Students were asked how severe their MPA was prior to and/or during a performance.
24.4 25
I settle after a couple of songs
22.9 20.5
20
I do breathing exercises to calm myself
18.6 17.25
Afraid it will affect my performance
15
10
I have other coping strategies in place
9.2 5.6
5
0
I want to throw up I get anxious but not enough to worry me I don't get anxious, I love the stage
Figure 3: Severity levels of MPA in music students. 17.25% of students informed that they wanted to throw up and 20.5% are concerned it would affect their performance. However, a combined 65.9% advise they either breathe, have other coping strategies in place or calm down after a couple of songs. FarnsworthGrodd (2012, p. 17) discussed that “Despite the prevalence of MPA, most musicians remain committed to their art form and strive for excellence”. But shared earlier that 22% declared they failed an assessment because of MPA and 49% had received a negative result due to MPA (Farnsworth-Grodd, 2012, p. 16).
24 To discover how MPA is discussed in music education students were asked who they speak to about their affliction.
70 60 50 40 30
Awareness of on Campus Mental Health Professional Spoke to on Campus Mental Health Professional Discussed with Classmates, friends, family Discussed with Tutor
20 10 0
Figure 4: Who did music students speak to about MPA Even though 65% of students recognised there was a mental health professional available on campus, there was a minimal 3.7% who took the opportunity to consult with their on campus or local mental health professional. Results are implying that students are concerned that if they admit they have issues surrounding MPA they may be somehow berated. This statement is strengthened by the results that 58% of students have spoken to classmates, friends and family about their performance nerves, compared to 25% mentioning it to their tutor. It further strengthens the argument that MPA needs to be openly discussed in the education environment. However, what does appear promising is when students were asked how they felt speaking to a tutor; friend or family member about their MPA, a healthy 44% advised they felt comfortable; compared to only 1.8% who were embarrassed and 3.7% who were nervous. This shows it is time to address this issue when students are ready to open up about the topic.
25 The New Zealand Music Foundation produces an annual report ‘The Music Community Wellbeing Survey’. Their report illustrated that 80% of participants did not seek out help for MPA due to embarrassment over an association to mental health issues; 63% didn’t know where to go and if they did would unlikely be unable to afford it. Furthermore, the report showed that nearly 60% of music respondents declared they had suicidal thoughts. It stated, “When asked whether they had experienced suicidal thoughts, almost six in ten had experienced a feeling that life wasn’t worth living and thought of taking their life” (Foundation, The New Zealand Music, 2016, p. 16). 4.2
Case Studies
Case study 1 Participant one is an education graduate. They suffer from no other known mental health issues. They shared that when studying vocals as their major, the MPA symptoms they experienced was shaking, and frequently forgetting lyrics. Sometimes they got the verses and lyric lines mixed up. There was no difference between covers and originals, lyrics were still easily forgotten due to the nerves experienced. They advised that they experience anxiety when going into new situations and places. Participant one mentioned that their MPA never diminished and remained throughout their music degree. Their vocal tutor at the time could not understand why practices were great and live performances were fraught with mistakes. They failed the performance paper due to overwhelming nerves and felt they would have been more successful if MPA was discussed and taught in class. To ensure they passed their degree they had to choose a new major which was education. It is disappointing that unaddressed MPA got in the way of their first choice. They said that although they love teaching music, their first love was singing and ever since have felt regret. While singing karaoke and performing outside of study, before and after the degree, they used alcohol to help reduce and control their nerves. Had this
26 participant been given the opportunity to understanding their fear of performing, they might have passed the performance paper. Case study 2 Participant 2 was a professional musician on another instrument, prior to studying vocals as an entry student. They do not suffer any other mental health issues. They are well rehearsed in live performance for their other instrument and do not suffer any MPA. However, when singing the nerves suddenly appeared; dry throat, forgetting lyrics and heart palpitations. It is obvious from the research and this participant’s onset of symptoms that lack of confidence has impacted MPA when singing. It makes sense as there has not been enough opportunity to desensitise themselves with vocals. Musicians, who are confident playing their instrument and have been exposed to many performances on that instrument, generally do not suffer excessive MPA. The literature around the coping strategy CBT, works by exposing the patient to the fear. It is likely how this participant went from not experiencing MPA on their confident instrument; to suffering from the symptoms of MPA on an instrument they lack confidence playing. The results of this particular case study does support the recommendation of including strategies and knowledge around MPA, at the entry level of studying music, especially if the musician is new to the instrument. Case study 3 This participant studied vocals in year one. Prior to studying they performed regularly and suffered from minimal MPA. When they first started the degree there were a few nerves but nothing major. As they progressed through the degree and were exposed to being assessed and critiqued, it was the feedback that created the anxiety. This participant had been ill which affected their voice; a tutor critiqued them as not being a good enough vocalist to pass the paper. After that they became incredibly self-conscious about their voice, it was suggested that they give up vocal performance as a major, and was advised to
27 move onto singer/songwriter. Their symptoms were indicative of the instrument they were using; breathlessness for singing, shaking hands if they are playing piano or guitar. This participant graduated a few years ago and although they are now comfortable with their voice, they still feel very self-conscious about performing, and are overly critical because of their experience in the degree. They felt that positive feedback and being given the knowledge on how to fix their issue was most important, which they felt never received. Before a performance and performance assessment during their study, they made up their own coping strategies by jumping up and down backstage to help deal with the adrenaline. Now when they are getting ready to perform, they start to over think the components of the first song. Half way through the first song they start relaxing and their performance improves. They mentioned that they do not use any coping strategies; however they did mention using positive reinforcement which is a mindfulness technique. There is minor depression and social anxiety present but the depression is managed. This participant suggested that maybe students should be put into different performing situations, which would fall within the format of the coping strategy CBT. The result of this case study shows that although this participant was ill, their nerves would have made their symptoms worse. One can speculate that if this participant had of received lessons on MPA, maybe they would have had more control over their vocals. Case study 4 This musician plays bass and guitar at SIT, their major is guitar. At the beginning of their degree they suffered severe MPA. They had symptoms of shaking hands, once again relative to their instrument. They shared that they used positive visual imagery by watching many YouTube videos and emulating what they saw. They used performing to screaming crowds on YouTube in their bedroom to initiate a positive experience for visual imagery. They felt this activity made a significant impact prior to having a lot of performance exposure which has desensitised the symptoms. In the beginning of the
28 degree their symptoms started while waiting back stage and continued during the performance. They would beat themselves up when they made a mistake. Even today after being desensitised to performing they are intimidated when performing with who they consider to be an outstanding musician. Now 2 years into a degree their anxiety has diminished. They agreed that MPA should be taught in the first semester of the first year, but after the topic of MPA had been addressed it should be left as the student’s personal responsibility, but that students need to realise that communication is the key to reaching out for help.
29 5
Conclusions There are numerous dynamics to be understood regarding the different anxiety initiators of MPA, and other mental health issues which can exacerbate the condition. With the variations in anxious arousal it is understandable why MPA is a difficult condition to manage. Beta blocker medications are only useful in managing the physical symptoms. The mental and emotional symptoms are far more difficult to control. There are several coping strategies available which can be explored within a syllabus. Self analysis tests like the Social Interaction Anxiety Scale (see figure 8), would enable music students the ability to assess their personal level of anxiety and seek out coping strategies. There is much to discuss and analyse on MPA for music students, and creating an opportunity for them to openly discuss this topic would aid in removing the stigma attached to it. Masterful things could happen if a light is shone on this topic that currently develops feelings of shame in some music students. Music students deserve every opportunity to perform to their full performance assessment potential and obtain the highest grades they are personally capable of, anything less is undermining their efforts. It is an educator’s responsibility to give a student all the information pertinent to their success. MPA is intimidating because music students do not understand it. This knowledge could have a direct effect on the welfare of music students and contribute toward their success or failure. When music students who are dealing with medium to severe MPA ask how to manage it, and who are then told it happens to every musician and they need to accept that, it makes light of the music students very real fears. This knowledge is not only for music students it is also pertinent for those who teach music. If the music teacher does not understand MPA, this undermines their ability for guiding their students towards a healthy way of dealing with it through knowledge and coping strategies. Music student’s fears regarding MPA deserve acknowledgment, and with education and coping strategies this would help provide necessary tools toward either helping themselves or aid them in feeling less stigmatised
30 when asking for help. By directly addressing MPA it encourages open conversation which in turn normalises the condition. It needs to be reiterated here that MPA is a Social Phobia, a mental health condition, and deserves to be respected as such. This information could help prompt music students towards helping each other manoeuvre through MPA prior to a performance or performance exam, and point them toward healthy ways of engaging in available coping strategies. Music students deserve to be given knowledge and support on MPA, which affects more than 65% of them and with 71% having specifically asked for it to be taught as part of the syllabus, is a strong indicator that it is needed.
31 6
Recommendations There are several components within MPA that could be considered relevant for teaching within a music syllabus. The discussion asks to what level of information the syllabus should package this information. An entire paper on MPA would be unnecessary; however three to four one hour lessons would offer students the opportunity to openly discuss MPA and how to manage it. It is further recommended that lessons on MPA is offered at an entry level as this appears to be when the anxiety emerges at its most elevated level. Farnsworth-Grodd (2012, p. ii) revealed that “during performance the coping strategies of positive focus, self-kindness, and self-acceptance partially mediated the relationships between levels of situational act with awareness and music performance anxiety.” Providing music students with the knowledge and skills to employ these techniques increases the opportunity for better performances and grades. Doing a degree is a massive undertaking and expecting a music student to deal with the added stress of researching, assessing, comprehending MPA jargon and actively participating in figuring out where they sit in the MPA cohort, as well as living with the psychological burden, is too much to ask of anyone. Farnsworth-Grodd (2012, pp. 7-8) continues by stating “Conditioning might occur if the musician perceives the performance as impaired and then experiences negative emotions and negative self-evaluation which, in turn, exacerbates anxious apprehension and further alarms.” Therefore to do nothing simply encourages the MPA cycle.
6.1
MPA Learning Outcomes
Below I have developed a recommended guide for suggested learning outcomes on which an ensuing lesson plan could be built. Subject: Musicians Performance Anxiety
Topic: Understanding MPA and associated coping strategies.
32
On successful completion of this course, the students will... 1) Understand and recognise the symptoms of Musicians Performance Anxiety (MPA) 2) Understand the multimodal stressors of MPA and how an education setting affects that. 3) Understand what coping strategies are available. 4) Have tools to help manage MPA 5) Write a 1000 word self-reflection essay on their experience with MPA, the knowledge and understanding they have gained and application of coping strategies in this module.
33
Lesson Content 1 What is Musicians Performance Anxiety (MPA)? What are some of the mental health issues surrounding MPA? What is MPA in relation to music education? What are some of the symptoms
Learning Outcome Understand and define MPA Student will be able to identify the symptoms of MPA Student will understand the basic functioning of MPA triggers. Students will be asked to consider their MPA during their last performance.
of MPA 2
What are the multimodal triggers Student will understand the difference of MPA What is the breathing technique and how to apply it? What is a Cognitive Trigger? How to apply positive
between the three multimodal triggers Students will understand how to apply a coping strategy. Students will understand and how to apply positive performance imagery.
performance imagery. 3
Positive imagery and the cognitive conversation. Understanding the inner
Student will understand how to turn negative cognitive conversation into a positive one and how it helps.
conversation and subsequent consequences. 4
Why being present is important (Mindfulness) What is a Somatic Trigger
Student will understand what mindfulness is and how to stay in the moment during a performance. Student will understand the physiology of the Somatic Trigger.
Table 2: MPA Module Learning Outcomes “The ability of musicians’ self-regulation efforts to interrupt the MPA conditioning sequence would appear paramount. Self-regulation is a dynamic process of setting goals, activating behaviour to achieve them, appraising progress, modifying goals, and selecting coping strategies to maintain progress” (Farnsworth-Grodd, 2012, pp. 7-8).
34 It is important that music students are educated in understanding how MPA affects them and how to manage it. In the appendices there are a few self assessment sources that music students could use for self evaluation or in cooperation with a mental health support person.
35
References Buswell, D. (2006). Performance Strategies for musicians. Hertforshire: MX Publishing. Carbonell, D. (2017, June 12). Social Anxiety Disorder. Retrieved from Anxiety Coach: http://www.anxietycoach.com/socialanxietydisorder.html Deborah C Beidel, S. M. (1992). Social Phobia: A comparison of specific and generalized subtypes and avoidant personality disorder. Journal of Abnormal Psychology, 326331. Dweck, C. (n.d). Dr. Dwecks discovery of fixed and growth mindsets have shaped our understanding of learning. Retrieved from Mindset Works: https://www.mindsetworks.com/science/ Farnsworth-Grodd, V. A. (2012). Mindfulness and the self-regulation of Music Performance Anxiety. The University of Auckland, 1-276. Foundation, The New Zealand Music. (2016). NZ Music Community Wellbeing Survey Report. Auckland: The New Zealand Music Foundation. Joseph O'Connor, Ian McDermott. (2013). Principles of NLP. London: Jessica Kingsley Publisher. Kenny, D. T. (2006). Music Performance Anxiety: Origins,. Research Gate, 1-50. Leary, M. R. (1983). A Brief Version of te Fear of Negative Evaluation Scale. Personality and Social Psychoogy Bulletin, 371-376. Lehrer, P. M. (1987). A Review of the Approaches to the Management of Tension and Stage Fright in Music. Journal of Research in Music Education, 143-153. Liebowitz, M. R. (1987). Social Anxiety Scale. Pharmacopsychiatry, 141-173. M Fredrikson, R Gunnarsson. (1992). Psychobiology of stage fright: The effect of public performance on neuroendocrine, cardiovascular and subjective reactions. Biological Psychology, 51-61. Mattick, R. P. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 455-470.
36 Meridith Coles, Richard Heimberg. (2000). Patterns of anxious arousal during exposure to feared situations in individuals with social phobia. Behaviour Research and Therapy, 405-424. Navy Medicine. (n.d). Beck Depression Inventory. Retrieved from Navy Medicine: http://www.med.navy.mil/sites/NMCP2/PatientServices/SleepClinicLab/Documents/ Beck_Depression_Inventory.pdf Ortner, N. (2013). The Tapping Solution. London: Hay House. Peter M McEvoy, David M Erceg-Hurn, Lisa M Saulsman, Michel A Thibodeau. (2015). Imagery enhancements increase the effectiveness of cognitive behavioural group therapy for social anxiety disorder: A benchmarking study. Behaviour Research and Therapy, 42-51. Pizzey, R. (2018, September 26). Coping with Performance Anxiety. Retrieved from Rhine Gold UK: https://www.rhinegold.co.uk/music_teacher/prepared-performance/ Richard P Mattick, J. C. (1998). Development and validation of measures of social phobia scruitiny fear and social anxiety. Behaviour Research and Therapy, 455-470. Roland, D. D. (1997). The confident performer. Sydney: Currency Press. S Safren, C Turk, R Heimberg. (1998). Factor Structure of the Social Interaction Anxiety Scale and the Social Phobia Scale. Behaviour Research and Therapy, 443-453. Sphan, C. (2011). Treatment and Prevention of Music Performance Anxiety. Freiburg. W de Vente, M Majdandzic, M Voncken, D Beidel, S Bogels. (2014). The Spai-18, a brief version of the Socil Phobia and Anxiety Inventory: Reliability and validity in clinically referred non-referred samples. Journal of Anxiety Disorder, 140-147. What is a suds rating. (2017, December 23). Retrieved from Very Well Mind: https://www.verywellmind.com/what-is-a-suds-rating-3024471
37 7
Appendices
Appendix 1: Information Sheet I am doing research on how Music Performance Anxiety (MPA) is addressed in music institutions in Canterbury, Otago and Southland. The purpose of doing this research is to open up dialogue and to ascertain if there is a need to provide specific learning about MPA within the education syllabus. This research will hopefully benefit music students, teachers and institutions alike. If possible I would like to engage SIT music students, graduates included, in this study. This would involve completing an online questionnaire. The questionnaire will be anonymous and has been granted ethical approval as a student project from the Southern Institute of Technology Human Research Ethics Committee. Whether you experience MPA or not, I would like a wide response to this phenomena. The questionnaire is now live and open to any musician who has studied a performance paper.
38 Appendix 2: Sample Questionnaire
39
40
41
42 Appendix 3: Interview Consent Southern Institute of Technology Declaration of consent to be interviewed for Musicians Performance Anxiety Support in Education Institutes. I have had the scope and nature of the research fully explained to me. Any questions about the research have been satisfactorily answered, and I understand that I may request further information at any stage. I accept and note that:
1. My participation in this research is entirely voluntary. 2. I may withdraw from participation in the research at any time without explanation, disadvantage or disincentive. 3. The information given during the interview is being utilised solely for the purpose of the specific research project and will not be disclosed to any other person or agency without my express consent. 4. The interview will be recorded for later transcription. 5. This information may be incorporated into the research report but actual names or other characteristics that may lead to identification of individuals or organisations will not be disclosed. 6. I may at any time request to view any completed drafts or sections of the research report to which I have contributed. 7. A copy of the completed research report will be made available to me, on request, at the conclusion of the research.
DECLARATION I have read and understood the information set out on this form, and give my informed consent to be interviewed in accordance with the stated terms and conditions. Name of Participant:
Name of Researcher/Interviewer:
………………………………………………………...........
…………………………………………………………………
Signature …………………………………………………
Signature …………………………………………………
Date ………………………………………………………..
Date ………………………………………………………..
43 Appendix 4: Sample Interview Questions 1.
Do you play more than one instrument and if so which is your most confident instrument
2.
How is your anxiety regarding performance in the hours leading up to it
3.
How would you describe your MPA
4.
What coping strategies do you use to manage your MPA
5.
Do you have any other anxiety-based conditions
6.
What are your music career aspirations
7.
How has your MPA affected your desires regarding your music career aspirations
8.
Have you had any negative experiences with being in front of people
9.
What, if any, support/education measures would you like to see incorporated into the curriculum?
44 Appendix 5: Subjective Units of Distress Scale (SUDS)
Social Anxiety and SUDs Ratings Subjective Units of Distress Scale Is an Essential Rating Tool The SUDs Rating Scale, or Subjective Units of Distress Scale (SUDs) as it is officially known, is used to measure the intensity of distress or nervousness in people with social anxiety. The SUDs is a self-assessment tool rated on a scale from 0 to 100. The SUDs can be a subjective tool used by your therapist or healthcare provider to evaluate your progress and the success of your current treatment plan. In this way, it can be used regularly over the months of your treatment to gauge different areas of disturbance that require additional work.
SUDs Rating Process A common technique in cognitive therapy is using the SUDs tool to gauge your distress or emotional state. Guidelines for the SUDs include rating the intensity of your anxiety as it is experienced in the moment and while tightening or tensing of the body. Below is a simplified version of the scale with different guide points:
0: Peace and complete calm 1: No real distress but perhaps a slight feeling of unpleasantness 2: A little bit sad or off 3: Worried or upset 4: Upset to the point that negative thoughts begin to impact you 5: Upset and uncomfortable 6: Discomfort to the point that you feel a change is needed 7: Discomfort dominates your thoughts and you struggle not to show it 8: Panic takes hold
45 9: Feeling desperate, helpless and unable to handle it 10: Unbearably upset to the point that you cannot function and may be on the verge of a breakdown
Precise accuracy of measurement is not important. Rather, the SUDs is a broad guide to give your therapist an idea of what you are experiencing. It is especially important to share this with your therapist because it reflects how you feel about your distress, rather than how anyone else judges your fears. It can be difficult to share with your therapist the intensity of what you are feeling. In this way, the SUDs gives you a simple way to express the severity of your emotions. It is common for those with social anxiety to feel emotions and fears more intensely than others. What could be a minor incident to someone else can feel like a catastrophe to you. Social anxiety influences your perspective and how you view yourself and those around you.
SUDs and Therapy Use of the SUDs can help you and your therapist track improvements or setbacks. Be sure to complete the scale honestly to enable your therapist to appropriately judge what is working and what is not. Through the SUDs scale, you may realize you feel intensely distressed by something that wouldn't bother others. This can help you identify areas you need to work on.
As you go through the SUDs assessment, you can identify areas to work on with your therapist. Your therapist may have you work through techniques such as disputation, during which you recognize irrational thoughts and work to replace them with more rational ways of looking at situations. This is a learned skill that you establish during
46 therapy, but continue to develop on your own in your daily routine. You may find that working through these issues improves your SUDs rating.
Ratings scales such as the SUDs are only useful if you complete them honestly. Try not to respond in the manner that you think your therapist wants, as this can be a trap for those with social anxiety disorder. Instead, give ratings based on how you are feeling in the moment, regardless of whether you think it is good or bad to be feeling that way. In particular, research on the use of the SUDs with children and teens has shown that miscommunication can sometimes be a problem. If you fall into this age range, be sure to tell your therapist or doctor if you are not sure how to complete the SUDs tool. (What is a suds rating, 2017)
47 Appendix 6: Beck’s Depression Inventory This depression inventory can be self-scored. The scoring scale is at the end of the questionnaire. 1. 0 I do not feel sad. 1 I feel sad 2 I am sad all the time and I can't snap out of it. 3 I am so sad and unhappy that I can't stand it. 2. 0 I am not particularly discouraged about the future. 1 I feel discouraged about the future. 2 I feel I have nothing to look forward to. 3 I feel the future is hopeless and that things cannot improve. 3. 0 I do not feel like a failure. 1 I feel I have failed more than the average person. 2 As I look back on my life, all I can see is a lot of failures. 3 I feel I am a complete failure as a person. 4. 0 I get as much satisfaction out of things as I used to. 1 I don't enjoy things the way I used to. 2 I don't get real satisfaction out of anything anymore. 3 I am dissatisfied or bored with everything. 5. 0 I don't feel particularly guilty 1 I feel guilty a good part of the time. 2 I feel quite guilty most of the time. 3 I feel guilty all of the time. 6. 0 I don't feel I am being punished. 1 I feel I may be punished. 2 I expect to be punished. 3 I feel I am being punished. 7. 0 I don't feel disappointed in myself.
48 1 I am disappointed in myself. 2 I am disgusted with myself. 3 I hate myself. 8. 0 I don't feel I am any worse than anybody else. 1 I am critical of myself for my weaknesses or mistakes. 2 I blame myself all the time for my faults. 3 I blame myself for everything bad that happens. 9. 0 I don't have any thoughts of killing myself. 1 I have thoughts of killing myself, but I would not carry them out. 2 I would like to kill myself. 3 I would kill myself if I had the chance. 10. 0 I don't cry any more than usual. 1 I cry more now than I used to. 2 I cry all the time now. 3 I used to be able to cry, but now I can't cry even though I want to. 11. 0 I am no more irritated by things than I ever was. 1 I am slightly more irritated now than usual. 2 I am quite annoyed or irritated a good deal of the time. 3 I feel irritated all the time. 12. 0 I have not lost interest in other people. 1 I am less interested in other people than I used to be. 2 I have lost most of my interest in other people. 3 I have lost all of my interest in other people. 13. 0 I make decisions about as well as I ever could. 1 I put off making decisions more than I used to. 2 I have greater difficulty in making decisions more than I used to. 3 I can't make decisions at all anymore. 14. 0 I don't feel that I look any worse than I used to.
49 1 I am worried that I am looking old or unattractive. 2 I feel there are permanent changes in my appearance that make me look unattractive 3 I believe that I look ugly. 15. 0 I can work about as well as before. 1 It takes an extra effort to get started at doing something. 2 I have to push myself very hard to do anything. 3 I can't do any work at all. 16. 0 I can sleep as well as usual. 1 I don't sleep as well as I used to. 2 I wake up 1-2 hours earlier than usual and find it hard to get back to sleep. 3 I wake up several hours earlier than I used to and cannot get back to sleep. 17. 0 I don't get more tired than usual. 1 I get tired more easily than I used to. 2 I get tired from doing almost anything. . 3 I am too tired to do anything. 18. 0 My appetite is no worse than usual. 1 My appetite is not as good as it used to be. 2 My appetite is much worse now. 3 I have no appetite at all anymore. 19. 0 I haven't lost much weight, if any, lately. 1 I have lost more than five pounds. 2 I have lost more than ten pounds. 3 I have lost more than fifteen pounds. 20. 0 I am no more worried about my health than usual. 1 I am worried about physical problems like aches, pains, upset stomach, or constipation. 2 I am very worried about physical problems and it's hard to think of much else. 3 I am so worried about my physical problems that I cannot think of anything else. 21.
50 0 I have not noticed any recent change in my interest in sex. 1 I am less interested in sex than I used to be. 2 I have almost no interest in sex. 3 I have lost interest in sex completely. INTERPRETING THE BECK DEPRESSION INVENTORY Now that you have completed the questionnaire, add up the score for each of the twentyone questions by counting the number to the right of each question you marked. The highest possible total for the whole test would be sixty-three. This would mean you circled number three on all twenty-one questions. Since the lowest possible score for each question is zero, the lowest possible score for the test would be zero. This would mean you circles zero on each question. You can evaluate your depression according to the Table below. Total Score____________________Levels of Depression 1-10____________________These ups and downs are considered normal 11-16___________________Mild mood disturbance 17-20___________________Borderline clinical depression 21-30___________________Moderate depression 31-40___________________Severe depression Over 40__________________Extreme depression (Navy Medicine, n.d)
51 Appendix 7: Brief Fear of Negative Evaluation Scale Read each of the following statements carefully and indicate how characteristic it is of you according to the following scale: 1 = Not at all characteristic of me 2 = Slightly characteristic of me 3 = Moderately characteristic of me 4 = Very characteristic of me 5 = Extremely characteristic of me 1.
I worry about what other people will think of me even when I know it doesn't make any difference.
2.
I am unconcerned even if I know people are forming an unfavourable impression of me.
3.
I am frequently afraid of other people noticing my shortcomings.
4.
I rarely worry about what kind of impression I am making on someone.
5.
I am afraid others will not approve of me.
6.
I am afraid that people will find fault with me.
7.
Other people's opinions of me do not bother me.
8.
When I am talking to someone, I worry about what they may be thinking about me.
9.
I am usually worried about what kind of impression I make.
10. If I know someone is judging me, it has little effect on me. 11. Sometimes I think I am too concerned with what other people think of me. 12. I often worry that I will say or do the wrong things. (Leary, 1983)
52 Appendix 8: Liebowitz Social Anxiety Scale Pt Name:
Pt ID #:
Date:
Clinic #:
Assessment point:
Fear or Anxiety: Avoidance: 0 = None 0 = Never (0%) 1 = Mild 1 = Occasionally (1—33%) 2 = Moderate 2 = Often (33—67%) 3 = Severe 3 = Usually (67—100%)
Fear or Anxiety Avoidance 1. Telephoning in public. (P) 1. 2. Participating in small groups. (P) 2. 3. Eating in public places. (P) 3. 4. Drinking with others in public places. (P) 4. 5. Talking to people in authority. (S) 5. 6. Acting, performing or giving a talk in front of an audience. (P) 6. 7. Going to a party. (S) 7. 8. Working while being observed. (P) 8. 9. Writing while being observed. (P) 9. 10. Calling someone you don’t know very well. (S) 10. 11. Talking with people you don’t know very well. (S) 11. 12. Meeting strangers. (S) 12. 13. Urinating in a public bathroom. (P) 13. 14. Entering a room when others are already seated. (P) 14. 15. Being the center of attention. (S) 15. 16. Speaking up at a meeting. (P) 16.
53 17. Taking a test. (P) 17. 18. Expressing a disagreement or disapproval to people you don’t know very well. (S) 19. Looking at people you don’t know very well in the eyes. (S) 19. 20. Giving a report to a group. (P) 20. 21. Trying to pick up someone. (P) 21. 22. Returning goods to a store. (S) 22. 23. Giving a party. (S) 23. 24. Resisting a high pressure salesperson. (S) 24. (Liebowitz, 1987)
54 Appendix 9: Social Interaction Anxiety Scale Instructions: For each item, please circle the number to indicate the degree to which you feel the statement is characteristic or true for you. The rating scale is as follows: 0 = Not at all characteristic or true of me. 1 = Slightly characteristic or true of me. 2 = Moderately characteristic or true of me. 3 = Very characteristic or true of me. 4 = Extremely characteristic or true of me. NOT SLIGHTLHARACTERISTIC AT ALL MODERATELY VERY EXTREMELY I get nervous if I have to speak with someone in authority (teacher, 1 0 1 2 3 boss, etc.). 2 I have difficulty making eye contact with others. 0 1 2 3 3
I become tense if I have to talk about myself or my feelings
0
1
2
3
4
I find it difficult to mix comfortably with the people I work with.
0
1
2
3
5
I find it easy to make friends my own age
0
1
2
3
6
I tense up if I meet an acquaintance in the street.
0
1
2
3
7
When mixing socially, I am uncomfortable.
0
1
2
3
8
I feel tense if I am alone with just one other person.
0
1
2
3
9
I am at ease meeting people at parties, etc.
0
1
2
3
10
I have difficulty talking with other people
0
1
2
3
11
I find it easy to think of things to talk about
0
1
2
3
12
I worry about expressing myself in case I appear awkward.
0
1
2
3
13
I find it difficult to disagree with another’s point of view
0
1
2
3
14
I have difficulty talking to attractive persons of the opposite sex
0
1
2
3
15
0
1
2
3
16
I find myself worrying that I won’t know what to say in social situations. I am nervous mixing with people I don’t know well.
0
1
2
3
17
I feel I’ll say something embarrassing when talking
0
1
2
3
18
When mixing in a group I find myself worrying I will be ignored
0
1
2
3
19
I am tense mixing in a group.
0
1
2
3
20
I am unsure whether to greet someone I know only slightly
0
1
2
3
(Mattick, 1998)
